Hives or urticaria is a skin disorder where a person gets raised, itchy welts that come and go. It may last for a few hours or several days. Hives have no permanent damage, but they can be incredibly uncomfortable and appear in the most inconvenient places. They are often found on the neck, stomach, outside of elbows, and knees. Hives are widespread and affect an estimated 20 to 30 percent of the population. Hives are also known as urticaria or nettle rash. They most often begin in childhood or adolescence, but they can appear for the first time during adulthood, too.
What causes hives?
Signs any symptoms of hives:
Hives are pink or red, with slightly elevated areas of skin that may appear alone or in crops. Hives generally become evident within minutes after exposure to an allergen, although it can take hours for the hives to develop.
 How do I treat chronic hives?
1) Avoiding known triggers:Â Identify and avoid activities or substances that spark bouts of urticaria. Common triggers include exercise, hot weather, cold air, stress, and sweating.
2) Taking antihistamines: Taking one or two tablets of the over-the-counter (OTC) diphenhydramine (Benadryl®) 30 minutes before an anticipated triggering event can help prevent hives. Antihistamines are available as OTC pills, capsules, liquids, and creams. Some versions have more sedative effects than others, so it is best to take a low dose first to see how you react. If you experience drowsiness, talk with your doctor about switching to another medication without causing drowsiness or other side effects that you find unacceptable.
3) Switching medications: Because some drugs have been known to trigger urticaria, your doctor may switch you to a different medicine if you are taking is a known urticaria trigger. They may also prescribe an injection of epinephrine for severe episodes during which swelling and breathing become compromised.
4) Corticosteroids:Â A prescription oral corticosteroid such as prednisone or hydrocortisone can be used short-term to ease acute symptoms during bouts of chronic urticaria. However, prolonged corticosteroid pills can cause serious side effects, so it’s important that the lowest possible effective dose be taken and only as long as required.
5) Underlying disorders:Â If no cause can be found and hives last more than six weeks, the possibility of an underlying medical condition is considered.
6) Other treatments: If you have specific food allergies, your doctor may prescribe antihistamines to take before eating the offending foods. Treating chronic hives requires a team effort, so it’s essential that everyone – doctors, nurses, and pharmacists – works together to find the best treatment for you.
Living with chronic hives:
Despite appropriate treatment, some people will continue to experience episodes of urticaria over their lifetime. Others may only experience occasional attacks that last less than six weeks. If you have chronic hives, consider keeping a journal to record each episode’s details. This can help your doctor determine if certain activities or foods are triggering your episodes. As you note the conditions that bring out your hives, try to avoid them or take medications before these reach levels that could trigger an attack. Only about one-third of people with chronic hives ever wholly recover from their symptoms. For others, it is possible to reduce the severity and frequency of attacks through continued efforts at identifying triggers and avoiding them where possible.
What are the complications of hives?
The most common complications of chronic hives are
Infections: If hives continue for long, skin infections may develop around the nose where antihistamines have prevented scratching.
Anaphylaxis:Â Another complication of chronic hives is anaphylaxis, a severe allergic reaction that can occur at any time. It is caused by the immune system overreacting to a triggering substance. Symptoms may include life-threatening breathing difficulties, external blood pressure, or fainting. If you experience signs of anaphylaxis, it’s essential to get immediate treatment in the form of epinephrine, urgent medical attention, and hospitalization if necessary.
Other complications: Chronic urticaria itself does not cause death, but serious complications are possible with some people who have more than one chronic illness at the same time. These include heart disease, diabetes, or kidney disease.
What are the other conditions associated with hives?
Asthma:Â Hives are common in people with asthma, sometimes they occur together, or one condition may trigger the other.
Fibromyalgia:Â Chronic generalized muscle pain that often is accompanied by fatigue, sleep problems, and digestive disturbances also has been linked to chronic urticaria, though no cause has yet been identified. People with fibromyalgia may experience worse symptoms when their urticaria flares up or diminishes during remission periods.
Multiple sclerosis:Â Hives also are associated with multiple sclerosis, a neurological condition affecting coordination and thinking skills that can cause extreme fatigue.
Lupus erythematosus:Â Another autoimmune disease in which the body’s immune system attacks its cells, lupus can lead to skin rashes, arthritis, kidney problems, and even heart or lung damage.
Blood cancers:Â Several types of blood cancers, including leukemia, lymphoma, and myelodysplastic syndrome ( MDS ), also are associated with chronic urticaria.
Autoimmune conditions affecting other parts of the body:Â Less commonly, hives may be a sign of an autoimmune condition that attacks organs in the body other than the skin. These include autoimmune thyroiditis, Addison’s disease, and vitiligo.
How are chronic hives diagnosed?
Your doctor will diagnose chronic urticaria based on a physical exam as well as your symptoms. In some cases, blood tests may also check for specific antibodies that indicate an autoimmune condition. If you have chronic hives, your doctor will look for signs of other illnesses that could be linked to the state. They may order tests or refer you to specialists who can better identify possible complications.
How to avoid hives or urticaria?
If you have chronic hives, learning the possible triggers for your condition is essential in preventing future outbreaks. Here are the ways by which you can avoid urticaria or Hives.
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