If you suffer from hives and are searching for a solution to what makes hives go away, This may help you with some clues. Hives, or urticaria, is a disease where itchy blisters appear on the skin that look like blisters after being burned with nettle. In most cases, there is acute urticaria that lasts less than 6 weeks. Most often, it is caused by allergies or medications. In most patients with acute urticaria, the lesions resolve without any treatment. Chronic urticaria is more difficult to treat and its cause is rarely identified.

What are hives?

Urticaria is a disease in which the skin, under the influence of some factor, forms raised, pale blisters surrounded by redness. These blisters resemble changes that arise when the skin comes into contact with nettle-hence the name. Urticaria causes severeitchingor burning of the skin, is painless and disappears without scarring or discoloration of the skin.

In about half of people, urticaria may be accompanied by the so-calledangioedema. This swellingIt affects the tissues under the skin, e.g. the mouth, eyelids, hands, feet, and sometimes the genitals. It is usually more severe on one side of the body, and the skin is sometimes red.

Often in patients with urticaria, the so-called dermatographism—in places exposed to minor trauma (e.g. scratching, rubbing, pressing), there are hives, e.g. in the line after rubbing the skin.

What causes hives (urticaria)?

The division according to the cause of urticaria is divided into: spontaneous (acute and chronic) urticaria and induced urticaria.

Acute and chronic urticaria

Urticaria is divided into acute (when skin changes appear and disappear within 6 weeks) and chronic (when skin changes last longer than 6 weeks). Most people find that hives are acute and will go away within 6 weeks.

Acute urticaria is most often caused by allergies or medications. On the other hand, in chronic urticaria in as many as 80–95% of cases it is not possible to find the factor responsible for its occurrence (contrary to what patients believe, it is rarely caused by allergy).

Table 1 lists the most common causes of urticaria, but it is important to know that this reaction may also appear in response to other, less frequent, factors.

Allergic, non-allergic and physical urticaria

Urticaria can be allergic (e.g. if you are allergic to cat allergens) or non-allergic (if you have a reaction to certain medications). So-called “physical hives” are triggered by physical factors such as cold, pressure, and sunlight. Urticaria may also occur in patients with infections (e.g. viral liver infections),cancer, autoimmune diseases (e.g. autoimmune thyroiditis, systemic lupus erythematosus), and other diseases.

If urticaria is caused by an allergy, it is caused by anIgE-dependent reaction and the secretion of various substances from the so-called mast cells (especially histamine, which is the main cause of blistering, redness, swelling, and itching of the skin – seeMechanisms of Allergy). The causes of chronic urticaria are poorly understood.

In some people, it is impossible to establish the cause of urticaria. In chronic urticaria, this is only possible in about 1/4 of the cases.

How common is hives?

10-20% of people experience acute urticaria during their lifetime. The vast majority are acute urticaria lasting from a few hours to 6 weeks. Urticaria can occur at any age. Acute urticaria is more common in children and young adults, and chronic – in women aged 20–40.

Symptoms of hives

Photo 1.Urticaria – urticarial wheal

Cholinergic urticaria: Photo2.

The symptom of hives is the appearance of hives on the skin which are itchy (sometimes painful or burning), porcelain white or pink, well limited, surrounded by red skin (erythema). The blisters are elevated above the skin surface, appear quickly and usually disappear quickly (<24 hours), leaving no changes in the skin. The blisters can merge to form various shapes and occupy a different surface of the skin (sometimes very large). Hives are similar to the effects of nettles.

Urticaria is most often accompanied by itching, and sometimes even the changes can be painful or cause so-called paresthesia – unpleasant sensations such as tingling, numbness, burning sensation.

In chronic urticaria, symptoms may appear daily or periodically (e.g. once a week or a month). A diurnal cycle of changes is often described, but the course of the disease varies greatly. Spontaneous remissions (withdrawal of symptoms) often occur within 12 months of disease onset, but a significant percentage of patients experience symptoms, at least intermittently, for many years.

