Urticaria (Hives) : Causes, Symptoms & Treatment

 Urticaria (Hives) : Causes, Symptoms & Treatment

Urticaria, commonly known as Hives, affects about 20 percent of people at some time during their lives. It can be triggered by many substances or situations and usually starts as an itchy patch of skin that turns into swollen red welts. It can occur at any age, from infancy to old age. The main cause behind urticaria is pre-existing allergies. 

 Causes :-

• Allergies - An allergic reaction is the single most common cause for an outbreak of hives. Bites and stings by insects like bees, mosquitoes, or wasps can cause hives.   

• Stress and psychological trauma - Stress is a big creator or enabler of hives.  Prolonged emotional and psychological stress can cause chemical and hormonal changes that can lead to hives. Stress also leaves us more susceptible to illness and exposure to hives. 

• Exercise - Sweat from exercise can cause hives in some individuals, and in others exercise itself can cause hives.

• Exposure to the sun -Sunlight can be harmful to your skin for a number of reasons, and hives can result from sun exposure. This is called solar urticaria.  

• Exposure to allergens -Continuous exposure to allergens leads to hives. This causes various allergic reactions. 

•  Diseases like thyroid, skin allergies, and joint pain may prompt urticaria.  

• Aquagenic urticaria -Hives from contact with water causes Aquagenic urticaria. Exposure to heat or cold can cause hives as well. 

•  Dermographism -It is an exaggerated wealing tendency when the skin is stroked. It is the commonest form of physical or chronic inducible urticaria.  

Spontaneous urticaria may last for some hours and do not stay longer on the surface of the skin.  It is characterized by the sudden onset of itchy weals. Weals are due to release of chemical mediators from tissue mast cells. These chemical mediators include histamine, platelet-activating factor and cytokines. Severe allergic urticaria may lead to angioedema. It usually occurs in soft tissues like near eyes, lips and genitals. It may last longer than a month. In such cases itching can’t be spotted.  

Physicians treat urticaria using deworming. Urticaria may be associated with allergic rhinitis and asthma as well. These patients are called as atopic patients, it means it is a genetic predisposition through secretion of more and more IGE cells (Immunoglobulin E cells). That's why it is advised to seek proper treatment from an allergy specialist. 

How is urticaria diagnosed?

• Urticaria is diagnosed in people with a history of weals that last less than 24 hours with or without angioedema. A family history should be elicited. A thorough physical examination should be undertaken. 

• Using blood count ( CBC) 

• Skin prick tests may be requested if airborne allergens like pollen,fungus moulds ,food allergy is suspected in acute urticaria.

• Drug allergy test can be requested if any drug causing allergy for example painkiller, sulpha drugs, quinolone are culprit

• The serum skin test is sometimes carried out in chronic spontaneous urticaria, but its value is uncertain. It is positive if an injection of the patient's serum under the skin causes a red weal. 

• Raised ESR may suggest some chronic infection may be the cause of urticaria.

• Eg : dental and GI infection. H pylori infection  in GI. 

• Testing total IGE level of patients to check if the person is an atopic in nature 

• Thyroid function (TSH) and free thyroxine (T4)

• ANA (Antinuclear Antibody). Urticaria is also caused in patients whose auto immune system is disturbed.  

Treatment for urticaria :-

The main treatment of all forms of urticaria in adults and children is with an oral second-generation antihistamine. If the urticaria lasts less than 6 weeks, then it is acute urticaria. And if it lasts more than 6 weeks it is chronic urticaria.

• Usually avoidance of allergens is advised by the doctors. 

• Pharmacotherapy includes usage of non-sedating second-generation antihistamines

• Mast cell stabilizers- Ketotifen is an oral anti allergic drug used in treatment of chronic urticaria. Nowadays ketotifen is not used.

• Patients with chronic urticaria that have failed to respond to maximum-dose second-generation oral antihistamines taken for four weeks should be referred to an allergy specialist.  

While hives may be bothersome for some, they are typically self-limiting. But it is really important for us to treat them because it may lead to further complications. Home treatments cannot cure these allergies completely. It’s very important to check these symptoms and seek professional help.   

In case you are suffering from any kind of allergy or want to know more about allergies you can contact me. 

 It would be a pleasure to help anybody in need. 

 Dr. Pramod Jhawar  

Jhawar Chest, Allergy, Asthma & Bronchoscopy, Sleep Study Centre

Call - 9827033089, 9424611137, 0731-2560011