Hives

Hives can have many different causes that are either allergic or non-allergic. Whatever causes the rash, the so-called mast cells react in the skin by releasing fluid with histamine that causes swelling, redness and itching.

The rash can occur due to direct contact of the skin with irritants or may be a reaction to something you have eaten. Infections and medicines can also cause hives. You can also get rash in connection with cold or sunlight. In about half of all cases, there is no clear explanation.

Hives in children are often caused by viral infections, but can also be a reaction to food, for example, eggs, milk, fish and nuts.

Hives may be caused by:

• infections – for example, respiratory and urinary tract infections  
• foods or food allergies – such as nuts, fish, seafood, strawberries, cheese and wine
• contact allergy – for example, on latex 
• insect bites and parasites – for example wasp stings, bedbugs, scabies  or intestinal parasites
• physical stimuli – cold or heat, sunlight, pressure, water 
• medicines – for example, antibiotics, antipyretic or anti-inflammatory drugs and opiates
• mental impact – such as stress or anxiety  
• severe illnesses – hives can be a secondary symptom of autoimmune diseases or various malignant conditions.

Hives can be acute or chronic. The acute form affects about every fifth person at some point of life and often disappears within hours or days. So-called chronic urticaria is uncommon and causes continuous complaints for more than two months, sometimes considerably longer than that, but most become symptom-free within a few years.

Hives rash is characterized by being volatile – it can appear quickly and change both shape and location just as quickly. The rash often starts to itch even before you see the skin reaction with the naked eye. The itching can be severe and feel burning.

Nettle rash is light red or skin-colored, often paler in the middle, and looks like raised small swellings on the skin. It is usually located on the chest, arms and legs, and looks like single bumps or clusters on the large skin areas. It usually disappears within a few days and leaves no marks.

Angioedema is swelling of areas of tissue under the skin, sometimes affecting the face and throat. This can occur separately or in combination with common hives. It gives swelling without the typical itching and is usually located on the face, for example on the eyelids, in the oral cavity or throat. If it is located in the throat, it can be a sign of a life-threatening condition called anaphylactic shock, that requires emergency treatment.

Bear in mind that not all itchy skin rashes are hives. Skin reactions may also occur due to dry skin, eczema or insect bites – but then the rash is not so volatile as in the case of hives.

If you know what causes hives in you, try to avoid substances and situations that cause the rash. If it is triggered by heat, it is good to avoid bathing or showering in hot water. If the rash occurs in connection with cold, you should not stay outdoors for long time in winter and refrain from particularly cold food and drink. Also, keep in mind that stress can sometimes trigger and aggravate your troubles.

At pharmacies you can purchase non-prescription antihistamine medications that can relieve itching. There is also a cortisone ointment that can be applied to the skin.

Hives generally doesn’t require any treatment and usually disappears by itself within a few days or weeks. Non-prescription allergy medication can relieve the symptoms.

For recurring or long-standing problems, a doctor may need to investigate the cause of your problems with the help of sampling and allergy tests. Sometimes there is reason to treat you with antihistamines in combination with cortisone. In case of severe respiratory reactions, acute adrenaline therapy is required.

Chronic urticaria may need to be examined in some cases by a dermatologist or allergist who sometimes prescribes other medications as well.

If you get a rash that does not clear up within a couple of weeks, or if the rash returns, you should get medical advice. This is also advised  if you suspect the hives are caused by allergies. 

Seek urgent care if the rash quickly spreads or if you feel generally unwell. Call emergency if you have angioedema in your throat that makes swallowing or breathing difficult. 

If you have trouble breathing or if you have an acute allergic reaction suggestive of anaphylactic shock – this includes palpitations and pressure over the chest, respiratory distress, abdominal pain, fainting sensation and cold hands and feet – call emergency services.

APPOTEK can help you with hives. A nurse or doctor will make an individual assessment based on your symptoms, then may prescribe treatment or refer you for further examination. If symptoms are severe or you suspect angioedema or have difficulty breathing, always go directly to the emergency room.