Urticaria is commonly known as hives, uredo or needle rash and is a type of allergic reaction that causes the skin to welt into red blotches. The welts are extremely itchy and can cover large areas of the human body including arms, legs, face, stomach and back. The cause of urticaria can be related to an immune response to food, other allergens or contact with an allergenic substance. Urticaria can also be related to excess stress. Urticaria can also present after a viral infection like mononucleosis, German measles or hepatitis.
Closely related to urticaria is a type of swelling called angioedema, which causes welts that are embedded deeper in the skin, particularly near the lips and eyes. Most of the time urticaria and angioedema will resolve without treatment in a short period of time, but there are cases that can be life threatening, especially with angioedema if the throat and/or tongue swell enough to block the airway. Angioedema and urticaria can occur at the same time and can be severe.
Angioedema can be caused by food allergies, medications like aspirin and latex allergies. Hereditary angioedema is related to a C1 inhibitor deficiency or lack of normal blood protein.
Different Types of Urticaria
There are basically four types of urticaria including acute, chronic, drug induced and physical. Acute urticaria comes on rapidly after touching an allergen. It can last as long as several weeks to as little as a few hours. Allergies to food and certain product ingredients fall into the ‘acute urticaria’ category. Common allergies to food include nuts, eggs, fish, shell fish, food dyes and acid derivatives. Common allergies to products include many different types of ingredients used in perfumes.
Chronic urticaria is a case of hives that lasts six weeks or longer. There are cases reportedly lasting as long as 20 years or more. There is no real known cause of chronic urticaria and it is often referred to as idiopathic in nature because of this.
Drug induced urticaria is serious and can result in cardiorespiratory failure. One of the main drugs known to cause drug induced urticaria is the anti-diabetic suphonylurea glimepiride or Amaryl®. This drug is documented as to causing severe allergic reactions, which appear as urticaria. Penicillin, aspirin, ACE inhibitors, sulfonamides, anticonvulsants and NSAIDs can also bring on or exacerbate angioedema and chronic urticaria.
Depending on cause, physical urticaria can be categorized into several categories including:
- Cold reactions like cold air, water or ice.
- Cholinergic reactions to exercise, after a hot shower or body heat
- Aquagenic reactions to water (extremely rare)
- Delayed pressure after standing for long periods of time, or to items like belts and bra straps
- Dermographism from skin scratching
- Heat reactions to hot objects or hot food
- Solar reaction to sunlight
- Adrenergic reaction to noradrenalin or adrenaline
Risk Factors For Urticaria and Angioedema
The risk factors for urticaria and angioedema increase if a person has experienced either in the past, has allergic reactions, suffers from disorders like lymphoma, thyroid disease or lupus, has a family history of angioedema, hereditary angioedema or hives.
Symptoms of Urticaria
There are several symptoms associated with urticaria that include severe itching, stinging and burning. Hives emerge as elevated, erythematous or papules, plaques and linear streaks that are transient and usually encompassed by a flare or halo. The lesions are usually pale, particularly in the center. They can vary in size from several centimeters to a few millimeters.
Hives brought on by heat, exercise, changes in temperature or emotions and induced by acetylcholine appear as morphologically unique lesions that usually disappear in an hour or less. Lesions caused by trauma or scratching have a streaking linear appearance that is pronounced with a surrounding flare. In angioedema, pale areas of edema with diffused borders can be recognized on various parts of the body and face. If angioedema affects the larynx, dyspnea, stridor or hoarseness can occur and can be quite serious, even leading to death.
In cholinergic urticaria, induced by acetylcholine and triggered by emotions, heat, exercise or changes in temperature, the lesions are morphologically different and disappear in 30-60 minutes. Dermographic lesions, induced by brisk scratching or trauma, are linear streaks with a surrounding flare.
Symptoms of Angioedema
Angioedema, as noted, is quite similar to hives and recognized clinically as pale areas of edema deeper in the skin. Angioedema appears as firm, thick, rather large welts, skin swelling, blistering and pain. Angioedema mainly appears on the eyes and lips but can also present on hands, genitalia, feet, or inner throat. Involvement of the larynx may lead to hoarseness, stridor and dyspnea, and may be fatal. Hereditary angioedema is uncommon and more serious than common urticaria or angioedema. It is identified by rapid and severe swelling of various body parts, as well as abdominal cramping if the digestive tract is involved.
Visiting a Doctor For Urticaria and Angioedema
As mentioned, most hives and angioedema episodes are not life threatening and can be treated at home. But in more chronic and severe cases, an appointment with a doctor to determine the cause and offer treatment is highly recommended. As a general rule of thumb, see a doctor if hives or angioedema does not go away after a day or two or if a home remedy or over the counter treatment (see Treatments Section Below) does not work in relieving symptoms. If symptoms include breathing difficulty, swelling of the throat or fainting and/or a lightheaded feeling, go to an emergency room for immediate treatment.
A doctor will take a patient’s history to try to identify the cause of urticaria or angioedema. It helps if a patient brings notes to the appointment that include important information like signs and symptoms of urticaria or angioedema, how often the symptoms occur, how long they last and any medications, herbs or vitamins taken to relieve symptoms. A patient should also write down any questions he or she might have regarding tests, causes, symptoms, alternate approaches, and best course of action to take.
A doctor will ask questions like:
- When was the onset of symptoms first noticed?
- How did the urticaria or angioedema present in appearance?
- Have symptoms changed at all?
- What makes symptoms worse?
- Have any home remedies or over the counter medications been used?
- Have prescription medications been taken?
The answers to these questions will help the physician put together a complete history and proper diagnosis of the condition and how it might best be treated.
