Urticaria (Hives)

1.    What is urticaria?

Urticaria (hives) is extremely common.  Approximately 15 – 25% of the general population experiences an episode of urticaria at some pint in their lifetime.  Urticarial lesions result from a vascular reaction to an internal external trigger.

2.    What does urticaria look like?

Urticarial lesions first appear as “wheals” (like mosquito bites) surrounded by a red halo and are severely itchy, stinging and / or pricking.  They may then clear centrally so that they have a circular pattern on the skin.

3.    Who gets urticaria?

Urticaria can affect anyone and, in fact, a large number of people have suffered from urticaria.  There are two types of urticaria:  1) acute urticaria, which evolves over days to weeks, producing lesions that last up to 12 hours and then completely resolve within 6 weeks and 2) chronic urticaria, which lasts more than 6 weeks. Chronic urticaria is twice as common in women as in men.

4.    What causes urticaria?

There are three categories of triggers of urticaria:  immunologic (allergic hypersensitivity, certain inflammatory protein deficiencies, and vasculitis), non-immunologic (certain drugs such as aspirin, ibuprofen, and morphine), and “idiopathic” (cause unknown).  Physical triggers cause up to 17% of chronic urticaria; these include scratching, cold, heat, water, sun, vibration and exercise.

5.    What triggers urticaria?

Additional triggers of urticaria include:  penicillin antibiotics, penicillin-contaminated milk, beer (penicillin in fermentation products), aspirin, intravenous contrast dye, mite-contaminated wheat flour, chocolate, shellfish, nuts, peanuts, tomatoes, strawberries, melons, pork, cheese, garlic, onions, spices, eggs, milk (especially in children), yeast, infections of the tonsils, teeth, sinuses, gallbladder, prostate, bladder and kidney, emotional stress, menthol, certain cancers, certain viruses and parasites, and alcohol.

6.    How can my urticaria be treated?

Antihistamines (such as Claritin, Zyrtec, Allegra, etc.) are the primary treatment of urticaria and avoidance of the trigger triggers.  It can sometimes be very difficult to identify the trigger, and sometimes no trigger can be found (so-called idiopathic urticaria).  Occasionally, for severe episodes, oral steroids will be prescribed for a short burst (4 days) to provide relief.  In addition, warm / cool baths with oatmeal (such as Aveeno Colloidal Oatmeal), Sarna lotion and Pramoxine cream (over the counter) can be helpful.