Hives and Angioedema

Hives, medically termed as urticaria, is a skin condition characterized by wheals on the skin which are smooth raised areas of the skin with commonly a blanched center and they are extremely itchy and red or flesh colored. These wheals can be of different shapes and can develop anywhere on the body as spots or blotches. The primary feature of hives is its tendency to fluctuate, i.e. moving and changing in size. It can resolve from one place and reappear in other places within a few hours. Hives are more common in females than males. In majority of the cases, hives resolve within 24 hours. If hives last for more than a few weeks or months, then they are known as chronic hives.

Hives & Angioedema

A deeper swelling which the patients experience along with hives is known as angioedema. This swelling can occur on hands, feet, eyelids and lips.

Treatment comprises of antihistamine medications for both the hives and angioedema. If the angioedema is severe, it should never be ignored as it can be fatal if the airway is blocked by the swelling in your throat or tongue.

Causes of Hives & Angioedema

  • In majority of the cases of hives, the cause is not clear or not known.
  • Certain foods can trigger allergic reactions and cause hives, such as fish, shellfish, peanuts, milk and eggs.
  • Medications can also cause hives or angioedema. Some common medicines, which can trigger this, are aspirin, penicillin, ibuprofen, naproxen and antihypertensives.
  • Allergens, such as animal dander, pollen, insect stings and latex can also trigger hives.
  • Certain environmental factors, such as heat, sunlight, cold, water, pressure on the skin, exercise and stress can also cause hives.
  • Some underlying medical problems, such as lupus, cancer, thyroid disorders, HIV etc. can also cause hives.
  • Inherited angioedema is a very rare condition and it occurs due to decreased levels or improper functioning of specific blood proteins, which help in regulating the function of the immune system.

Risk Factors for Hives & Angioedema

  • Patients who previously have had hives or angioedema are at a higher risk for developing it again.
  • Patients suffering from related medical problems such as thyroid disease or lupus are at an increased risk for hives and angioedema.
  • Patients who have experienced other allergic reactions are more prone to develop hives.
  • Patients with a family history of angioedema, hives or hereditary angioedema are at a higher risk for having them.

Signs & Symptoms of Hives

  • Abrupt appearance of flesh or red colored wheals on the patient’s body.
  • These wheals can develop anywhere on the body.
  • Patient has intense itching.
  • These welts are shaped like a worm or are roughly oval in shape.
  • They vary in size and can be about some millimeters to many inches in diameter.
  • They can resolve in a matter of hours and then reappear on a different location on the body.

Signs & Symptoms of Angioedema

Angioedema is a condition where there is swelling in the deeper layers of the skin; commonly around the eyes, lips or cheeks. Angioedema can occur with hives or can be present individually. Angioedema is characterized by:

  • Presence of thick, large and firm welts on the skin.
  • There is redness and swelling.
  • Patient has pain.
  • The affected regions are warm to touch.

Serious Symptoms: If the patient has trouble breathing and feels his/her throat or tongue swelling up, then immediate medical attention should be sought. If there is a rapid drop in the blood pressure and the patient has gone into shock, then the patient should be taken to emergency care immediately.

Types of Hives

  • Acute hives or urticaria are not fatal and resolve in a few hours or within 6 weeks.
  • Chronic hives or urticaria is which continues for more than 6 weeks.
  • Physical urticaria is a subtype of chronic urticaria which occurs as a result of physical stimulus, such as when a patient’s skin is rubbed or scratched resulting in appearance of a red welt in the line of the scratch.
  • Dermographism urticaria is an exaggerated type of physical urticaria where the patient develops itchy and raised welts along with adjacent flare ups in the places where the skin is rubbed by clothing, belts etc.
  • Cholinergic urticaria is another type of physically induced hives characterized by hundreds of minute, itchy bumps. These appear within 15 minutes of physical exertion, such as exercise or sports activity and resolve before the patient has had time to consult a doctor. This type of hives is more common in young adults.

Investigations for Hives & Angioedema

  • Physical examination and medical history.
  • An allergy skin test can also be done to confirm diagnosis.
  • For confirmation of hereditary angioedema, blood tests are done to assess the function and the levels of certain blood proteins.
  • Biopsy can be done to rule out other skin conditions which resemble hives.

Treatment for Hives & Angioedema

For mild symptoms, treatment may not be required. Most of the times, hives and angioedema resolve on their own; but if the patient has severe symptoms, like intense itching and discomfort, then treatment is needed and it includes medications such as:

  • Antihistamines are the common treatment done for hives and angioedema. They help in decreasing the swelling, itching and various other allergy symptoms. Antihistamines cause drowsiness and should be taken preferably at bedtime. If taken during the day time, then the patient should avoid driving or operating any heavy machinery.
  • Oral corticosteroids, such as prednisone, are prescribed in severe cases to relieve itching, swelling and redness. Long term use of corticosteroids has serious side effects.
  • Immunosuppressants are prescribed if the above mentioned treatments are ineffective. Immunosuppressants help in calming the patient’s immune system.
  • Blood protein controllers are prescribed for hereditary angioedema. They help in regulating the levels of specific blood proteins and help in alleviating symptoms.
  • Epinephrine injection is given in an emergency situation where the patient has had a severe or acute attack of hives/ angioedema.
  • Topical creams and lotions, which numb the nerve endings and relieve itching, can be prescribed, but they are generally ineffective.
  • Even topical corticosteroids are not helpful in relieving the itching of the hives.
  • Other relatively new treatments are available, such as antifungal antibiotics, ultraviolet radiation and tricyclic antidepressants; but the importance and requirement of these treatments is debatable.

Home Remedies & Prevention of Hives & Angioedema

  • Identify your triggers and avoid them. These could be anything from certain food items, pollen, medications, latex, pet dander or insect stings.
  • OTC oral antihistamines can be taken to relieve itching.
  • Application of wet/cool compresses on the affected regions helps in soothing the skin and relieving the itching.
  • Taking a cool bath in which some baking soda, colloidal oatmeal or uncooked oatmeal has been sprinkled helps in relieving the symptoms.
  • Try to wear loose, comfortable and smooth-textured cotton clothes and avoid wearing, tight, scratchy, rough and woolen clothes, as these will worsen your skin irritation.
  • Try to maintain a food and symptom journal or a diary, if you suspect there is a certain food item which is causing the problem.

Written, Edited or Reviewed By:

, MD, FFARCSI

Last Modified On: December 8, 2014

Pain Assist Inc.

Pramod Kerkar
  Note: Information provided is not a substitute for physician, hospital or any form of medical care. Examination and Investigation is necessary for correct diagnosis.

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