Hives

What are hives?

Hives refer to the red raised welts (bumps) or splotches found on the skin. They are a form of swelling on the skin surfaces occurring due to an allergic reaction that happens when the body's immune system encounters an allergen. While allergens are harmless proteins in most people, they can trigger a response in those who are sensitive.

Hives are usually very itchy and one may as well experience a burning, or stinging sensation. They can also vary in size, ranging from as small as a fingertip to as large as a dinner plate. Urticarial is another medical term for this condition.

In some cases, the bumps from hives merge to form bigger areas known as plaques. And although hives typically fade away within 24 hours, they can remain visible for a few days or even longer.

Types of hives

Hives may occur due to an allergic response or have no recognizable cause.

Allergic reactions

Allergic reaction is the leading cause of hives. These can result from the allergens one may be sensitive to. The most common types are:

• Foods (like milk, nuts, and eggs)
• Pollen
• Pet dander
• Dust mites
• Insect bites or stings
• Medications (mainly cancer drugs, antibiotics, or ibuprofen)

Minor cases of allergy-triggered hives are generally treated with short or long-term allergy drugs and by avoiding the possible trigger.

Anaphylaxis

This is a severe and dangerous allergic reaction where hives occur along with nausea or vomiting, breathing difficulties, dizziness, and severe swelling. So, if you suspect anaphylaxis, dial 911 or the local emergency services right away.

Chronic hives

Chronic hives are persistent cases that may not have a recognizable cause. The condition, which is also known as chronic urticaria, is characterized by repeated hives that may disrupt a person's everyday life. These types of hives can last from weeks to a few months or even years.

You may have chronic hives if welts persist and don't disappear in six weeks. This condition although not life-threatening could be uncomfortable and challenging to treat. It may also indicate a health issue such as:

• An autoimmune disorder
• Lupus
• Celiac disease
• Type 1 diabetes
• Thyroid disease
• Rheumatoid arthritis

Dermatographism

A dermatographism is a mild form of acute hives caused by excess scratching or constant pressure on the skin. It usually resolves on its own within a short period and without treatment.

Temperature-induced hives

Fluctuations in temperature can sometimes trigger hives in sensitive individuals. Cold-induced hives might result from exposure to cold water or air, whereas exercise-induced hives can occur due to body heat following physical activity. For some, sunbeams or tanning beds could also cause solar hives.

Infection-induced hives

Hives can be caused by both bacterial and viral infections. The common bacterial infections are urinary tract infections (UTI) and strep throat. Also, viruses such as those causing hepatitis, infectious mononucleosis (mono), and colds may lead to hives.

Symptoms of Hives

What are the symptoms of acute hives?

Acute hives can appear differently based on the individual and the specific situations. They can also manifest anywhere on the body.

The common signs of acute hives are:

• Elevated welts or bumps on the skin which may appear reddish on lighter skin tones.
• Hives that blanch (the middle part turns pale when pressed upon).
• Skin itchiness.
• Swelling beneath the skin that causes puffiness (angioedema).
• Painful swelling of the eyes, lips, and inside the throat.

What are the symptoms of chronic hives?

In most cases, chronic hives share similarities with acute hives, such as swollen, itchy, elevated bumps that become lighter in the middle when pressed. Nonetheless, chronic hives are likely to:

• Change in size and shape.
• Appear, go away, and recur for a few days over long periods, sometimes months or even years.
• Occur alongside heat, stress, or exercise.

What Causes Hives?

Causes of acute hives

Acute hives often result from an allergic reaction to components you ingest, such as food, drinks, or medicine, or from something you come into contact with. The skin contains immune cells known as mast cells, which release chemicals like histamine when they are in action. Histamine is the primary cause of hives formation.

Hives may as well develop because of other various reasons such as stress, infections, and physical strain on the skin. Sometimes, healthcare providers cannot determine the exact cause of the hives.

Causes of chronic hives

Chronic hives, unlike acute hives are not typically triggered by allergies. Instead, they may result from bacterial or viral infections or other health conditions such as lupus. The healthcare providers might not identify an actual cause, and in these situations, the hives are considered idiopathic or spontaneous.

