What are the common symptoms of hives and angioedema. How are hives different from other skin conditions. What factors can trigger hives and swelling. How do doctors diagnose and treat hives and angioedema.

Understanding Hives and Angioedema

Hives (urticaria) and angioedema are related allergic skin reactions that can cause significant discomfort. While they often occur together, they have distinct characteristics:

Hives

Hives appear as red, raised welts or bumps on the skin. They typically:

• Cause intense itching
• Come and go in groups
• Range from a fraction of an inch to several inches in diameter
• Can appear suddenly and disappear just as quickly
• Turn white when pressed (a phenomenon called blanching)

Angioedema

Angioedema involves swelling of the deeper layers of skin. It commonly affects:

• Areas around the eyes
• Lips and tongue
• Hands and feet
• Throat and mouth (in severe cases)

Unlike hives, angioedema usually doesn’t itch but can cause a painful or burning sensation.

Key Symptoms of Hives and Angioedema

Recognizing the symptoms of hives and angioedema is crucial for proper diagnosis and treatment. Here are the primary signs to watch for:

Hives Symptoms

• Sudden appearance of red, raised welts
• Intense itching
• Welts that blanch (turn white) when pressed
• Lesions that come and go, often in groups

Angioedema Symptoms

• Swelling around the eyes, lips, or tongue
• Swollen hands or feet
• Difficulty breathing (in severe cases)
• Stomach cramps

Can hives and angioedema be life-threatening? In rare cases, severe angioedema can lead to anaphylaxis, a potentially life-threatening allergic reaction. Symptoms of anaphylaxis include difficulty breathing, vomiting, and loss of consciousness. If these symptoms occur, immediate medical attention is necessary.

Causes and Triggers of Hives and Angioedema

Understanding what causes hives and angioedema can help in prevention and management. The triggers can be broadly categorized into three groups:

Physical Triggers

Physical factors that can induce hives or angioedema include:

• Extreme temperatures (hot or cold)
• Pressure on the skin
• Sunlight exposure
• Vibration
• Water contact

Allergic Reactions

Common allergens that may trigger hives or angioedema are:

• Pollen
• Animal dander
• Mold spores
• Certain foods (e.g., nuts, shellfish, eggs)
• Medications
• Insect stings or bites

Non-Allergic Causes

Other factors that can lead to hives or angioedema include:

• Infections
• Autoimmune conditions
• Stress
• Idiopathic causes (no identifiable trigger)

Why is it important to identify the cause of hives and angioedema? Identifying the underlying cause is crucial for effective treatment and prevention of future episodes. In some cases, particularly with chronic hives, pinpointing the exact cause can be challenging and may require specialized testing.

Diagnosing Hives and Angioedema

The process of diagnosing hives and angioedema typically involves several steps:

Medical History and Physical Examination

The first step in diagnosis is a thorough medical history and physical examination. The doctor will ask about:

• Recent exposures to potential triggers
• Duration and frequency of symptoms
• Any associated symptoms
• Family history of allergies or skin conditions

Allergy Testing

If an allergic cause is suspected, the doctor may recommend allergy testing. This can include:

• Skin prick tests
• Blood tests to check for specific antibodies
• Food challenge tests (in cases where food allergies are suspected)

Additional Tests

In cases of chronic hives or recurrent angioedema, additional tests may be necessary:

• Blood tests to check for underlying autoimmune conditions
• Skin biopsy (in rare cases)

How does the duration of symptoms affect diagnosis? Acute hives (lasting less than six weeks) are often easier to diagnose, as they’re frequently linked to a specific trigger. Chronic hives (lasting more than six weeks) can be more challenging to diagnose and may require more extensive testing.

Treatment Options for Hives and Angioedema

The treatment of hives and angioedema focuses on symptom relief and preventing future episodes. Here are the main treatment approaches:

Avoidance of Triggers

If a specific trigger is identified, avoiding it is the most effective way to prevent future outbreaks. This might involve:

• Dietary changes
• Avoiding certain medications
• Protecting the skin from physical triggers

Medications

Several types of medications can help manage symptoms:

• Antihistamines: These are the first-line treatment for hives and can help relieve itching and reduce swelling.
• Corticosteroids: For severe cases, short-term use of oral corticosteroids may be recommended.
• Epinephrine: In cases of severe angioedema or anaphylaxis, an epinephrine auto-injector may be prescribed for emergency use.

Immunotherapy

For chronic cases or those associated with specific allergies, immunotherapy might be considered. This involves gradually exposing the body to increasing amounts of an allergen to build tolerance.

