Dr Sunaina Hameed's
Family Dermatalogy, Asthetic Lasers, Anti-Ageing Medicine & Plastic Surgery.

URTICARIA/ HIVES

Urticaria, "wheals" or nettle-hives are pale red swellings of the skin that occur in groups or any part of the skin. Each hives lasts for a few hours, rarely up to a day, before gradually fading away without a trace. New hives may develop as old ones fade. Some may appear as reddish raised streaks over the area where the nails have scratched. Hives are itchy, but may also burn and sting. During an acute episode, it is common for the patient to experience flushing, weakness, headaches, nausea, dizziness and tremors as well.

Hives are caused by tiny amounts of fluid that leaks from the blood vessels just under the skin surface. In some cases a condition called angio-edema develops. The swelling of angio-edema can occur anywhere in the body but most commonly affects the eyelids, lips and genitals. Sometimes the tongue and throat are affected and become swollen. The swelling sometimes becomes bad enough to cause difficulty in breathing. Symptoms of angio-edema tend to last longer than urticarial wheals. It may take up to three days for the swelling of the lips to subside and go. Angio-edema may not always be itchy, and may or may not be associated with hives. Angio-edema is a medical emergency and has to be treated with antihistamines, adrenaline or steroid injections.

Hives and Angio-edema are caused by the release of a chemical called Histamine. Allergic reactions, chemicals in food, or certain medications notably pain-killers can cause histamine release. Sometimes no cause may be identified.

Hives are very common. 10-20% of the population will have at least one episode in their lifetime. Hives of less than 6 weeks duration are called Acute Urticaria. With this type of hives, the cause can usually be found, eg food, medications, insect bites, infections etc. Hives which occur on a daily basis for more than 6 weeks are called Chronic Urticaria. It is twice as common in women. The cause of this type of urticaria is usually harder to isolate. Your dermatologist will need to ask several questions and perform several tests in an attempt to find the possible cause. In up to a third of cases, the cause may be an 'auto-immune' problem. Auto-immune means that the body's antibodies cause disease. Antibodies normally fight off germs (viruses and bacteria). In some people, one type of antibody attaches to cells under the skin and causes them to release histamine and other chemicals. The reason why this happens is not clear. Chronic urticaria may last for several years. In about half the cases, symptoms disappear within 3-5 years.

FOODS THAT CAUSE URTICARIA

The most common culprits are fish, meat, eggs, chocolates, soya, nuts and milk. Food additives and preservatives may also cause hives. These hives appear within minutes or within an hour of a meal.

MEDICATIONS THAT CAUSE URTICARIA

Are mostly pain-killers, antibiotics and sedatives. Vaccines, toxins, injectable dyes and insect bites are also included in this category. If you have an attack of hives, it is important to tell your doctor about all the medications you use (Allopathic or alternative).

INFECTIONS THAT CAUSE URTICARIA

Common cold and stomach infections are the commonest causes. If you have a chronic tonsil or ear infection, if you suffer from stomach acidity, recurrent urinary tract infections or intestinal worms, these infections can also be responsible for your hives.

MEDICAL CONDITIONS THAT CAUSE URTICARIA

Thyroid disorders and Lupus are most commonly associated.

PHYSICAL URTICARIA

Hives can be caused by sunlight, heat, cold, pressure, vibration or exercise. These can be easily diagnosed with a 'challenge' test, which should only be performed under a doctor's supervision.

DERMOGRAPHIC URTICARIA

Hives that form after firmly stroking or scratching the skin are called 'dermographism' or 'symptomatic urticaria'. It affects about 5% of the population.

TREATMENT

The best treatment is to find the cause and eliminate it from your surroundings. This is not always easy, and is sometimes just impossible. Antihistamines are usually prescribed by your doctor to provide relief. Antihistamines work best if taken on a regular schedule. The newer antihistamines do not cause drowsiness or tolerance after prolonged use. No one antihistamine works best for everyone, so your dermatologist may have to try more than one, or different combinations to find out what works best for you. Severe cases have to be treated with oral steroids.

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