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Hives

 Hives



Overview

Hives are raised red bumps (welts) or splotches on the skin. They’re a type of swelling on the surface of your skin and happen when your body has an allergic reaction. Allergic reactions happen when your immune system comes in contact with an allergen. Allergens are proteins that are harmless to many people but cause an allergic reaction in sensitive people.

Hives are often very itchy, but you might also feel burning or stinging. They can be as small as a fingertip or as big as a dinner plate. The medical name for hives is urticaria.

Sometimes, the welts from hives join together to form larger areas called plaques. Hives tend to fade within 24 hours, although they may be noticeable for several days or longer.

Types of hives

Acute urticaria refers to hives that don’t last very long (less than six weeks). Chronic urticaria refers to hives that happen at least twice a week for more than six weeks.

Chronic, spontaneous urticaria is the name for chronic hives that don’t have an obvious cause. An older name for this condition is chronic idiopathic urticaria.

There’s also a condition called physical urticaria, or inducible urticaria. These hives might pop up when you’re in the cold, heat or sun. Some people react to vibrations or pressure, exercising or sweating. Physical hives usually appear within an hour after exposure. This type of hives can also be chronic

Symptoms

Hives look different depending on the person and the situation. They can show up anywhere on your body. Signs of acute hives include:

Raised welts or bumps on your skin. The bumps may look reddish on lighter-colored skin.

Hives blanch (the center of the hive becomes pale when pressed).

Itchy skin.

Swelling under your skin causing puffiness (angioedema).

Also appearing with painful swelling of your lips, eyes and inside your throat.

Causes

Causes of acute hives

Acute hives are often an allergic reaction to something you put into your body, like food, drink or medication, or something that you touch. The skin has immune cells called mast cells. When these cells go into action, they release chemicals, including one called histamine. Histamine is the reason that hives form.

You can also get hives for a variety of other reasons. Some of these include having an infection, stress or physical pressure on your skin. It’s not uncommon for healthcare providers to be unable to determine exactly what caused your hives.

Causes of chronic hives

Unlike acute hives, chronic hives aren’t usually caused by allergies. They may be caused by infections from bacteria or viruses, or as a result of other medical conditions like lupus. Your provider may not discover an exact cause. In these cases, chronic hives are said to be idiopathic or spontaneous.

Chronic hives do last for long periods of time but usually aren’t permanent. They can be uncomfortable, but they aren’t life-threatening.

Diagnosis

Your healthcare provider can diagnose hives and angioedema by looking at your skin. Allergy tests can help identify what’s triggering a reaction, but this is true primarily for acute hives. Knowing the cause can help you avoid allergens and the hives that come with them. Allergy tests to diagnose hives include:

Skin tests: During this test, healthcare providers test different allergens on your skin. If your skin turns red or swells, it means you’re allergic to that substance. This type of allergy test is also called a skin prick or scratch test. Skin testing usually isn’t done for chronic hives.

Blood tests: A blood test checks for specific antibodies in your blood. Your body makes antibodies to fight off allergens. If your body makes too many antibodies, you can develop hives and swelling.

Treatment

Most of the time, hives go away without treatment. Your healthcare provider might recommend medications and at-home care to help you feel better and lower your chances of having hives again. Treatments include:

Allergy medications: Medicines called antihistamines block histamine’s effects. They can be taken orally (swallow a pill) or topically (put on the affected skin). Antihistamines relieve itching from hives and make allergic reactions go away or become less severe. Some antihistamines react quickly, such as diphenhydramine (Benadryl®). Depending on how severe the hives are, your healthcare provider may recommend daily allergy medications, like loratadine (Claritin®), fexofenadine (Allegra®), cetirizine (Zyrtec®) or levocetirizine (Xyzal®).

Allergy shots: For hard-to-treat chronic hives, your healthcare provider may discuss monthly injections of drugs that block allergic reactions. People with severe allergies make too much IgE. These injections block your immune system from making IgE.

At-home treatments: To relieve hives, you can take a cool bath or shower, wear loose-fitting clothing and apply cold compresses. An over-the-counter (OTC) hydrocortisone or antihistamine cream can relieve itching and swelling.

Oral steroids: Corticosteroids, such as prednisone, can relieve hive symptoms that don’t respond to antihistamines or topical steroids.

Epinephrine: Severe acute allergic reactions can lead to a life-threatening condition called anaphylaxis. Symptoms include hives, swelling of your face, mouth or throat, shortness of breath, wheezing, vomiting and low blood pressure. Anaphylaxis is life-threatening and anyone having this kind of reaction needs an immediate epinephrine injection (EpiPen®) to open a swollen airway.

Complications of hives

Anyone who has a severe acute allergic reaction could have life-threatening swelling of the airways — your throat and lungs. This condition is known as anaphylaxis. It can potentially close off the airways, resulting in death.

Anaphylaxis is often triggered by a severe allergic reaction to a certain food, like peanuts and tree nuts, or to a bee sting. If you have anaphylaxis, you need an immediate shot of epinephrine, such as injectable epinephrine (EpiPen® or AUVI-Q®).

Epinephrine opens airways, raises blood pressure and reduces hives and swelling. If you take epinephrine outside of a medical setting, you should go to the emergency room to be monitored. Symptoms of anaphylaxis can return as the epinephrine wears off.

Type of Doctor Department : A primary care doctor, an allergist, or a dermatologist


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