While chronic hives persist for extended periods, they are generally not permanent. Also, they may cause discomfort yet not life-threatening.

Who is at risk?

Persons with known allergies are at a high risk of developing hives. You might also be susceptible to the condition if you are using certain medications, or accidentally get exposed to allergens like food or pollen. Moreover, having an existing infection or a medical condition increases the likelihood of hives.

Diagnosis

How are hives diagnosed?

During hives and angioedema diagnosis, medical providers start by examining the skin. They also perform allergy tests to help determine triggers, particularly for acute hives. Identifying the cause is essential in avoiding allergens as well as associated hives.

Some of the allergy tests used to diagnose hives are:

• Skin tests: The providers perform this test to assess various types of allergens on the skin. If the skin swells or becomes red, then you are allergic to that element. This form of allergy test is also known as a scratch test or a skin prick. Usually, skin testing is not conducted for chronic hives cases.
• Blood tests: These look for particular antibodies in the blood. The body produces antibodies that help fight off allergens. However, excess creation of antibodies can cause hives and swelling.

How are Hives Treated or Managed?

The initial step in treating hives is confirming the diagnosis, which can be done through a physical exam. If you have the condition, the skin will portray welts signs associated with hives.

The medical provider can also order blood tests, or perform skin tests to help identify potential allergens. This is particularly considered when the hives occur due to an allergic reaction.

For mild hives cases not linked to allergies or other medical conditions, prescription treatment may not be necessary. Instead, the provider might recommend temporary relief measures such as:

• Using antihistamines, like cetirizine (Zyrtec) or diphenhydramine (Benadryl)
• Avoiding irritating the affected area
• Keeping off the hot water which can worsen the hives
• Bathing in cold or lukewarm water with colloidal oatmeal or baking soda

How Can I Prevent Hives?

Acute hives

The doctor can help identify the substances that prompt acute hives using the outcomes of your allergy tests. Once you are aware of the triggers, you can take the necessary precautions to avoid them. Hence, you can consider:

• Eliminating certain foods from your diet.
• Reducing exposure to airborne allergens.
• Switching to unscented, dye-free detergents and soaps.
• Avoiding extreme temperature changes.
• Taking breaks and relaxing when overworked or stressed out.
• Wearing loose-fitting and lightweight outfits.

Some of these measures might also be helpful in managing chronic hives.

Chronic hives

Preventing chronic hives can be more challenging, as the doctor might not know the exact cause or triggers. Moreover, chronic hives could be part of a larger medical condition affecting a person's immune system.

When to See a Doctor

While hives often improve without any treatment, you should contact your doctor if you experience the following:

• Hives or swelling lasting for over a week.
• Bumps that appear infected (swollen, red, or pus-filled).
• Recurrent hives that reappear every few months.
• Severe itchiness that can interfere with your sleep.
• Symptoms of anaphylaxis, such as shortness of breath, wheezing, or vomiting.
• Swollen face or lips.

What questions should I ask my healthcare provider?

If you are diagnosed with hives, consider asking your doctor the following questions:

• Why did I develop hives?
• When should I expect the hives to go away?
• Should I undergo an allergy test?
• What steps do I need to take to prevent hives in the future?
• What is the best treatment option to minimize itching?
• What is the ideal approach to getting rid of hives?
• Should I watch out for signs of complications?

A Note from MD

Hives are generally the body's response to a substance or allergen you are sensitive to. While they can be uncomfortable, the reactions are usually not serious. One might experience hives only, hives accompanied by swelling, or simply swelling alone. In most cases, the reactions disappear within one or two days.

It's important to discuss with your doctor about undergoing tests to identify triggers if you are susceptible to these reactions. After identifying the possible causes, you should take the appropriate measures to avoid them and manage reactions.

Chronic hives may take weeks or even longer to resolve. Ensure that you inform your provider if treatments are not responding. Despite not knowing the reasons for having chronic hives, the treatment could still be effective.