Hives, also known as urticaria, is a common inflammatory condition that can present as pink to red whelps anywhere on the skin. Symptoms include inflammation, itching, and swelling of the skin. People may also experience swelling around the eyes or swelling of the lips. In rare severe cases, some patients may experience difficulty breathing due to swelling of the throat and airway. As with most inflammatory conditions, urticaria is due to an over-activation of the immune system. This can be either due to an allergic reaction which stimulates the immune response or an intrinsic problem with a gradual onset.
There are multiple potential causes for hives and can often be difficult to pinpoint an exact cause. Hives are broadly categorized as either “acute urticaria” or “chronic urticaria” depending on how long the symptoms persist. Acute urticaria is hives that resolves in less than six weeks and is typically due to an allergic reaction. Multiple allergic triggers have been implicated in hives, including certain foods (commonly shellfish & nuts), medications, infections, and other environmental factors. Chronic urticaria is hives that continue to persist after six weeks. The cause of chronic hives is often very difficult to obtain and is usually idiopathic (unknown). Recent studies suggest that chronic urticaria may be an autoimmune reaction in which the body’s immune system becomes sensitized and remains over-activated. The underlying cause is unknown. Chronic urticaria can be frustrating and debilitating due to persistent hives that continue to come and go.
Other common and rare environmental factors that can cause recurrent hives include: certain medication and foods, heat, cold, pressure, sunlight, exercise, and even water!
- Medication-induced urticaria: Almost any medication can cause an allergic reaction with hives. Common medications known to cause hives include antibiotics and non-steroidal anti-inflammatory medications (Aspirin, Ibuprofen, Motrin, Aleve, etc.).
- Food-induced urticaria: Shellfish and nuts are the most common food allergens which can induce hives, although other foods can also be implicated.
- Heat-induced urticaria: Hives triggered by continued application of heat onto the skin. Lesions begin to appear within five minutes of exposure and can last minutes to hours. Lesions are usually confined to exposed areas.
- Cold-induced urticaria: Triggered by exposure of the skin to extreme cold conditions and is common in young adults. Patients may experience hives on the face, neck or hands after exposure to cold weather. In rare forms, patients may experience generalized hives a few hours after exposure to cold temperatures.
- Cholinergic urticaria: More common form of hives that can develop after exercising, exposure to heat, stress or any activity that raises the body’s core temperature. Usually presents as small red itchy spots that can last minutes to hours.
- Solar Urticaria: Sun-induced hives that develops shortly after exposure of skin to sunlight. There are various subtypes of solar urticaria depending on the wavelength of light involved. Lesions typically last minutes to hours and fade.
- Pressure-induced urticaria: Hives that may develop in response to vibration or pressure on the skin. Lesions can present right after exposure to the stimulus or can present hours later.
- Dermatographic-induced urticaria: Development of whelps or hives after the skin is scratched or firmly stroked. This is a very common form of chronic hives which can affect up to five percent of the population. Lesions present shortly after stroking the skin and usually resolve in less than half an hour.
- Infection-induced urticaria: Hives may be triggered by certain viral or bacterial infections as the body mounts an immune reaction to the infection. Certain parasitic infections have also been known to cause hives.
- Aquagenic urticaria: Very rare form of hives which develops in response to exposure of the skin to water. While patient’s can drink water, exposure of their skin to water can result in a hive-like reaction within minutes of exposure.
Treatment and management of urticaria is often dependent upon the underlying cause. Acute urticaria can often be treated with oral antihistamines and removal of potential allergens. Systemic corticosteroids such as prednisone or a Kenalog injection may be used for severe outbreaks. Topical corticosteroid creams and moisturizers with menthol often help reduce inflammation and soothe the skin. Patients are also encouraged to keep a diary of potential allergens or triggers that can cause a flare of their skin.
Management of chronic urticaria can often be challenging with limited effectiveness. Despite extensive clinical workup and lab-work, an underlying cause may be difficult to obtain. Patients that don’t respond to topical therapy and oral antihistamines may need systemic immunosuppressant therapy to help calm the over-active immune response that may be responsible for their hives.
Depending on your skin type and clinical symptoms, our physician and help provide a treatment plan that’s appropriate for you.