Hives (Urticaria)

General Illness Information


Common Name:

Hives

Medical Term: Urticaria

Description: Disorder characterized by a skin rash with raised areas with redness and itching. Commonly allergic but may also occur on a non-allergic basis.

Causes:

  • Allergic or non-allergic; massive histamine release from mast cells in skin;
  • Drug reaction especially Aspirin, Non-steroidal anti- inflammatory drugs;
  • Food or food additive allergy;
  • Allergy to peanuts and/or tree nuts a leading cause of severe (sometimes fatal) food-induced allergic reactions. Affects 1% of the general population. Other foods that cause hives are chocolate, fish, tomatoes, eggs, fresh berries, milk. Also food additives and preservatives;
  • Inhalant, contact allergy;
  • Transfusion reaction;
  • Insect bite, sting;
  • Infection – viral upper respiratory infections (esp. in children) and infectious mononucleosis, viral hepatitis; bacterial (strep throat, sinusitis, dental abscess, otitis); vaginitis; fungal ; helminthic; protozoan. Helicobacter pylori has been increasingly associated with, and its eradication may stop, chronic urticaria;
  • Collagen vascular disease (cutaneous vasculitis, serum sickness, lupus);
  • Thyroid autoimmunity often associated. Administering thyroid hormone may alleviate chronic urticaria in hypothyroid patients with autoantibodies;
  • Physical trauma (heat, cold, sunlight, etc.);
  • Emotional stress.

Prevention:

  • If you have had hives and identified the cause, avoid the source;
  • Keep an anaphylaxis kit if you experience severe reactions.

Signs & Symptoms

Itchy skin papules (small, raised bumps) with the following characteristics:

  • They swell and produce pink or red lesions called wheals. Wheals have clearly defined edges and flat tops. They measure 1 cm to 5 cm in diameter;
  • Wheals join together quickly and form large, flat plaques (larger areas of raised, skin-colored lesions);
  • Wheals and plaques change shape, resolve and reappear in minutes or hours. This rapid change is unique to hives.

Risk Factors

Diagnosis & Treatment

This is a clinical diagnosis. Laboratory studies not usually helpful.

General Measures:

  • Emergency room care for life threatening reactions like difficulty swallowing, talking or breathing;
  • Laboratory studies are not usually helpful in the evaluation of acute or chronic reactions unless there are suggestive findings in the history and physical examination;
  • Cause of chronic reaction is rarely found;
  • Treatment aims are to prevent contact with the triggering factors;
  • Allergy skin tests are usually not helpful;
  • Desensitization injections are useful only when a specific allergen is found on skin testing;
  • Don’t take drugs (including aspirin, laxatives, sedatives, vitamins, antacids, pain killers or cough syrup) not prescribed for you;
  • Don’t wear tight underwear or foundation garments. Any skin irritation may trigger new outbreaks;
  • Hot baths or showers may aggravate the condition;
  • Apply cold-water compresses or soaks to relieve itching;
  • Using colloidal oatmeal in a tepid bath may help relieve the itching.

Medications:

  • Mainstay of treatment is antihistamines. Sometimes combination of antihistamines will be more helpful;
  • For rapidly progressing acute urticaria subcutaneous injection of epinephrine is used;
  • Corticosteroids may sometimes need to be prescribed for a severe acute reaction;
  • Tricyclic antidepressants appear to be effective in some cases of chronic urticaria.

Activity:

As desired. Avoid overheating.

Diet:

As desired. Avoid foods implicated as possible etiologic agents.

Possible Complications:

Severe systemic allergic reaction (bronchospasm, anaphylaxis).

Prognosis

  • Of all patients with acute urticaria, 70% will be better in < 72 hours. 30% will become chronic;
  • 20% have attacks for > 20 years.

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