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Skin Conditions: A Review Of Urticaria (Or Hives)

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One out of five people experience hives in their lifetime. These are itchy bumps, which are surrounded by a field of redness, and itch like crazy.

Hives are caused by the release of histamine from mast cells in the tissues, or basophiles in the bloodstream.

Itching is the chief annoyance, which can cause sleep loss, as well as misery severe enough to distract from normal activities. Hives are sometimes associated with angioedema, which is swelling in certain areas, such as the throat and windpipe, which can be fatal. Extensive hives, with leaking of fluid out of the blood vessel’s can also cause low blood pressure, which can be fatal, especially if you’re in a precarious situation, such as swimming.

The topic has been increasingly understood, and therefore growing increasingly complex, and I will only touch on some high points. I would recommend the review of Dermnet from New Zealand, which is included below if you want more complete and reasonably understandable information.

I have had hives only one time, after being stung by a bee for the third or fourth time. Within a few seconds, I started itching all over my body, but had no dizziness so apparently didn’t lose much fluid from my blood vessels. The hives went away after taking an antihistamine. I sometimes get itchy after wearing a tight belt, which is probably caused by histamine release due to “ pressure urticaria. As mentioned in previous articles, I also get itchy skin without hives if I let my skin get too dry, helped by lubricants, and have itchy ears for which I take drops of mineral oil into my ears, and wash the wax out every few months.

Urticaria, or hives, can be in a limited  area or all over the body, can last a few days or come and go indefinitely, and can be mild or incapacitating. They can be caused by a huge variety of known things, from infections, such as upper respiratory infections, foods such as peanut, drugs such as antibiotics, contactants, such as latex gloves, and stings or other injectants, which  can generalize into severe and sometimes fatal anaphylaxis.

Adrenaline, and antihistamines, are needed immediately in these situations. You may have heard of the rapidly injectable EpiPen, which you must carry with you if at risk.

Often with chronic urticaria, the cause remains unknown or “idiopathic”. As an allergist, this used to drive me almost as crazy as my patients, A lot of progress has been made in the last few decades. About half of the unknown causes turns out to be antibodies directed towards the allergic antibody, IGE, which can be treated by yet another antibody, omalizumab, or some other expensive new medications.

If you have urticaria that continues, and interferes with your enjoyment of life, You can help your doctor out by carefully remembering the circumstances, under which the hives occur, and the places on your body where they are the most annoying. Ask your relatives if they have any autoimmune diseases, like lupus, or vitiligo. Know exactly what medication you are taking, and bring a list with you.

Angioedema can be fatal due to blockage of breathing and demands immediate attention. ACE Inhibitors can cause these swellings, which often occur without itching.

Once again, go to the excellent and understandable article by Dermnet/urticaria/an overview.

—Dr. C.

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THE DOCTORS 101 CHRONIC SYMPTOMS & CONDITIONS #48: URTICARIA (HIVES)

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ALLERGY is a type of reaction that can vary from annoying to fatal. The question has always been: what possible utility to the body does the allergic reaction, which has survived evolution, provide? The best theory fingers parasitic infestations; not only can parasites cause allergic reactions, Indicate allergy by showing blood eosinophilia, but the allergic reaction seem to help us fight parasitic infestation, which was much more common in humanity’s  past, and in present day underdeveloped societies.

URTICARIA consists of a number of little welts or bumps that pop up on the skin and are very itchy. This reaction is caused by little darkly-staining cells called MAST CELLS, which release Histamine  and other irritants into the skin, causing hives. These mast cells are provoked into releasing their irritating cargo by IGE antibodies, the basis of true allergy.

Treatment consist of removing the cause, blocking the action of the IgE antibodies, or giving medication to block the action of the histamine( anti-histamines).

There are multiple common causes, several giving its name to a type of Urticaria. Pressure urticaria can be caused by a belt or tight fitting clothing pressing on the skin to cause the hives. Solar urticaria can be caused by sunlight.

Cold urticaria can be caused by exposure to very cold objects. Hives can also be caused stress, exercise, different foods(seafood and strawberries are the most famous), different drugs(penicillin and aspirin are the most famous), and scratching on the skin(dermatographia).

Hives can occur as a feature of ANAPHYLAXIS. If the IgE-mast cell reaction is extensive, the blood pressure can drop, internal organs can be affected, and emergency treatment must take place to prevent death.
My only experience with hives was after a bee sting, when I broke out with itchy bumps. I had desensitization with honeybee venom, although this is not always done these days. Be sure to check with your doctor if you have such a reaction, however.

The biggest recent improvement in treating people who are incapacitated with frequently recurring and long lasting hives is anti-IGE, an expensive but very effective injection.

If you have hives, be sure to keep a record of events that immediately preceded the hives, including foods, activities,, and exposures. Although the recommended Mayo clinic article that follows suggests that you see a dermatologist or an allergist, I would reverse that and suggest the allergist first.

—Dr. C.

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