Urticaria is a skin condition characterized by itchy wheals or hives over the body. The below article details the same.
Urticaria, also known as hives, is a skin reaction that causes itchy welts. It usually occurs alone but sometimes may appear along with swelling of the eyes, lips, and face (angioedema).
Urticaria usually happens when the body has an allergic reaction to an allergen. But can also occur in autoimmune or systemic conditions. Urticaria may be itchy or give a burning sensation. Sometimes, the urticaria welts merge into larger areas called plaques.
There are two main types of urticaria according to the time scale-
Acute Urticaria - Urticaria that lasts for less than six months is called acute urticaria. This form of urticaria occurs due to allergic reactions to certain foods or medications.
Chronic Urticaria - When urticaria is present for more than six months, it is called chronic urticaria. In most chronic conditions, the cause is unknown, though it is believed to be an autoimmune condition.
Physical Urticaria - This often develops within an hour after exposure.
Some individuals may develop hives and swelling in specific situations like cold, heat, sun, vibrations, pressure, exercise, or sweating.
The itchy welts that come with urticaria are mainly caused by releasing immune system chemicals, such as histamine, into the bloodstream. However, it is still unknown why chronic urticaria happens or why short-term urticaria sometimes turns into a long-term condition.
The skin reaction may be triggered by:
1. Airborne allergens, such as tree and grass pollen.
2. Heat or cold.
5. Allergies from medications, such as codeine, ACE inhibitors, and non-steroidal anti-inflammatory drugs (NSAIDs).
6. Bacterial infections, like urinary tract infections and strep throat.
7. Pressure on the skin, like from a tight waistband.
8. Medical conditions include infection, thyroid disease, allergy, and cancer.
9. Allergies to certain materials, like detergents and latex.
10. Insect bites.
Symptoms of urticaria include:
1. Batches of welts or wheals that can appear anywhere on the body.
2. Welts that vary in size and shape.
3. Red, purple, or skin-colored welts, depending on the skin color.
4. Intense itching.
5. Painful swelling around the eyes, cheeks, or lips.
6. Flares that get triggered by heat, cold, exercise, or stress.
7. Symptoms last for more than six weeks and may recur anytime, sometimes for months or years.
8. Allergies to certain food items, such as milk, peanuts, eggs, fish, and shellfish.
The doctor can diagnose urticaria and swelling simply by looking at the affected skin. In addition, the provider may perform allergy tests to help determine what triggers a reaction. An accurate diagnosis helps the doctor with treatment options.
The tests include:
Skin Tests - Healthcare providers may test different allergens on the skin during this test. If the skin turns red or swells, the person is allergic to that substance. This allergy test is also called a skin prick or scratch test. However, skin testing is not done for chronic urticaria.
Blood Tests - A blood test helps look for specific antibodies in the blood.
Treatment for urticaria usually starts with non-prescription anti-itch drugs (antihistamines). If these do not help, the healthcare professional may prescribe one or more of the following treatments:
Prescription Anti-Itch Drugs - The mainstay of treatment for chronic urticaria is prescription antihistamine pills. These drugs soothe itching, swelling, and other allergy symptoms. In addition, daily use of antihistamines helps block the release of histamine. Examples of antihistamines include:
These medications may cause side effects.
Always consult a doctor before taking these medications if someone is pregnant or breastfeeding, has a chronic medical condition or takes other drugs.
If the first line of drugs does not ease the symptoms, other drugs may help, including:
Oral Steroids - Corticosteroids, including Prednisone, can reduce urticaria symptoms that are unresponsive to antihistamines.
At-Home Treatments - People with urticaria can take a cool bath or shower, wear loose-fitting clothing, and apply cold packs or compresses to relieve urticaria. Over-the-counter Hydrocortisone cream can ease itching and swelling.
Chronic urticaria does not lead to a sudden risk of a serious allergic reaction (anaphylaxis). However, this condition can potentially block the airways, resulting in death. Anaphylaxis symptoms include trouble breathing, dizziness, tongue, lips, mouth, and swelling. Seek emergency care if someone gets urticaria as part of a severe allergic reaction. People with anaphylaxis need an immediate shot of Epinephrine, like injectable Epinephrine.
