Hives, manifest as raised red irritation or spots on the skin, usually due to an allergic reaction to food or foreign substances. Whether transiently acute or persistently chronic, these skin reactions can be treated with measures such as antihistamines or steroids.
Table of Contents
Overview:
What about hives ?
- Hives, scientifically called urticaria, present as raised red bumps or dots on the skin surface—a visible result of the body’s allergic reaction Allergens, usually harmless proteins triggering a reaction in sensitive individuals, cause these itchy, burning, stinging or welts to form dinner -Hives in size up to the proportions of the plates can be assembled into larger areas known as patches. While they usually fade within 24 hours, their visibility can last for several days.
Types of hives:
Acute vs Chronic Urticaria:
- The distinction between acute and chronic urticaria depends on their duration. Acute hives resolve within six weeks, whereas chronic hives last for a more extended period, occurring at least twice a week for more than six weeks. Chronic spontaneous urticaria, also known as chronic idiopathic urticaria, lacks a clear cause. Physical or induced urticaria is another type that is triggered by factors such as cold, heat, sun exposure, vibration, pressure, exercise, or sweat and usually appears within an hour of exposure.
Differentiating Hives from Rashes:
- While hives represent a specific type of rash—characterized by swelling, itching, and redness—rashes typically encompass a variety of skin conditions, including unusual spots and inflammation, so while hives fall into the broader rash category, not all rashes manifest as hives.
Affected person:
- Hives can affect anyone, and frequency varies depending on individual allergy sensitivity. Some experience the hives sporadically, while others encounter it only once or a few times in their lives. Acute hives can demonstrate an association with conditions such as asthma, allergic rhinitis, and atopic dermatitis, especially in children. In addition, periods of intense stress can trigger hives.
Dispersion:
- Approximately 20% of the population encounters hives at least once, with chronic hives affecting 1% to 3% of individuals. By understanding the nuances of the hive, individuals are empowered to navigate and manage these common skin reactions effectively.
Symptoms and causes:
Symptoms of acute urticaria:
Appearances and feelings:
- Acute urticaria presents in a variety of forms across individuals and at different locations on the body. Recognizable signs include raised red spots or bumps that swell when pressed, accompanied by intense itching. Swelling may also be experienced under the skin, causing swelling called angioedema. In severe cases, acute hives can spread to painful swelling of the lips, eyes, and lining of the throat.
Symptoms of chronic urticaria:
Continuous Features
- Chronic urticaria shares similarities with its acute counterpart, consisting of itchy, swollen raised lesions that become lighter in the center under pressure. However, chronic urticaria presents additional nuances:
– Changing shape and size.
– Cyclic appearance, disappearance, and reappearance every few days, continuing for months or years.
-Relation to factors such as heat, exercise or stress.
Reasons for hives:
Acute hives:
- Allergic reactions, which are often triggered by the consumption of food, beverages, or medications, or by contact with certain substances, cause acute hives. Mast cells, immune cells in the skin, release histamine during such reactions, which contributes to the formation of hives. Additionally, hives can also be caused by infection, stress, or physical pressure on the skin, although in some cases the exact cause is unknown.
Chronic urticaria:
- Unlike acute urticaria, chronic urticaria is usually not induced by allergies. Underlying medical conditions, such as lupus, as well as infections with bacteria or viruses, may contribute to their onset. Often, the cause remains unknown, and such hives are called idiopathic or spontaneous. Although discomfort may persist for a long time, chronic hives are usually not permanent or life-threatening.
Infectious nature of hives:
- Unlike some skin conditions, hives are not contagious. However, if hives are caused by exposure to secretions of plants such as poison ivy, the allergy-causing substances may be transferred to others unless the affected skin is thoroughly washed.
- Understanding the diverse manifestations and triggers of hives empowers individuals to effectively understand their symptoms and seek appropriate medical guidance.
Diagnosis and testing of hives:
How are hives diagnosed:
- Healthcare providers diagnose hives and angioedema primarily by examining your skin. While allergy tests are beneficial for identifying triggers, they are more applicable to acute hives. Finding the cause helps avoid allergies and manage associated hives. Diagnostic methods include:
1. Skin Test:
– Procedure: Various allergens are applied to your skin, and any redness or swelling indicates an allergic reaction.
– Alias: Commonly known as skin prick or scratch test.
– Applicability: Mainly used for acute urticaria, and not generally used for chronic urticaria.
2. Blood Test:
– Procedure: Your blood is checked for specific antibodies related to allergies.
– Purpose: To identify increased antibody counts, indicating an increased response to allergens that can cause hives and swelling.
- Understanding the cause through these tests not only aids in accurate diagnosis but also guides strategies to avoid allergies and effectively manage associated skin reactions.