Look out for hives symptoms such as:

• dizziness
• feeling very weak
• palpitations
• hoarseness
• feeling of lack of air
• nausea and vomiting
• low blood pressure.

They may herald the development of an anaphylactic shock.

Angioedema is also a dangerous symptom, as it may lead to breathing difficulties and even death (most often caused by such a strong swelling, “swelling” of the tissues of the throat that the larynx closes and the patient suffocates).

Acute hives or angioedema may appear suddenly, within minutes to hours, or be secretive, over time. It is characteristic that the changes fade quickly.

Urticaria and stress

Emotional stress is a factor that can exacerbate or trigger hives.

What to do in the event of hives symptoms?

If urticaria develops, the patient should take an antihistamine, and in the case of more severe symptoms, especially angioedema – a glucocorticosteroid (if these drugs have been previously prescribed by a doctor). The patient should see a doctor.

Important

If urticaria is accompanied by angioedema or other symptoms that may herald anaphylactic shock accompanying the urticaria – an ambulance should be urgently called (at 112 or 999) and adrenaline should be administered (if previously prescribed to the patient).

Diagnosis of urticaria

Usually the picture of hives is so typical that diagnosis is not difficult. However, bubbles can vary depending on the underlying causes:

• in the so-called cholinergic urticaria is often minor
• in exercise-induced – giant (this form of urticaria can cause anaphylactic shock)
• in pressure-induced urticaria – they occur in the place of skin contact, e.g. with the strap of a heavy bag or on the feet after a long walk
• vibrational urticaria occurs in patients working, for example, with a jackhammer
• light urticaria – after sunbathing.

The location of urticarial lesions on the body and the time it takes to fade away are also important for the doctor. Many sufferers do not know how long the changes have been present (you can trace the bubble with a pen and watch when the change fades away).

The medical history collected from the patient is of key importance in determining the causes of urticaria. The doctor will ask about:

1. when and under what circumstances hives first appeared
2. frequency of urticaria episodes and how long the eruptions last
3. connection with travel, way of spending holidays or weekends
4. the size, shape and location of the wheals
5. whether there is also angioedema
6. current or recent medications and other substances (both prescribed by a doctor and over-the-counter, herbal preparations, vitamins, dietary supplements, etc.)
7. time relationship between the onset of urticaria and contact with food (ingestion, touching)
8. Relation of symptoms to potential physical factors (e.g. exposure to cold, heat, sunlight), exercise, or sweating
9. viral infections of the respiratory tract, liver,infectious mononucleosis
10. contact with animals
11. occupational exposure to allergens or irritants (e.g. latex, other rubber products and cosmetics), ask about the type of work
12. recent insect bites or stings
13. exposure to contact or inhalation allergens
14. implantation of prostheses or implants during surgical procedures
15. symptoms from other systems
16. family history of urticaria and atopy
17. relationship with the menstrual cycle
18. mental stress, mental illness
19. the use of stimulants: tobacco (the use of flavored tobacco), alcohol, cannabinols
20. diagnostic tests performed so far
21. reaction to current treatment.

Urticaria diagnosis

The diagnosis of urticaria is complicated and time-consuming, and in the case of chronic urticaria, its cause can only be determined in about 20% of patients. Some researchers believe that the diagnosis of acute urticaria does not require testing.

The initial diagnosis of chronic urticaria includes the determination of referral of the patient for blood tests – ESR or CRP (these tests generally assess the presence of inflammation in the body), blood count with smear,liver tests, urine tests, and sometimes the assessment of thyroid function.Skinand contact tests with allergens, or blood IgE tests, are performed in patients with acute or chronic urticaria, who have had urticaria in the past after contact with an allergen.

