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Hives

Hives are itchy, raised, reddish or skin colored welts on the surface of the skin. Most common symptom of hives is itchiness. Oftentimes the itching starts before the welts appear. Sometimes along with excessive itchiness you will feel burning or stinging sensation. You can develop hives due to an allergic reaction to food or medications or as a response to stress. But sometimes they appear without a known reason (idiopathic or spontaneous hives). Hives can appear anywhere in the body, and they can vary in size. About 20% of the population will get hives at least one time in their lives. About 1% to 3% of the population has chronic hives. Hives can occur in anyone, from infants to older individuals. The medical term for hives is urticaria.

Types of hives (Urticaria)

Depending on how long they would last and what triggers them, hives can be divided into few categories.

These hives will last less than 6 weeks after developing. The most common causes of acute hives are food allergy, medication allergy, and insect bites. Food and food additives are the most common causes of acute hives. Eggs, strawberries or other fresh berries, nuts, shellfish, milk, and tomatoes are at the top of the list for developing acute hives due to food allergy. Some people develop acute hives not due to any outside chemical or physical trigger, but due to stress.
These hives typically last more than 6 weeks with no identified causes (1). Physiological changes due to an infection (bacterial or viral), thyroid disease, hepatitis, autoimmune diseases or some cancers could be causing the development of chronic spontaneous hives.
These hives will have recurrence itchy rash that lasts more than 6 weeks and can be induced by specific physical trigger (2). Some of the common physical and environmental triggers causing chronic inducible urticaria are temperature (hot or cold), exercise, pressure, sunlight, vibration. Unlike acute hives where the trigger is typically easy to isolate, management of chronic inducible urticaria is complex as the accurate identification of the possible trigger and its avoidance is difficult.
These are types of hives you can develop due to physical causes like pressure, cold, or sun exposure. Sometimes, you will notice hives developed from putting pressure on the skin for a long time such as from sitting too long or carrying a heavy backpack over the shoulder. Similar to acute hives, physical hives will also go away when the trigger is removed.

What are the signs and symptoms of hives?

Hives can show up anywhere in your body. In many aspects, acute and chronic hives may look alike. Both types of hives share symptoms like:

  • itchiness
  • red, purple or skin color blotchy rash
  • raised welts with lighter centers
  • round, oval, or worm shaped rash
  • can be as small as a fingertip or as big as a dinner plate.
  • appear in clusters
  • can be associated with the swelling around the eyes, cheeks, or lips causing puffiness (angioedema)
  • shift sizes and shapes of the rash

Apart from the symptoms shared with the other types of hives, chronic hives have unique symptoms such as:

  • flares triggered by heat, exercise, or stress
  • symptoms persist for more than six weeks
  • hives can recur often sometimes for months and years
Rash is a common word we use to describe a skin condition that involves something out of the ordinary such as spots, redness, itchiness, or swelling. So, hives can be described as a type of a rash as it is characterized by itchy, reddish bumps on the skin. But not all the rashes are hives.
Hives are not contagious, meaning you cannot get hives if you touch a person with hives. But if you have developed hives after your skin was exposed to a chemical or poison ivy, you can transfer the allergenic chemical or the plant product to others which can cause hives in them, until you wash the allergen off of your skin.

Causes and triggers for hives

When your body get exposed to an allergen, your immune system responds by activating a special cell type called mast cells. When these cells go into action, they release chemicals including histamine. This is the same chemical that get released when you get allergies to pollen. When histamine is released into the small blood vessels, especially the ones closer to your skin surface, capillaries dilate and form welts. Histamine also cause excessive itching. There are multiple causes for the breakout of hives. Most common triggers are:

  • food allergies (shellfish, milk, nuts, berries, etc.)
  • insect stings and bites
  • penicillin and other antibiotics
  • allergy shots
  • infections (hepatitis, strep throat, dental infections, other bacteria or viral infections)
  • poison ivy
  • pets and other animals
  • pollen
  • stress
  • exercise
  • sun exposure
  • exposure to cold (snow or cold water)
  • scratching (dermatographia)
  • putting pressure on the skin for a long time such as sitting or wearing tight clothing
  • latex

There are less common causes of hives such as exposure to water at any temperature (aquagenic urticaria), autoimmune diseases like celiac disease and rheumatoid arthritis, sweat or heat, vibration (vibratory urticaria), and friction.

The best thing to prevent hives from developing is by avoiding the triggers. Once you know what triggered the hives try to avoid them. If you are allergic to a certain food such as nuts, shellfish or milk, read the labels of food packages before consuming to make sure to avoid the triggering food items.
Typically hives fade away within 24 hours or when the trigger is removed. There are several home remedies that you can try to get some relief from hives. None of these home remedies are medically approved and you have to use caution when using them to treat hives at home.

