What is Urticaria ?
Hives or Urticaria is the pinkish rash with long lines or welts in a criss-cross pattern that come up suddenly, anywhere on the body, often with zero provocation.
Urticaria Rash on the back
The rash is accompanied by itching which can vary from a mild itch to a mad intolerable itch. Some patients report a direct link between the rash and things they eat, drink or do. Tight clothing, undressing, friction, zari border, bathing or getting wet in the rain, exercising, alcohol intake, intake of hot tea, spicy food, sun exposure can trigger the rash.
What are the symptoms of Urticaria?
The symptoms of Urticaria may last for a few minutes to several hours. Often there are recurring bouts that go on for months or years.
The hives can appear on any area of the body, change shape, disappear and reappear over short periods of time. Urticaria shows up as weals or angioedema.
A weal is a superficial skin colored swelling surrounded by redness that lasts anything from a few minutes to 24 hours. They can itch and burn. Weals may be round or irregular in shape, may form rings or come up in the form of giant patches. Pressing the centre of a weal makes it turn white, a process called blanching.
Weal formation on the back
Angioedema is a deeper swelling within the skin or the mucous membrane and can be skin colored or red. It usually resolves within 72 hours. Angioedema is usually localized. It commonly affects the face (eyelids & lips), hands and feet.
Angioedema on the lips
What causes Urticaria?
When an allergen or offending agent comes in contact with the body, it can stimulate the release of a chemical called histamine. Histamine makes blood plasma leak out of small blood vessels in the skin causing hives or angioedema. It can be triggered by many substances or situations like:-
• Some foods (especially peanuts, eggs, nuts and shellfish)
• Artificial food colors
• Canned foods which have preservatives
• Medications, such as antibiotics (especially penicillin and sulfa), aspirin and ibuprofen
• Insect stings or bites
• Physical stimuli, such as pressure, cold, heat, exercise or sun exposure
• Blood transfusions
• Bacterial infections, including urinary tract infections and streptococcal throat infection
• Viral infections, including the common cold, infectious mononucleosis and hepatitis
• animal dander from pets
• Some plants, such as poison oak and poison ivy
What are the types of Urticaria?
Acute Urticaria – is the Urticaria that lasts for less than 6 weeks. It often may last for a few hours or days.
Chronic Urticaria – is the Urticaria which lasts longer than 6 weeks with daily or episodic attacks.
Dermatographic Urticaria – It is also called Dermographism which literally means ‘writing on the skin’. Those who suffer from it know why it is called so.
Dermographism is a skin disorder in which the skin becomes raised and inflamed when stroked, rubbed or scratched. It is caused by the release of a protein called histamine which then leads to leakage in small blood vessels and the subsequent accumulation of fluid under the skin. It is usually associated with severe itching. The condition can last for many years. Symptoms are induced by tight or abrasive clothing, watches, spectacles, heat, cold or anything that causes stress to the skin or the patient.
Cold Urticaria – is caused by exposure to cold.
Cholinergic Urticaria – is caused by sweating. It is also called heat bumps. In this type, a rise in the body temperature resulting in sweating causes the rash. Common triggers are exercise, hot baths, fever, eating spicy or hot foods and emotional stress.
Cholinergic Urticaria due to sweating
Contact Urticaria – is caused by direct contact with the allergen or the offending substance. It is caused by a variety of compounds such as foods, preservatives, gums, fragrances, metals and rubber latex.
Contact Urticaria due to rubber footwear
Pressure Urticaria – is characterized by the appearance of weals after pressure to the skin. Lesions can be triggered by standing, walking, wearing tight clothes, carrying a heavy bag or sitting on a hard surface.
Solar Urticaria – is the Urticaria in which the skin swells within minutes of exposure to sunlight. The exact cause is not known but it is believed that a chemical created in the body reacts with UV radiation to cause an allergic reaction.
Heat Urticaria – as the name suggests it is triggered by heat or after consuming hot drinks.
Aquagenic Urticaria – causes the person to break into itchy lesions when exposed to water. Possible triggers are bathing, getting wet in the rain, swimming, sweating or even crying.
How is Urticaria treated ?
Acute Urticaria is treated with anti-allergy medications that block the effect of histamine. Eliminating the allergen or the offending agent is the best way to treat chronic Urticaria. In cases where the cause remains unknown or is such that cannot be eliminated, a combination of therapies consisting of the below is prescribed.
External applications – consist of applications which help to reduce the symptoms like redness, inflammation and itching.
Oral medication – to reduce the allergy levels and block the effect of histamine.
Diet – Certain foods contain chemicals that trigger Urticaria. Avoiding or cutting down on foods that contain these chemicals help to improve symptoms. Maintaining a food diary helps to rule out food allergens and to ensure that people are not avoiding foods unnecessarily. To prevent deficiencies food substitutes and supplements are also advised.
Avoid triggers – Avoiding triggers can keep the symptoms under control. If the triggers are known, it is easy to avoid them. For example alcohol and caffeine or allergenic foods can be restricted. However often the triggers are known but they cannot be avoided easily, for example Stress. Avoiding stress can be difficult. In such cases lifestyle changes are advised to manage it better.