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Hives (Urticaria)

Overview

hives

Hives, also known as urticaria in medical terminology, are very common and will affect about 20 percent of the population at some time during their lives. The skin lesions start with intense itching, followed by swollen, red welts, which sometimes sting or hurt. The welts range in size from small spots to large blotches, roughly oval in shape, and up to several inches in diameter. Hives are often caused by allergies, but can also be triggered by exposure to some foods, medications, or other substances that you come into contact with.
There are two types of hives: acute, which are present for six weeks or less, and chronic, lasting six weeks or longer. The causes are very different.

Hives, both acute and chronic, can be treated with antihistamines, and topical corticosteroids. Less commonly, oral corticosteroids may be used for more severe, persistent cases. Recurrent cases may need to be evaluated by an allergist. The most effective management is to identify what triggered the hives, then avoid or eliminate the trigger(s). Identifying the exact cause can sometimes be difficult to determine.
Causes of Hives

flu-season

Acute urticaria has virtually countless causes, including:  

  • Allergies to foods, especially peanuts, eggs, nuts, and shellfish
  • Insect stings or bites
  • Medications, such as aspirin and antibiotics (sulfa, penicillin)
  • Heat, and/or cold
  • Exercise
  • Infections, including: the common cold, urinary tract infection, strep throat, infectious mononucleosis, hepatitis, and other viral infections
  • Allergens which are present as particles in the air or that touch your skin

In most cases, the hives resolve when the cause is eliminated.  

The cause of chronic urticaria often cannot be identified. It is thought to be related to a person's own immune system about 50 percent of the time. These cases are called idiopathic urticaria. Some types of chronic urticaria are associated with:  

  • Changes in temperature
  • Exertion
  • Emotional stress
  • Alcoholic drinks
  • Fever
  • Hyperthyroidism
  • Menstrual periods
  • Pressure hives - people sitting all day, or wearing a belt too tightly.
  • Sun exposure

Signs And Symptoms

Hives can appear on any part of the body. Hives, or “wheals,” are usually pale red swellings on the skin's surface. New areas may develop as old areas fade. The skin lesions start with itching, often extremely intense, followed by swollen, red welts, which sometimes sting or hurt. The welts range in size from small spots to large blotches, roughly oval in shape, and up to several inches in diameter.

Hives should not be confused with a more severe allergic type reaction, called angioedema. Angioedema is swelling below the surface of the skin that forms large, thick, firm welts. They may be accompanied by swollen eyes and mouth, swelling of the hands, feet, and throat, difficulty breathing, stomach cramping, and chemosis, which is swelling of the lining of the eyes. The affected areas may be painful and feel warm to the touch. It can be life-threatening and requires emergency medical attention. 

Prevention

If you are able to figure out the exact cause of your hives, preventing further outbreaks is simple: Eliminate or avoid the known trigger(s) of your hives.
If you have yet to find the exact cause of your hives, one suggestion is to track your symptoms. Write down your symptoms and signs, when they occurred, and how long they lasted. This may help you identify triggers, which should then be avoided. 

Treatments

Treatment for Hives  
Despite the several causes of hives, the treatment is fairly standard for all:
● Antihistamines are the standard treatment for hives. They reduce itching and swelling. Low-sedating or non-sedating antihistamines are preferred because they have minimal side effects. A physician may use a combination of 2 or 3 antihistamines. Lortadine (Claritin), cetirizine (Zyrtec) or diphenhydramine (Benadryl, others) are over the counter, and may relieve itching.
● Corticosteroids may be used for severe hives, temporarily. An oral drug, such as prednisone, can reduce swelling, redness and itching
● Autoimmune drugs may be used if antihistamines and corticosteroids are ineffective. They may help suppress an overactive immune system.
● Cool, wet compresses may soothe the skin and prevent scratching. A comfortably cool bath may relieve itching. Add baking soda, uncooked oatmeal or colloidal oatmeal (finely ground, for the bathtub). 
Your Questions About Hives Answered

I had hives once last summer. Will I get it this summer? If you know what caused the hives before, you can avoid whatever caused it. You may get hives in reaction to something else, however.  

Is there a vaccine for hives? No. There is a countless number of things which can cause hives. It isn't possible to vaccinate against everything.  

Are hives contagious? No, because it is not usually caused by an infection. If your hives are in response to an infection, you may pass on the infection, but you don't pass on the hives.  

The spot where I got my flu shot got red, itchy and tender. Was that a hive? No, it was just a localized irritation of the site where you got your flu shot. 

Is it possible to get hives from an allergic reaction to a person? It's extremely rare, but it has happened. It may not be the person, though, but fabric, soap, lotions or some substance the other person uses and lingers on their clothing or skin.  

It seems like I get hives all the time. What should I do? First, see your family doctor. He or she may investigate the causes or refer you to an allergist, a doctor who specializes in treatment of allergies.  

Will I "grow out of" having hives? Anyone can get hives. If you tend to react to situations or substances by getting hives, you may get them in the future, no matter your age.  

Do hives run in families? Yes, there does seem to be a genetic tendency to get hives.  

I got bad hives and my doctor told me to carry a syringe for emergencies. What's she talking about? Severe hives may be associated with sudden, severe swelling in the mouth and throat, cutting off getting enough oxygen when you try to breathe. Death can occur before medical help arrives. The specially prepared injection contains epinephrine, to reduce the swelling in an emergency. The person carries the device to self-inject when extreme symptoms may put his/her life at risk.  

Article Written By Sheila M. Krishna M.D., FAAD

Dr. Krishna is a board certified dermatologist. She received her undergraduate degree at the Massachusetts Institute of Technology where she double majored in biology and foreign languages and graduated with Phi Beta Kappa honors. She is fluent in both English and Spanish. Dr. Krishna received her medical degree at the David Geffen School of Medicine at the University of California, Los Angeles, where she was a member of the Alpha Omega Alpha Medical Honor Society. She completed her dermatology residency at the Virginia Commonwealth University in Richmond, Virginia, and she served as Chief Resident in the Department of Dermatology. She completed an additional research year at UCLA with Dr. Lloyd Miller, where she gained expertise in research methods and protocol design and execution. Dr. Krishna is a Fellow of both the American Academy of Dermatology (AAD) and the American Society for Mohs Surgery (ASMS). Dr. Krishna practices in San Diego, California where she treats adults and children for skin conditions. Dr. Krishna was selected as a Top Doctor by her peers in San Diego in 2017. Website - https://www.sheilakrishnamd.com/

Article Reviewed By Natalia Kerr, Licensed Esthetician/Facial Specialist

Natalia Kerr is a licensed esthetician/facial specialist. She graduated from Orange Technical College in 2019 with her diploma in Facial Specialty. She is passionate about skincare and skin health, and has continued her education since graduation by attending various seminars, trainings, and trade shows. She struggled with acne for many years throughout her middle and high school years, and knows the damage to self-confidence that comes with it. This inspired her journey into the world of skincare, and she currently owns and practices at Skin by Natalia in Orlando, Florida. Website - https://skin-by-natalia.square.site/

More Information For The public

1. The Mayo Clinic

2. The American Academy of Family Physicians  

References

1. American Academy of Dermatology

2. Asthma and Allergy Foundation of America

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