Hives (Urticaria): Symptoms, Causes, Treatment

What are the symptoms of hives (Urticaria)?

Hives, also known as urticaria, are characterized by several distinct symptoms:

1. Raised, Red or Skin-Colored Welts: These welts can appear anywhere on the body and can vary in size, from small spots to large patches.
2. Intense Itching: The welts are often very itchy, which can be quite uncomfortable.
3. Swelling: There may be swelling of the affected area, which can sometimes extend to the deeper layers of the skin (angioedema), often around the eyes, lips, throat, or extremities.
4. Welts that Change Shape and Location: The welts can change shape, move around, disappear, and reappear over short periods.
5. Pain or Burning Sensation: In some cases, the welts can cause a painful or burning sensation.
6. Worsening with Triggers: Symptoms may worsen with exposure to certain triggers, such as heat, stress, exercise, or specific foods.

Hives can appear suddenly and may last for a few hours to several days. In chronic cases, they can persist for more than six weeks or recur frequently over months or years.

What are the causes of hives?

Hives, also known as urticaria, are itchy, red, and swollen areas of skin that can appear anywhere on the body. There are many possible causes of hives, and they can be acute or chronic. Here are some of the most common causes:

1. Allergic reactions: Allergies to foods, insect bites, medications, or other substances can trigger hives.
2. Insect bites or stings: Mosquito bites, bee stings, and other insect bites can cause hives.
3. Food allergies: Common culprits include nuts, shellfish, milk, eggs, soy, wheat, and fish.
4. Medications: Certain medications like antibiotics, painkillers, and blood pressure medications can cause hives as a side effect.
5. Infections: Bacterial or viral infections like strep throat, ear infections, or sinus infections can trigger hives.
6. Skin conditions: Conditions like eczema, dermatitis, or psoriasis can cause hives.
7. Asthma: Some people with asthma may experience hives as a symptom.
8. Hormonal changes: Hormonal fluctuations during pregnancy, menstruation, or menopause can cause hives.
9. Stress: Stress can trigger hives in some individuals.
10. Autoimmune disorders: Conditions like lupus or rheumatoid arthritis can cause hives.
11. Viral infections: Viral infections like the common cold or flu can trigger hives.
12. Foods that are commonly consumed by people with hives:
    • Citrus fruits (lemons, oranges, grapefruits)
    • Tomatoes
    • Soy products
    • Fish (especially finned fish like salmon)
    • Shellfish (like shrimp)
    • Dairy products (milk, cheese)
13. Other triggers:
    • Sun exposure
    • Cold temperatures
    • Exercise
    • Heat
    • Anxiety
14. Chronic conditions: Certain chronic conditions like thyroid disease, anemia, or kidney disease can cause hives.

In some cases, the exact cause of hives may not be identified. If you experience frequent or severe hives, it’s best to consult a healthcare professional for proper diagnosis and treatment.

How is the diagnosis of hives made?

The diagnosis of hives, also known as urticaria, is typically made based on a clinical evaluation that includes the following steps:

1. Medical History: The doctor will ask about your symptoms, including when they started, how long they last, any patterns, and any potential triggers (such as foods, medications, stress, or physical activities). They will also inquire about any personal or family history of allergies or other medical conditions.
2. Physical Examination: The doctor will examine your skin to look for the characteristic raised, red, and itchy welts that define hives. These welts can vary in size and shape and often appear and disappear quickly.
3. Trigger Identification: The doctor may try to identify possible triggers for your hives. This could involve reviewing your diet, medications, recent illnesses, or exposure to allergens.
4. Allergy Testing: If an allergic reaction is suspected, the doctor may recommend allergy tests. These can include skin prick tests or blood tests (such as specific IgE tests) to identify potential allergens.
5. Blood Tests: Blood tests may be ordered to check for underlying conditions or to rule out other causes of your symptoms. These tests might include a complete blood count (CBC) and tests for thyroid function, liver function, and inflammatory markers.
6. Skin Biopsy: In rare cases, a skin biopsy may be performed to examine a small sample of the affected skin under a microscope. This can help rule out other skin conditions that might mimic hives.
7. Challenge Tests: In some cases, the doctor might perform a challenge test where you are exposed to a potential trigger under controlled conditions to observe if it causes hives.
8. Elimination Diet: If a food allergy is suspected, an elimination diet might be recommended, where you avoid certain foods for a period to see if your symptoms improve.

Chronic hives (lasting more than six weeks) might require a more extensive evaluation to identify any underlying chronic conditions, such as autoimmune diseases or chronic infections. If no specific cause is identified, the condition is often referred to as idiopathic urticaria.

What is the treatment for hives?

The treatment for hives, also known as urticaria, depends on the underlying cause and severity of the condition. Here are some common treatments for hives:

Symptomatic relief:

1. Antihistamines: Over-the-counter (OTC) or prescription antihistamines, such as diphenhydramine (Benadryl) or hydroxyzine (Atarax), can help relieve itching and reduce the size of the hives.
2. Topical corticosteroids: Creams or ointments containing hydrocortisone can reduce inflammation and itching.
3. Cool compresses: Applying a cool, wet compress to the affected area can help soothe itching and reduce swelling.

Medications:

1. Antihistamines: For mild to moderate hives, OTC or prescription antihistamines may be prescribed to relieve itching and reduce the size of hives.
2. Corticosteroids: For more severe cases, oral corticosteroids like prednisone may be prescribed to reduce inflammation and swelling.
3. Epinephrine injectors (e.g., EpiPen): In severe cases, epinephrine injectors may be prescribed for anaphylaxis, a life-threatening allergic reaction.
4. Biologics: For severe, chronic hives, biologics like omalizumab (Xolair) may be prescribed to block the action of immunoglobulin E (IgE), an antibody involved in allergic reactions.

Dietary changes:

1. Avoid trigger foods: Identify and avoid foods that trigger hives, such as nuts, shellfish, dairy products, or certain spices.
2. Increase omega-3 fatty acids: Omega-3 fatty acids found in fatty fish, flaxseeds, or walnuts may help reduce inflammation.
3. Drink plenty of water: Staying hydrated can help flush out allergens and reduce inflammation.

Lifestyle changes:

1. Stress management: Stress can exacerbate hives; practicing stress-reducing techniques like meditation or yoga may help alleviate symptoms.
2. Avoid irritants: Avoid exposure to environmental triggers like pollution, dust mites, or extreme temperatures.
3. Keep cool: Wearing loose-fitting clothing and staying in air-conditioned spaces may help reduce sweating and discomfort.

Natural remedies:

1. Aloe vera gel
2. Tea tree oil
3. Oatmeal baths
4. Ginger
5. Quercetin (a natural antihistamine)

It’s essential to consult a healthcare provider for proper diagnosis and treatment of hives, as self-medication can sometimes mask underlying conditions that require attention.