  • Cool wet compresses applying a cool wet bandage or a dressing over the affected area to help with the pain and itching.
  • Soothing bath To relieve itching and discomfort associated with hives, add uncooked oatmeal or colloidal oatmeal or a few teaspoons full of baking soda to the bath water. There are finely ground oatmeal available to use in bath water.
  • Herbal remedies applying aloe vera could help reduce inflammation. If you are using natural aloe vera gel directly from the leaf, make sure to test it on your skin before using it for the first time. If you are using a commercial product containing aloe vera, make sure to check for other ingredients (such as fragrance) added to the product as they can sometimes induce allergic reactions, especially if you have sensitive skin.
  • Over-the-counter antihistamines Over-the-counter oral antihistamines (allergy medicine) can reduce the itchiness and inflammation associated with hives. Some of the common antihistamines are diphenhydramine (Benadryl), loratadine (Claritin), cetirizine (Zyrtec Allergy), and fexofenadine (Allegra allergy).

When should I see a doctor for hives?

Typically most of the hives will go away with time. But if you have hives that last for more than a few days and/or symptoms get worse with time, you should see a healthcare provider. There are several prescription options available to treat chronic or severe hives such as:

  • Anti-inflammatory drugs Typically prednisone is given to patients with chronic and/or severe hives. This is an oral steroid medication (corticosteroid) that can help reduce inflammation. As corticosteroids can have side effects, you should only use this medication for a short period of time as directed by a healthcare provider.
  • Medication to control the pain If the pain and swelling associated with the hives don’t go away with over-the-counter medication, your doctor might prescribe a type of nonsteroidal, anti-inflammatory medication called leukotriene-receptor antagonists.
  • Immune suppressors Hives are developed due to an over reaction of the immune system. When the over-the-counter antihistamines cannot reduce the symptoms, your doctor will prescribe drugs to calm down the immune system. These drugs can include but not limited to cyclosporine (Gengraf), tacrolimus (Prograf), hydroxychloroquine (Plaquenil), and mycophenolate (Cellcept).
  • Blood protein controllers For some types of hives you might have to take drugs that can regulate certain proteins [e.g., amyloid A protein (3) and C-reactive protein (4)] in the blood that are associated with hives.

In some rare cases, along with hives there can be a possibility of developing anaphylaxis. It is a life-threatening whole body allergic reaction that causes breathing difficulty. Therefore, if you have difficulty in breathing, dizziness, tightening of the chest, swelling of the tongue, lips or face along with hives, you should immediately contact a healthcare provider.

Final word on hives

Hives are itchy rashes typically fade away with time or with the use of over-the-counter medications. But sometimes, consultation of a dermatologist and the use of prescription medication is needed to treat chronic and/or severe hives. The staff at Saguaro Dermatology are dedicated to providing you with compassionate and quality health care to treat many skin conditions including hives. Our board-certified dermatologists along with our caring and experienced staff are always ready to help you at Saguaro Dermatology, with three convenient locations: Ahwatukee, Phoenix and Mesa.

Histamine: https://www.webmd.com/allergies/what-are-histamines
Dermatographia: https://my.clevelandclinic.org/health/diseases/17793-dermatographism-dermatographia
Aquagenic urticaria: https://rarediseases.info.nih.gov/diseases/10901/aquagenic-urticaria
Vibrational urticaria: https://rarediseases.info.nih.gov/diseases/9806/vibratory-urticaria
Dermatographia: https://my.clevelandclinic.org/health/diseases/17793-dermatographism-dermatographia
Antihistamines: https://my.clevelandclinic.org/health/drugs/21223-antihistamines

  1. Saini SS, Kaplan AP. Chronic Spontaneous Urticaria: The Devil’s Itch. J Allergy Clin Immunol Pract. 2018;6(4):1097-1106. doi:10.1016/j.jaip.2018.04.013
  2. Pozderac I, Lugović-Mihić L, Artuković M, Stipić-Marković A, Kuna M, Ferček I. Chronic inducible urticaria: classification and prominent features of physical and non-physical types. Acta Dermatovenerol Alp Pannonica Adriat. 2020;29(3):141-148.
  3. Lu W, Chen B, Wang C, Yang X, Zhou C. Serum amyloid A levels in acute and chronic urticaria. An Bras Dermatol. 2019;94(4):411-415. Published 2019 Oct 17. doi:10.1590/abd1806-4841.20197761
  4. Kolkhir P, Altrichter S, Hawro T, Maurer M. C-reactive protein is linked to disease activity, impact, and response to treatment in patients with chronic spontaneous urticaria. Allergy. 2018;73(4):940-948. doi:10.1111/all.13352

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Our comprehensive dermatology clinic is dedicated to providing you with the highest quality of care, innovative practices, helpful resources and state-of-the-art technology to prevent and treat a multitude of skin disorders. Led by Carsten R. Hamann, MD, PhD, Dathan Hamann, MD, FAAD, Michael McBride, DO, Millard Thaler, MD, Mohs Surgeon and Jenna Wald, MD, Mohs Surgeon, our passionate team looks forward to serving you with respect and compassion.

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