Sometimes the doctor, based on an interview and the presence of other symptoms, decides to perform less frequent tests: bloodeosinophiliaand tests for the so-called autoimmune diseases, thyroid gland, viral liver infections, and other medical conditions. In some patients, the so-called skin test with the patient’s own serum. Before that, the patient’s own blood is collected, the blood cells are separated from the rest of the blood, thanks to which the so-called serum – a liquid that is applied to the punctured skin of the forearm, similar to skin tests with allergens. The appearance of a bubble means that there are antibodies in the patient’s blood – they are important in the formation of urticaria. In specialized centers, provocation trials are sometimes performedwith food or medicine (as well as factors causing physical urticaria).

Sometimes it is necessary to perform a skin biopsy – that is, cutting out a section of a few millimeters and examining it under a microscope.

What makes hives go away? Ways to treat urticaria

Treatment of urticaria must be carried out by a physician and self-medication should be avoided.

General recommendations include:

1. Avoidance of the triggering factor(e.g. allergen, physical factor, etc.) if identified. In the case of food urticaria, it may be necessary to apply an elimination diet (skin lesions disappear after 2-3 weeks).
2. Avoiding factors that increase or cause urticaria: drugs (acetylsalicylic acid, other NSAIDs, opioids), alcohol, mental stress.
3. Treat the underlying diseasewhen the urticaria is secondary to another condition.

Pharmacological treatment

The main medications used in the treatment of urticaria are antihistamines, which reduce the itching of the skin and make the wheals disappear. Antihistamines that are effective in the treatment of urticaria include bilastine, cetirizine, desloratadine, fexofenadine, levocetirizine, loratadine, and rupatadine.

Your doctor may also prescribe other medications, such as montelukast, cyclosporine (in severe, recurrent cases of chronic urticaria), omalizumab (in rare cases of severe urticaria), and glucocorticosteroids.

For patients with exercise-induced urticaria (with or withoutanaphylaxis), your doctor may prescribe antihistamines as a preventative measure to reduce the frequency or severity of symptoms. For patients who have experienced an anaphylactic reaction or angioedema of the larynx, your doctor may advise you to carry an adrenaline pre-filled syringe or anadrenalineauto-injector for self-administration when required.

Is it possible to completely cure urticaria?

In patients with acute urticaria, symptoms disappear within 6 weeks (usually within a few days; in many of them it is the only such episode in life), and the response to drugs is very good.

In about two-thirds of patients with acute urticaria, the changes resolve without any treatment.

In 5% of patients with acute urticaria, the changes may become chronic. Chronic urticaria disappears within a year in approximately 30–50% of patients. Nevertheless, in 1/5 of patients, symptoms are still present after 5 years.

What should I do after treatment for urticaria?

An important element in the management of urticaria is to identify the causes of it, which is not always possible. The patient requires the care of not only an allergist, but also a dermatologist. If he is diagnosed with any of the diseases in the allergy circle, he should check himself regularly and follow medical recommendations.

Education plays an important role in patients with chronic urticaria. Patients are often frustrated by itchy skin and their appearance. The disease makes their work difficult and disturbs their sleep. It is not uncommon for the environment to believe that lesions are contagious.

Important

It should be remembered that in most patients the changes will subside within a year, they are not contagious, and the therapy usually gives very good results. Of course, if the causative agent of urticaria is known, it should be avoided.

What to do to avoid getting sick?

It has not been established what measures help to avoid developing urticaria, but its relapses are usually effective in combating the above-mentioned drugs and avoiding the known triggers.

Many patients with chronic urticaria notice deterioration of changes under the influence of non-steroidal anti-inflammatory drugs (e.g. aspirin), nervousness and diet. Truefood allergyin them is rare, but some foods can exacerbate the changes – for example, strawberries can increase the secretion of histamine in the body, and alcohol dilates the vessels. The effect of special diets has not been conclusively proven, but some patients (30–70%) experience improved skin appearance by avoiding certain foods (such as alcohol, spices, preservatives, dyes, raw vegetables and fruit).