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Hives (Urticaria)

Hives Definition

Hives, also known as uticaria, is a medical condition marked by the appearance of pale red itchy swellings on the skin. There are two types of hives, acute hives lasting for less than 6 weeks and chronic hives lasting for more than 6 weeks. An allergic reactions following certain food or drug intake is one of the main reasons of acute hives, whereas in most cases of chronic hives the cause remains unknown. Sometimes the skin rash is also accompanied by angioedema, swelling under the skin, and anaphylactic shock which is a potential fatal complication.  Mild hives usually does not require any treatment other than oral antihistamines but severe cases require hospital admission.

Hives Symptoms

Common symptoms of hives includes :

  • Appearance pale red to white itchy bumps (wheals) covering large area on the skin.
  • Sometimes one area of swelling disappears followed by appearance of new batch of swellings at another site. It seems that the rashes are moving.
  • Stinging or burning sensation may occur although uncommon.

Acute hives are short lasting, may appear within minutes of exposure to allergen and resolving within 6 weeks. Chronic hives remain for more than 6 weeks. Sometimes severe chronic hives may even persist for decades.

Hives and Angioedema

Angioedema, a reaction similar to hives affecting the deeper layer of the skin and tissue, often co-exists with hives. Common symptoms of angioedema include :

  • Large firm painful and warm swellings appearing usually around the eyes and lips.
  • Sometimes hand, feet, genitalia even inner wall of the air way (larynx) and digestive tract may be swollen.
  • Swelling of larynx may cause life threatening breathlessness and swollen digestive tract may cause diarrhea.

Hives and Anaphylaxis

Anaphylactic shock is a serious and life threatening complication of hives requiring immediate medical attention. It presents with :

  • Severe narrowing of airways (breathlessness)
  • Fall in blood pressure
  • Confusion and disorientation

Unconsciousness, bluish discoloration of the skin, cessation of breathing and a pulses that is difficult to find are dangerous signs. Without rapid treatment, a person can die within minutes.

Hives Causes

Acute Hives

Hives, particularly acute hives, mainly occurs due to exposure to allergens. Allergens stimulate special cells in the body (mast cells) to release histamine and other chemicals in the blood stream and eventually leading to inflammatory reactions (wheals).

Common allergens are :

  • Foods: common allergen are milk, peanuts, shellfish, eggs.
  • Drugs: penicillin, aspirin, sulfur-containing drugs like antidiabetic drug glimeperide.
  • Pollen.
  • Animal dander ( mainly fur).
  • Latex

Sometimes infection, by bacteria, parasites and viruses (Epstein-Barr virus, cytomegalovirus, HIV) may lead to hives. Other possible triggers of hives includes :

  • Stress
  • Exercise
  • Continued application of heat
  • Sun exposure (solar urticaria)
  • Exposure to cold, damp windy conditions
  • Scratching or stroking of the skin (dermatographic urticaria)
  • Pressure

Chronic Hives

Unlike acute hives chronic hives are rarely caused by allergy. Autoimmune disease like lupus, some thyroid disease, occurring due to faulty activation of one’s immune system against self proteins, may sometimes lead to chronic hives. Angioedema and hives may occur due to inherited abnormal functioning or low circulating level of certain blood proteins namely C1 inhibitors.

Hives Treatment

Mild cases of hives require no treatment. It passes on its own within a short period of time and various measures can be undertaken to ease the symptoms.

  • Cold water may help reduce the symptoms.
  • Petroleum jelly and other emollients are helpful in reducing the skin irritation with scratching.
  • Avoid heat and direct sunlight exposure of the affected part.

Severe symptoms that are unbearable or are not resolving needs more definitive treatment.

  • Antihistamines like loratadine, cetrizine and levocetirizine is useful in reducing itchiness.
  • Corticosteroid reduces inflammation and suppresses the immune response.

Serious conditions like anaphylactic shock require hospital admission, injection of adrenaline and breathing assistance.


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