For most people, urticaria does not cause serious problems. Most of the time, the symptoms disappear in a day or two. In addition, children usually outgrow allergic reactions that cause urticaria. For some people, urticaria can cause anaphylaxis that can potentially block the airways, resulting in death. People with anaphylaxis should always carry injectable Epinephrine to manage severe allergic reactions.
Allergy tests can help the healthcare professional determine which substances are causing urticaria and swelling. Once the triggers are known, they can be avoided. The following things may help:
1. Exclude certain foods or liquids from the diet that may cause allergies.
2. Choose detergents and soaps without scents or dyes.
3. Reduce exposure to airborne allergens.
4. Avoid extreme temperature changes.
5. Relax when feeling stressed or overworked.
6. Wear loose-fitting and lightweight clothing.
7. Avoid known triggers. If someone knows what has triggered their urticaria, try to avoid that allergen.
8. If grass pollen, mold spores, or animal contact has triggered urticaria in the past, take a bath or shower and change the clothes if exposed to pollen or animals.
Urticaria is the body's way of responding to a substance or allergen. These allergic reactions are uncomfortable and annoying but are not always serious. Most of the time, the symptoms disappear in a day or two. However, if someone is prone to urticaria, see a healthcare professional and get an allergy test. Knowing the triggers can help to avoid allergens and take the necessary steps to avoid the triggers.
Urticaria does not have a permanent cure, and remission after a few months or years is usual; however, it can be managed by reducing the release of histamines.
Cholinergic urticaria occurs due to an increase in the body temperature, resulting in the formation of tiny hives of size between 1 to 3 mm surrounded by large red circular patches called wheals. Antihistamine medications help in treating cholinergic urticaria.
The prevalence rate of cold urticaria is less than 0.05%, with a female predisposition. It is predominantly seen in young and middle-aged adults as compared to children and older adults.
A single hive usually lasts for about a few hours to weeks which new ones later replace. Urticaria which is present for less than six weeks, is characterized as acute, and those which persist even after that are termed chronic urticaria.
Urticaria present as reddish, itchy, smoothly raised areas of varying shapes and sizes, occurring anywhere in the body. It has a blanched center, and the average diameter of urticaria ranges from a few millimeters to centimeters.
Autoimmune urticaria occurs when the immune system itself attacks the cells of the body. Anti-FcεRI and anti-IgE autoantibodies are produced, which activate the basophils and mast cells, thereby leading to histamine and proinflammatory mediators release.
Urticaria is generally not a fatal condition but is a benign condition that causes discomfort. However, it is also present with underlying chronic disease of infective, idiopathic, psychical, physical, and vascular etiology.
Sometimes urticaria is associated with an underlying autoimmune disorder, in which the cells of the body are attacked by their own immune system cells, which is called autoimmune urticaria.
First and second-generation antihistamines are used to treat urticaria, which is used alone or in combination to produce a synergistic effect. Glucocorticoids are used in cases that do not respond to antihistamines.
It has been reported that chronic urticaria is an early sign of underlying autoimmune thyroid disease. Although it is not the only sign, developing chronic urticaria indicates a thyroid problem, and thyroid tests should be prompted.
Urticaria or hives occur as reddish and itchy hives of different sizes on the skin due to a triggered response to foods, medicines, or other substances.
- Wear cotton clothes that are loose-fitting.
- Use cold compress over the affected area.
- Take over-the-counter antihistamine medications or Calamine topical lotion.
- Dairy products like cheese and yogurt.
- Processed meats.
- Frozen and canned foods.
- Fermented foods.
- Chilli powder.
- Beverages that contain alcohol.
- Fresh foods or uncooked foods.
- Food additives.
Urinary tract infections and streptococcal throat infections caused by bacteria, and viral infections like flu, infectious mononucleosis, herpes, etc., are responsible for causing urticaria or hives.
Last reviewed at:
19 Jul 2022 - 4 min read
Query: Hi doctor, I have been experiencing skin rashes, as shown in the attached photo, for the past three weeks. It all started with itching sensation in both hands, and then red spots came all over my arms, face, and legs. I have also itching in my head. I was given Avil injection at the hospital and Avi... Read Full »
Query: Hi doctor, I am a 30 year old male. Recently, I have been diagnosed with having urticaria (burning, itching sensations throughout the body from head to toe). It started out in an acute way but is turning out to be chronic. It has been more than two and a half months and I am still suffering from it... Read Full »
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