Following a complete history and evaluation, the physician may do a scratch or prick test to help identify any allergies to foods, insects, pollen, animal fur, medications, etc. The doctor may also do a patch test, which is an allergen placed on a patch and applied to the skin. If it causes a reaction, the allergen is identified and the appropriate treatment can be initiated.
Similarly, the doctor may do an intradermal test, whereby an allergen is injected into the skin. Intradermal testing is usually performed if the physician suspects an allergy to insects or penicillin. A doctor suspecting a patient might be suffering from hereditary angioedema, may request a blood test to evaluate levels and blood protein function.
Treatment Options For Urticaria and Angioedema
If treatment for urticaria or angioedema is recommended, standard antihistamines should help. Antihistamines will block the release of histamine, which causes the symptoms and discomfort of urticaria and angioedema. Over the counter medications include:
- Diphenhydramines like Benadryl
- Chlorpheniramines like Chlor-Trimeton
- Loratadine like Claritin and Alavert
- Cetrizines like Zyrtec
Some of these medications can cause drowsiness, so caution should be taken before medicating. For instance, a patient should not drive when taking antihistamines, unless the medication states that it does not cause drowsiness.
Prescription medications include:
- Desloratadine or Clarinex
- Fexofenadine or Allegra
- Hydroxyzine or Vistaril
- Levocetrizine or Xyzal
If the hives or angioedema are severe, a physician may prescribe a corticosteroid drug like prednisone to help bring down swelling and ease itching.
To treat hereditary angioedema, a physician may prescribe a long term treatment of androgens like danazol, which help maintain and regulate blood protein levels. There are also many new medications that are in clinical trials that might be recommended.
If the episode of hives or angioedema appears to be severe or life threatening, an emergency adrenaline injection may be necessary. This will require visiting an emergency treatment center immediately. If these severe episodes are frequent, a physician may recommend and prescribe adrenaline that can be used by a patient in an emergency.
After self injecting an adrenaline, a patient should go to an emergency room for further treatment if necessary.
Side Effects of Antihistamines
As mentioned, drowsiness can be a side effect of taking antihistamines for urticaria or angioedema. Other side effects include changes to the immune system. A patient should speak to a physician about side effects and complications of mixing antihistamines with other medications.
Side Effects of Corticosteroids
The side effects of corticosteroids can be serious affecting the joints and other parts of the body. That is why, when prescribed, they are used for a short period of time in hopes of alleviating severe symptoms of urticaria or angioedema. Most corticosteroids must be withdrawn gradually to avoid further complications.
Home Remedies and Lifestyle Changes To Help Relieve Urticaria and Angioedema
Rather than taking over the counter medications or prescribed medications, some patients choose to try home remedies and lifestyle changes to help urticaria and angioedema symptoms. To relieve itching and pain associated with urticaria and angioedema there are natural remedies and lifestyle changes that could help significantly. They include:
- soaking in oatmeal baths
- soaking in detoxifying baths
- rose water and vinegar applications
- mint and brown sugar drinks
- Turmeric powder
- the herb rauwolfia mixed in a cup of water
- applying anti-pruritic lotions.
Lifestyle changes include switching to an all fruit diet for five days, maintaining a balanced food diet of nuts, seeds, fruits, grains and vegetables and avoiding foods like coffee, tea, alcohol, and foods that are hard to digest.
Epson salts baths in hot water are claimed to be the most effect way to relieve outbreaks of urticaria or angioedema. The patient should soak in a hot bath treated with a cup of Epson salts for 20 minutes or more at least three times a week. Do not use soap as it may introduce harmful chemicals and prevent the positive effects and results of the Epson salts.
There is also a chemical free technique or Organic technique that is proving quite helpful for treating chronic urticaria. The theory is by wearing and using clothes and other items like sheets and bath towels that have not been exposed to laundry detergent chemicals, toxicity levels are greatly reduced in the body, and the immune system is boosted.
After about four to six weeks, urticaria and angioedema could disappear. To successfully carry out this technique, a patient must use chemical free, cold water methods to wash items they come in contact with. High levels of baking soda should be added to the long rinse wash cycle, and all items must be air-dried to prevent heat combustion that can cause chemical residue in a dryer.
Preventing Outbreaks of Urticaria and Angioedema
Active patient participation is important in preventing outbreaks of urticaria and angioedema. There are ways to lower the chances of outbreaks by staying away from known triggers like foods that seem to bring on hives or angioedema, medications or situations that provoke onsets. Situations can include anything from temperature changes, stressful environments and exposure to chemicals that could provoke an allergic reaction.
It is also highly recommended that patients keep a log of their outbreaks of urticaria or angioedema, noting what foods seem to cause reactions, what environment brought on a reaction like extreme heat or cold and what chemical (for instance, a certain component in a perfume) caused an allergic attack. By using these self-help techniques, many times a patient can identify and eliminate the cause or causes of their urticaria or angioedema attacks and avoid taking over the counter or prescription medications and the side effects that go along with them.
It is worth the time invested to research urticaria and angioedema to know the various degrees and forms of both conditions. In most cases, urticaria and angioedema are temporary and not serious, but there are rarer forms of urticaria and angioedema that can present serious and life threatening conditions.
Patients experiencing hives or mild angioedema should benefit by taking an antihistamine that can help relieve swelling and itching. In severe cases, corticosteriods may be prescribed for a short period of time. If a patient experiences any difficulty in breathing, swallowing or maintaining consciousness, immediate emergency treatment must occur. Some patients with severe reactions carry epinephrine injections and antihistamine pills to administer should a severe reaction occur.
Hereditary angioedema is not an allergic reaction. It is a genetic disorder that affects the immune system. It can be triggered by injury, infection or stress and the main symptom is swelling, particularly around the mouth and eyes. If swelling occurs in the windpipes, breathing can be inhibited and immediate attention is required. Certain treatments may relieve hereditary angioedema symptoms.