Management and Treatment of Hives:
How are hives treated or managed?
- In many cases, hives resolve on their own without the need for specific treatment. However, healthcare providers may recommend a combination of medications and home care to ease symptoms and reduce the chance of recurring hives. Treatment options include:
- Allergy medications: Antihistamines, either taken orally or applied topically, are commonly prescribed to block the effects of histamine. Fast-acting antihistamines such as diphenhydramine (Benadryl®) can provide immediate relief from itching, while for ongoing management loratadine (Claritin®), fexofenadine (Allegra®), cetirizine (Zyrtec®), or levocetirizine (Xyzal®) Daily medications such as: ,Allergy Shots: For persistent and challenging cases of chronic hives, healthcare providers may discuss monthly injections of medications that prevent allergic reactions. The purpose of these injections is to counteract the excessive production of IgE, a component involved in severe allergic reactions.Home Remedies: To get relief from hives at home, a person can take a cold bath, wear loose-fitting clothes, and apply a cold compress. Over-the-counter hydrocortisone or antihistamine creams can be used to relieve itching and swelling.Oral steroids: Corticosteroids such as prednisone may be prescribed for cases where hive symptoms do not respond adequately to antihistamines or topical steroids.
- Epinephrine: In cases of severe acute allergic reactions, leading to a life-threatening condition known as anaphylaxis, immediate administration of epinephrine (EpiPen®) is important. Symptoms of anaphylaxis include hives, swelling of the face or throat, trouble breathing, wheezing, vomiting, and low blood pressure. Epinephrine helps open airways, increase blood pressure, and reduce hives and swelling. It is essential to seek emergency medical attention after using epinephrine, as symptoms may reappear after its effects wear off.
Complications of Hives:
- Severe acute allergic reactions can result in life-threatening airway swelling, called anaphylaxis. This condition can be caused by severe allergic reactions to foods such as peanuts or tree nuts, or insect stings. In such cases, immediate administration of epinephrine (EpiPen® or AUVI-Q®) is important to open the airway, increase blood pressure, and reduce hives and swelling. If epinephrine is used outside a medical setting, monitoring in the emergency room is advised due to the possible return of anaphylaxis symptoms once its effects wear off.
Prevention of Hives:
How can I prevent hives?
Acute urticaria:
- Healthcare providers use allergy test results to identify triggers for acute hives, enabling individuals to take proactive measures. Prevention strategies may include:
- Dietary Changes: Remove specific food products identified as triggers from your diet.
- Reduce exposure to allergens: Minimize contact with airborne allergens.
- Non-scented products: Switch to detergents and soaps without fragrances or dyes.
- Temperature Management: Avoid extreme temperature changes.
- Stress Management: Take breaks and practice relaxation techniques during times of stress or overwork.
- Choice of clothes: Choose loose-fitting, light clothes.
- These preventive measures may also be beneficial for chronic hives.
Chronic Urticaria:
- Preventing chronic hives can be a challenge, as the exact cause may be unclear or linked to broader immune system conditions. In such cases, it may not be possible to identify specific triggers.
Outlook/Forecast:
What is the prognosis for people with hives?
- For most individuals, hives generally do not cause serious complications. Children often recover from the allergies associated with hives, giving them a positive outlook.
- However, in some cases, allergic reactions such as angioedema can lead to anaphylaxis – severe swelling of the airways and lungs. Persons experiencing this life-threatening condition should carry injectable epinephrine (EpiPen®) with them and be well-versed in its proper use, to ensure prompt intervention in the event of an emergency.
Living With Hives:
When should I contact my healthcare provider about hives?
Hives often improve without intervention, but it’s important to contact your healthcare provider if you experience:
– Persistent hives or swelling lasting over a week.
– Bumps that appear infected, characterized by redness, swelling, or pus.
– Recurring hives, occurring every few months.
– Intense itching disrupting sleep.
– Signs of anaphylaxis, such as wheezing, shortness of breath, vomiting.
– Swelling of lips or face.
What questions should I ask my doctor?
If you develop hives, consider asking your healthcare provider:
– The cause of your hives.
– Expected duration of the hives.
– Whether an allergy test is recommended.
– Preventive measures against future hives.
– Optimal treatments for reducing itching.
– Strategies for hives resolution.
– Indicators of potential complications.
Additional Common Questions:
Q. How long does it take for hives to heal ?
A. Hives typically resolve within a few days to weeks. However, chronic hives may persist for months or longer.
Q. Are hives common with COVID-19?
A. Similar to other infections, COVID-19 may be associated with skin rashes, including hives. Monitoring for such symptoms is advised during illness.
