Hives are red, elevated bumps or patches on the skin, also known as urticaria in medical terms. They occur when your body develops an allergic reaction triggered by contact with an allergen—proteins harmless to most individuals but can lead to responses in those who are sensitive.
Urticaria is usually very itchy and may also cause a burning or stinging sensation. Their size can range from as small as a fingertip to as large as a dinner plate. In some cases, the welts may merge, forming bigger areas referred to as plaques. While hives usually disappear within 24 hours, they can sometimes persist for days or even longer.
Acute urticaria can vary in appearance and location and develop anywhere in the body. The common signs include:
Chronic urticaria shares similarities with acute hives, such as being itchy, elevated, swollen welts that lighten in the center under pressure. Nevertheless, chronic hives are characterized by:
Acute urticaria often results from an allergic reaction to substances you ingest or come into contact with, such as food, drinks, or drugs. The skin contains immune cells known as mast cells, which release chemicals—primarily histamine—when activated. Histamine is the key factor in the development of hives.
In addition to allergies, other triggers of acute hives include stress, infections, or physical pressure on the skin. In some cases, doctors may be unable to identify a specific cause for acute urticaria.
Unlike acute urticaria, chronic urticaria are typically not caused by allergies. Instead, they may stem from bacterial or viral infections or underlying medical conditions, such as lupus. When the cause of chronic hives cannot be determined, they are classified as idiopathic or spontaneous.
Although chronic hives can persist for extended periods, they are usually not permanent. While they may cause discomfort, they are not considered life-threatening.
Doctors diagnose urticaria by examining your skin. For acute hives, allergy tests may help pinpoint the triggers causing the reaction. Identifying the cause can assist in avoiding allergens and preventing hives.
Allergy tests used to diagnose urticaria are:
In many cases, urticaria resolves independently without treatment. However, medications and home remedies may be recommended to alleviate symptoms and reduce the chances of recurrence.
Antihistamines. These medications hinder the effects of histamine, relieving itching and eliminating or reducing allergic reactions. They can be applied topically or taken orally as a tablet. Diphenhydramine (Benadryl®) is one antihistamine that reacts rapidly. Your doctor may also prescribe daily allergy drugs such as loratadine (Claritin®), cetirizine (Zyrtec®), fexofenadine (Allegra®), or levocetirizine (Xyzal®) based on the severity of your hives.
Monthly injections may be recommended for chronic, hard-to-treat urticaria. These shots help block the immune system from overproducing IgE, which drives allergic reactions.
Put loose-fitting outfits, apply cold compresses, and take cool baths or showers to ease hives. Itchiness and swelling can be alleviated with over-the-counter hydrocortisone creams or antihistamine lotions.
For hives unresponsive to antihistamines or topical treatments, corticosteroids like prednisone may be prescribed to reduce symptoms.
In cases of severe acute allergic reactions, hives can be a sign of anaphylaxis — a life-threatening condition. Symptoms involve swelling of the mouth, face, or throat, vomiting, difficulty breathing, and low blood pressure. Immediate treatment with injectable epinephrine (EpiPen® or AUVI-Q®) is essential to open airways.
A severe acute allergic reaction can cause life-threatening airway swelling (anaphylaxis). This condition can close air paths and be fatal if not treated promptly.
An allergic reaction to a food, such as peanuts and tree nuts, or a bee sting frequently causes anaphylaxis. An instant dose of epinephrine, like an injectable epinephrine (EpiPen® or AUVI-Q®), is necessary if you are experiencing anaphylaxis.
Epinephrine lowers swelling and hives, increases blood pressure, and opens air passages. Symptoms of anaphylaxis can recur after the initial treatment as the epinephrine wears off, so monitoring in a medical setting is essential.
Acute urticaria:
Identifying and avoiding your triggers is important to reduce the risk of acute hives. Allergy test results can help pinpoint substances that cause reactions. Once you are aware of your triggers, consider the following tips:
These strategies can also provide some relief for those with chronic hives.
Chronic urticaria:
Chronic hives might not be preventable. It’s possible that your provider won’t be able to pinpoint the precise problem. They might also constitute a more serious illness that impacts the immune system.
While urticaria often resolves on its own, there are certain situations where medical attention is necessary. Reach out to your provider if you experience any of the following:
Urticaria is the body’s response to allergens or triggers that it finds sensitive. While these reactions can cause discomfort, they are not usually serious. Hives may appear on their own, alongside swelling, or only swelling. These symptoms typically subside after one or two days. If you frequently experience these reactions, consult your healthcare provider about allergy testing. Identifying your triggers can help you avoid them and manage future reactions effectively.
Chronic hives, however, may persist for weeks or longer. You should inform your provider if your symptoms don’t improve with treatment. Even if you are unsure of the cause of your persistent hives, treatment can still be effective.
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