Urticaria / Hives

The treatment options available for Urticaria Treatment at Auro Skin Clinic are:

  • Diagnosis is done by clinical examination by the Doctor.
  • The treatment includes a combination of avoiding things that cause or worsen the hives and certain medications.
  • The first treatment for acute Urticaria is to figure out what is triggering it and then avoid that trigger.
  • Antihistamines are the mainstay medicines for Urticaria that can relieve itching and most people respond to antihistamines. A relatively high dose or more than one type of antihistamine may be needed to control symptoms, and is recommended before trying other treatments.
  • In unresponsive cases, oral steroids or other treatments like montelukast, cyclosporine or omalizumab may be recommended by the dermatologist.

What is Urticaria?

  • Urticaria or hives are raised areas of the skin that itch intensely and are red in color. 
  • It is a very common condition and about 20 percent of people have hives at some time during their lives.

What are the types of Urticaria?

  • Urticaria can be acute, chronic or physical. But when you first get Urticaria, you cannot tell how long they will last, and so you cannot tell if you have acute or chronic lesions. 
  • Although all types of Urticarial lesions look similar, they often have different triggers. Learning what triggers your Urticaria can help you to avoid the trigger.
    Acute Urticaria
    • Hives will not last beyond a few days or will last for a maximum of 6 weeks.
    • Triggers of acute hives include infections, drugs, insect stings (bees, wasps, ants), food allergies and physical contact with certain agents. 
    • Food-associated Urticaria appears within 30 minutes of eating the food and the foods most likely to cause it include milk, eggs, peanuts, other nuts, soy, wheat, fish and shellfish. Physical contact.​
      Chronic Urticaria
    • Hives occur almost daily and last longer than six weeks, sometimes for years. These hives come and go and can interfere with sleep, work, or school. 
    • In most cases of chronic hives, the cause is unknown. Problems in the immune system may play a role. can be a sign of medical or autoimmune conditions, including thyroid or liver diseases, chronic infections, or lupus.
    • Food-additives like colorants, preservatives and essence and NSAIDs are important triggers of both acute and chronic Urticaria.
      Physical Urticaria
    • Hives can be triggered by physical factors like exposure to cold, changes in temperature or sweating, vibration, pressure, exercise, sunlight or water. 
    • Dermographism is a type of physical Urticaria in which red, raised lines develop if the skin is stroked firmly or scratched. Physical forms of hives tend to be long lasting.

How does Urticaria look? Can Urticaria spread to other parts of the body?

  • Urticaria are raised red areas that itch intensely. These raised areas may enlarge and merge together. 
  • Itching is the most bothersome symptom. Rarely severe pain, purple spots, raised lesions along with fever and joint pains can occur. 
  • Use of cosmetics (oil based), scrubs can aggravate Acne.
  • Urticaria can affect any area of the body, especially the trunk, thighs, upper arms and face. 
  • Most individual lesions fade quickly, but new crops may appear every 24 to 72 hours if the person continues to be exposed to the environment or substance that triggered the hives. 
  • In up to one-half of people with Urticaria, a condition called angioedema also develops. Angioedema causes puffiness of the face, eyelids, ears, mouth, hands, feet, and genitalia. It may be associated with pain. 
  • Hives can also occur as part of a serious allergic reaction. It can be associated with breathlessness, tightness in the throat, nausea, vomiting, cramping abdominal pain and giddiness. If these symptoms occur, get immediate medical attention. You could be developing anaphylaxis, a life-threatening condition.

What should one do if one develops hives?

  • Recognizing and avoiding the trigger is most important. 
  • In mild cases, consult a physician; an antihistamine tablet and application of a soothing calamine lotion will provide relief. 
  • In recurrent episodes, or chronic cases, consult a dermatologist. 
  • Consult a physician or go to a hospital immediately if one experiences angioedema or breathlessness, tightness in the throat, nausea, vomiting, cramping abdominal pain and giddiness.

Are there any tests to confirm Urticaria?

  • Most people with Urticaria do not need any testing. The diagnosis is usually based on the history and appearance of skin lesions. 
  • However, tests may be recommended if lesions do not resolve within six weeks. 
  • Skin testing for food and drug sensitivities may be done for people with acute Urticarial, but may not yield satisfactory results.
  • Blood tests are done if Urticaria continues for more than 6 weeks, to check for underlying diseases, such as liver or thyroid problems or an autoimmune disease.
  • A skin biopsy may help identify uncommon causes of Urticaria (in case of persistent fever, painful hives, individual hives that last for days at a time, hives associated with bruising of the skin or abnormal blood tests).

What is the course of Urticaria? Can it recur? 

  • Hives usually respond well to treatment, which includes medicines and avoiding whatever triggered the hives. 
  • Most simple cases of Urticaria fade quickly, and the affected skin returns to normal within hours. 
  • Even when you have episodes that recur over several weeks, without a known cause, they often stop coming back after a few months 
  • Consult your doctor if hives persist for several days or if itching interferes with your ability to sleep or perform normal daily activities. 
  • Chronic Urticaria in a significant percent of patients are non-allergenic in origin. Hence unnecessary elimination of diet should not be done. 
  • Second generation of antihistamines like fexofenadine, loratadine. cetirizine and levocetirizine are very safe for long term use for several months to several years at a stretch with proper monitoring.

What are the important aspects to know about Urticaria?

  • Urticaria is not contagious.
  • They are rarely permanent: almost 50 percent of people are free of lesions within one year. 
  • Chronic Urticaria is rarely caused by allergies and is not life threatening. It is treatable in most people and may need a few months to a few years of long term antihistamine therapy. This is very safe but regular monitoring is needed.

Disclaimer

The above clinical content is published by The Indian Association of Dermatologists, Venereologists and Leprologists (IADVL) for circulation amongst patients for their education purposes.

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