Understanding Hives (Urticaria)

Hives, or urticaria, is a disease characterised by red, itchy bumps that suddenly appear on the skin. They can appear anywhere on the body and vary in size. Hives typically come and go within a short period and are usually red, pink, or flesh-coloured.

Hives are common and not contagious. You will not develop hives through skin contact or by being close to a person with hives.

A rash is usually characterised by irritation or swelling of the skin, whereas hives are a type of rash that shows the area of the skin raised or puffy with intense itching.

Classifications and Causes of Hives

Hives occur due to an immune response that activates mast cells in the skin. The mast cells release natural chemicals, with histamine being the key one, which brings about itching, redness, and swelling, resulting in a hive being formed.

Classification	Description
Acute hives	The triggers and causes of acute hives include infections, specific medications, insect stings, food allergies, and physical contact with certain substances. Common cases of hives are usually acute and will last from a few days to two weeks.
Chronic hives	It occurs on a daily or near-daily basis, may last longer than six weeks, and there are cases of it lasting for years. This condition may disturb a person’s quality of life as it comes and goes, but it is treatable to most people. It is not life-threatening and is rarely caused by allergies. It is rare for hives to be in a person’s life permanently, as nearly 50% of people are hive-free within a year. The cause of chronic hives is still unknown, but they may be linked to the immune system. Hives classified into this category may be brought upon by medical or autoimmune conditions such as thyroid, liver diseases, chronic infections, or lupus. People with any of these conditions may experience additional symptoms beyond hives.

Hives Symptoms

Symptoms associated with hives include:

Raised bumps or patches appear in various shapes and sizes.
Can appear either in one area or spread across the body.
Itchy, stinging, or burning sensation.
For people with lighter skin tones, they may appear pink or red; whereas those with darker skin tones may have a harder time noticing it.

Diagnosing Hives

Most people with hives usually do not need to go through any testing, as the diagnosis is usually based on their symptoms and a physical examination.

Skin tests: Skin testing for food and drug sensitivities is recommended if there are concerns that allergies may be causing the hives. This is commonly done for people with acute hives as chronic hives are seldomly caused by an allergy.

Blood tests: If an individual has hives lasting for over six weeks, it is recommended to do a blood test as it can detect potential signs of underlying diseases such as thyroid problems or an autoimmune disease.

Skin biopsy: A small sample of skin is needed to be removed to help identify rare causes of hives. This procedure is recommended for people with chronic hives accompanied by other symptoms, such as persistent fever, painful hives, hives that last for days, or hives associated with skin bruising. In some cases, a skin biopsy may be needed for those with other symptoms or abnormal blood test results.

Treating and Managing Hives

Treatment or Management	Description
Avoiding triggers	Avoiding specific triggers such as certain foods, medications or environmental factors, can help in preventing hives.
Medications	Non-prescription antihistamines: Helps to manage the itch and swelling. Oral steroids (glucocorticoids) like prednisone: These are prescribed to help alleviate serious acute hives if antihistamines do not improve the condition. However, oral steroids are not recommended for long-term use, as extended consumption (months or years) may cause severe side effects. The dosage is gradually reduced and discontinued once the condition improves. For chronic hives, oral steroids offer only a temporary solution.
Anti-itch cream or lotion	For milder cases of hives, your dermatologist may prescribe a corticosteroid to be applied to the skin to help alleviate itchiness.
Other treatments	Omalizumab is a treatment used for hives that are difficult to control. It is administered as a monthly injection and must be given by specialists.

Preventing Hives

Identifying and avoiding triggers can help in preventing hives.

Foods that have been identified causing your symptoms have to be avoided.
Avoid using products with harsh chemicals.
Avoid rubbing your itchy skin with a washcloth, loofah, or mesh sponge.
During showers or baths, use lukewarm water and remember to be very gentle with your skin.
Avoid wearing tight-fitting clothing.
If you suspect that any medication is triggering your hives, inform your doctor immediately.

It is best to consult with an expert allergist who is trained to identify triggers of your hives and recommend appropriate treatments to help alleviate the symptoms or address the condition. The treatment may be prescription-based or over-the-counter, depending on factors such as the severity of your discomfort.

The causes may not always be identifiable, but monitoring the flare-ups can help in determining potential triggers.

Make an Appointment at Gleneagles Hospitals

Consult a doctor if your hives symptoms worsen or new symptoms appear. The team of expert dermatologists at Gleneagles Hospitals is available for consultation, ensuring the best care and support for patients.

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