Urticaria (hives)

Urticaria / Hives

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The urticaria rash is a symptom of an allergic and immunological event which takes place at the skin’s dermal level. It’s a hypersensitive reaction during a histamine release, possibly from skin cells called ”mast cells” as antigens and antibodies combine to activate this immunological reaction.

During this process of antibody-antigen reaction, histamine and/or the neurotransmitter acetylcholine is generated, possibly causing dilation of the vessels, swelling, itching, pain and rash.

This disorder affects 15-20% of the worldwide population at some time during their life. It occurs in all races and in both men and women, but the more chronic form of it occurs more frequently in women. As far as age, the chronic form is more common in the 40+ and 50+ age ranges. Severe cases of these hives may cause difficulty in breathing or swallowing where immediate medical attention is required.

It can appear on any part of the skin and range from a couple of spots that last anywhere from just a few minutes to widespread rashes that can linger for as long as months. Some episodes may occur many times throughout the day and other times just an occasional eruption may be noticed.

It looks like well-defined, reddish areas that are itchy, raised and can be linear, circular, or wavy and indented. There are a large number of variants. Dermographism may occur, which are lesions resulting from light skin scratching).

The most common causes of acute urticaria are foods, drugs, or infections. Other precursors can include:

  • Exposure to new pets/animals (dander), as well as dust, mold, chemicals, or plants
  • Foods such as nuts, shellfish, fish, eggs, cheese, chocolate, berries or tomatoes
  • Recent illness, like headache, fever, sore throat, cough, vomiting, or diarrhea
  • Switching to a new perfume, cream, lotion, hair dye, detergent, nail polish, etc.
  • Use of medication including penicillins, cephalosporins, iodides, bromides, quinidine, chloroquine, vancomycin, sulfas, diuretics, aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), isoniazid, antiepileptic agents.
  • Travel and exposure to amebiasis, ascariasis, strongyloidiasis, trichinosis, malaria, etc.
  • Pregnancy
  • Contact with nickel (as in jewelry), rubber (such as gloves and elastic bands) and latex
  • Exposure to sun or cold
  • Exercise

    The best treatment for urticaria is to pinpoint and eliminate the cause whenever possible. Antihistamines may be prescribed for relief and they work best when taken on a regular schedule to prevent hives from forming. There are many types available and your dermatologist may use them in combination to control it. In severe cases, an injection of epinephrine (adrenalin) may be needed. Cortisone may also bring relief.

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