Understanding Urticaria (Hives): Causes, Symptoms, and Treatments

The sound of laughter filled the air at a local family picnic when I noticed Sophie, one of my neighbors, sitting on the sidelines, scratching her arms with visible frustration. Beside her, a red rash with raised welts had appeared on her skin, spreading rapidly across her arms.

“Dr. Priya,” she called out as I approached, “I don’t know what’s happening to me. These itchy bumps just came out of nowhere. Do you think I’m allergic to something?”

As I examined her arms and listened to her story, it was clear she was experiencing urticaria, commonly known as hives.

What Is Urticaria?

“Urticaria,” I explained to Sophie, “is an allergic skin reaction where itchy, red welts suddenly appear on the skin. These welts, known as wheals, can form anywhere on the body, including the palms, soles, and even the face. They vary in size, from small spots to large patches, and can join together to form larger irregular areas.”

I pointed to the raised borders and pale centers of the welts on her arms. “This pattern is typical of hives,” I added. “The good news is that it’s often harmless and resolves on its own.”

Urticaria is categorized as:

• Acute Urticaria: Lasting less than six weeks and often triggered by specific allergens.
• Chronic Urticaria: Persisting longer than six weeks, with triggers that are harder to identify.

Sophie’s eyes widened as I explained. “Does this mean I’ll have to deal with this for weeks?”

“Not necessarily,” I reassured her. “Let’s look into what might be causing this.”

What Causes Urticaria?

Urticaria is triggered by the release of histamine, a chemical in the body that causes swelling and itching. The exact cause isn’t always clear, but common culprits include:

Checklist of Possible Causes:

• Foods: Eggs, peanuts, shellfish, fish, strawberries, nuts, and additives like tartrazine.
• Infections: Viral, bacterial, or fungal infections, particularly upper respiratory tract infections.
• Medications: Penicillin, aspirin, codeine, and sulfur antibiotics.
• Insect Bites: Bees, wasps, mosquitoes, sandflies, and fleas.
• Plants: Nettles, poison ivy, and similar irritants.
• Animals: Cats, dogs, and horses can trigger reactions.
• Exposure to Heat or Cold: Sudden temperature changes can cause hives.
• Sunlight: Overexposure can irritate sensitive skin.
• Underlying Conditions: Chronic illnesses like lupus or lymphoma.
• Stress or Pregnancy: Emotional or physical changes, particularly in the last trimester of pregnancy.

“Tension and stress,” I added, “can worsen hives. Have you been feeling stressed lately?” Sophie nodded. “I’ve been juggling a lot lately,” she admitted.

What Are the Symptoms?

“Hives appear suddenly,” I explained. “The welts can:”

• Be extremely itchy.
• Change shape and size over minutes or hours.
• Disappear and reappear on different parts of the body.

I noted that Sophie’s rash had spread to her palms. “These welts are typical of acute urticaria, likely caused by something you ate or touched today.”

When to Worry: Angioedema

“Sometimes, hives can be accompanied by a more severe reaction called **angioedema,”” I said. “This involves swelling of the deeper tissues, particularly around the lips, eyes, and throat. If you notice:”

• Swelling of the tongue or throat.
• Difficulty breathing or choking.
• Pale, sweaty skin.

“You must seek medical attention immediately. These symptoms can indicate a life-threatening allergic reaction.”

Sophie looked concerned but reassured me that she hadn’t experienced any swelling beyond her rash.

How Is the Cause of Urticaria Found?

“For recurrent cases,” I explained, “a doctor may recommend keeping a food diary or undergoing allergy tests to identify triggers. Sometimes, patch testing is necessary to uncover hidden allergens.”

“For today, though, we’ll focus on managing your symptoms and avoiding further irritation,” I said.

What Is the Treatment for Urticaria?

Medications:

• Antihistamines: These are the first line of treatment. Taken by mouth, they help relieve itching and reduce the rash.
• Corticosteroids: For more severe cases, doctors may prescribe a short course of cortisone to reduce inflammation.

“Avoid aspirin and other over-the-counter drugs unless prescribed,” I cautioned.

Self-Care Measures:

1. Cold Compresses: Applying a cold, wet cloth to the affected area can soothe itching and reduce swelling.
2. Cool Baths: Soaking in cool water can help relieve irritation. Avoid hot baths or showers, as heat can make symptoms worse.
3. Hydration: Drink at least 2 liters of water during an attack to flush out potential irritants.
4. Avoid Triggers: Whether it’s a food, cosmetic, or environmental factor, identifying and avoiding your triggers is key.

“Reduce strenuous activity,” I added. “Sweat and heat can aggravate hives.”

Sophie wrote down the advice. “I’ll start with antihistamines and take it easy today,” she said.

When to Seek Urgent Care

I emphasized that while most cases of hives resolve quickly, certain situations require immediate medical attention. These include:

• Problems breathing.
• Swelling of the tongue or throat.
• Fainting or dizziness.
• Severe choking.

“If any of these occur, don’t wait. Call for emergency help immediately,” I stressed.

Conclusion: Sophie’s Path to Relief

Two days later, Sophie sent me a message. “Dr. Priya, the rash is gone! The antihistamines worked wonders, and I’ve been extra careful with what I eat. Thank you for your help!”

I smiled, relieved to hear her recovery was quick. Urticaria, while often harmless, can be a frustrating condition. With the right treatment and awareness, most people can manage their symptoms effectively and prevent future episodes.

FAQs About Urticaria (Hives)