Urticaria, more commonly referred to as hives, frequently appears as an eruption of raised patches, or welt-like bumps which can be reddish or raised and swollen. The welts often “run together” to form wheals or plaques that cover larger areas of the skin. Urticaria can appear without any warning, and the underlying cause is often some sort of allergen.  However, the underlying cause is only discovered between 20% and 50% of the time; many outbreaks only last a few minutes, days, or weeks. These types of eruptions are classified as acute outbreaks of urticaria. Contrasted with these are chronic hives, which last six weeks or longer, and can recur on a longer term basis.

Many possible underlying causes include some foods like peanuts, shellfish, and eggs. Medications can also cause outbreaks: this is true of both over-the-counter substances like aspirin, and also, prescription medication like penicillin or cipro. Various other factors have been identified: these include a change in temperature, sometimes an extreme change, and exposure to sunlight. If an individual experiences water on the skin, that can also be an underlying cause. In general, urticaria has been linked to the immune system, so some cases of chronic hives are thought to be caused to an accompanying autoimmune disorder like lupus. Common infections can also cause hives, as can blood transfusions. These common infections include colds, strep throat, and viral infections. If a person physically brushes his/her skin, hives can also occur as a result of this sustained pressure.

Hives can impact all regions of the body, including the extremities of the arms and legs, and also, the fingers and toes. People can also have hives on their faces, ears, tongue, and lips.

Hives is typically treated with an administration of antihistamines. In many cases, antihistamines will be able to treat the symptoms even when the underlying cause is not fully known. Antihistamines can be taken orally on a daily basis. Sometimes doctors will prescribe a combination of 2-3 antihistamines with low sedative levels unless the itchiness caused by the hives is excruciating, in which case sedatives could help the patient sleep more comfortably. If sedatives are not effective, a doctor can also prescribe corticosteroids, as this method can help suppress the immune system. This approach will usually be effective in eliminating the urticaria symptoms; however, it should not be used more than 5 days in a row, as more extensive treatment could greatly compromise the immune system and increase the patient’s risk of contracting an infection. If a person suffers from chronic hives, a doctor will frequently prescribe a daily antihistamine dosage, as opposed to a “take as necessary” recommendation that is ingested only in the event of an outbreak.

If a person has difficulty breathing or a swollen lips and tongue in conjunction with an outbreak of hives, immediate medical attention should be obtained. A doctor might also prescribe that the patient carry an “epy pen”, or a dosage of epinephrine that can be administered quickly intravenously in the event of an unexpected and extreme outbreak.

In some cases, a specialist must be brought in to try and ascertain an underlying cause of hives. This might especially be the case for chronic hives. An allergist will compile an extremely detailed personal medical history of the patient, and also, gather complete information about the patient’s family medical history. The allergist will also probably examine elements of the patient’s home living environment to see if any of these factors could be playing a contributing role in causing the patient’s urticaria. This type of information can serve the allergist will in determining what a potential underlying cause could be. A complete physical examination would also likely be conducted. The allergist might also perform tests like a skin allergy test and a food allergy test. In more intensive cases, a skin biopsy might be performed.

One of the greatest challenges in obtaining an official confirmation of an urticaria diagnosis is its similarity in appearance with a number of other skin disorders. These include atopic dermatitis, contact dermatitis, and insect bites. One primary way that a physician can clearly obtain a confirmed diagnosis of urticaria is through the welt-like raised patches that the condition causes on the skin, and also, the predilection of hives to turn to a whitish pigmentation if physical pressure is applied to the inflamed areas of the skin.

In all cases where hives or urticaria are suspected when a person has a rash or similar outbreak, a physician or dermatologist should be consulted to obtain an official confirmed diagnosis, and also, to secure an appropriate treatment protocol plan.