What factors determine the choice of treatment? The selection of treatment depends on several factors, including the severity and frequency of symptoms, the identified triggers (if any), and the patient’s overall health status. Treatment plans are typically personalized to meet individual needs.

Living with Hives and Angioedema

Managing hives and angioedema extends beyond medical treatment. Here are some strategies for coping with these conditions:

Skin Care

Proper skin care can help alleviate symptoms and prevent flare-ups:

• Use mild, fragrance-free soaps and moisturizers
• Avoid hot showers or baths, which can trigger or worsen hives
• Wear loose, comfortable clothing to reduce skin irritation

Stress Management

Stress can exacerbate hives and angioedema in some people. Stress-reduction techniques that may help include:

• Regular exercise
• Meditation or mindfulness practices
• Adequate sleep

Diet Considerations

While not all cases of hives and angioedema are food-related, some dietary changes may be beneficial:

• Keep a food diary to identify potential triggers
• Consider an elimination diet under medical supervision
• Stay well-hydrated

How can patients effectively communicate their condition to others? It’s important for patients to educate family members, friends, and colleagues about their condition. This includes explaining potential triggers, symptoms to watch for, and what to do in case of a severe reaction.

When to Seek Medical Help

While many cases of hives and angioedema can be managed at home, there are situations where medical attention is necessary:

Emergency Situations

Seek immediate medical care if you experience:

• Difficulty breathing or swallowing
• Dizziness or fainting
• Swelling of the throat or tongue

Non-Emergency Situations

Consider consulting a healthcare provider if:

• Hives persist for more than a few days
• Symptoms are severe or interfering with daily life
• Over-the-counter treatments aren’t providing relief

Why is it crucial to have an action plan for severe reactions? For individuals prone to severe reactions, having an action plan can be life-saving. This plan should include steps to take during a reaction, emergency contact information, and instructions for using any prescribed emergency medications.

Research and Future Directions

The field of allergy and immunology continues to advance, offering hope for improved treatments and management strategies for hives and angioedema:

Emerging Treatments

Researchers are exploring new treatment options, including:

• Biologics: Medications that target specific parts of the immune system
• Immunomodulators: Drugs that modify the immune response
• Personalized medicine approaches based on genetic profiles

Ongoing Research

Current areas of study include:

• The role of the microbiome in allergic reactions
• Genetic factors contributing to chronic hives and angioedema
• Novel diagnostic techniques for identifying triggers

How might future research impact patient care? Advances in research could lead to more targeted treatments, improved diagnostic tools, and potentially even preventive strategies for hives and angioedema. This could significantly improve quality of life for those affected by these conditions.

Understanding hives and angioedema is crucial for effective management and treatment. While these conditions can be challenging, with proper care and guidance from healthcare professionals, most people can successfully manage their symptoms and lead normal, active lives. As research continues to advance, we can look forward to even better treatments and management strategies in the future.

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Hives (urticaria) are an inflammation of the skin that causes red, raised welts or bumps. Hives itch, and they tend to come and go in groups. They range in size from a fraction of an inch to many inches in diameter.

The itchiness, grouping and size range of hives make them different from other allergic skin reactions like atopic dermatitis. Hives may occur suddenly as a reaction to a specific trigger (acute hives), or they may occur repeatedly or for long periods of time (chronic hives).

Hives may appear with angioedema (swelling of the deeper tissue of the skin). Angioedema usually does not itch and commonly occurs around the eyes, lips, tongue, hands and feet. Children who have hives with angioedema are more likely to have recurring or chronic hives.

The symptoms of hives may last anywhere from a few minutes to a few months or longer. Signs and symptoms of hives often include:

• Itching
• Red, raised bumps or welts on the skin that turn white when pressed (blanching)
• Sudden appearance and disappearance of these bumps

Angioedema (swelling) can occur at the same time as hives or as a separate reaction. Symptoms of angioedema include:

• Swelling around the eyes or the lining of the eyes
• Swelling of the hands and/or feet
• Swelling of the mouth and/or throat
• Difficulty breathing
• Stomach cramps

Hives can appear in one area or all over the body. If your child suddenly develops severe hives or angioedema and is having trouble breathing, is vomiting or loses consciousness, he or she may be experiencing anaphylaxis, a severe allergic reaction. Anaphylaxis is an emergency. If you think your child is experiencing a severe allergic reaction, take him or her to the hospital for immediate treatment.

Many different factors can cause your child to develop hives or swelling. These causes may be physical reactions, allergic reactions or nonallergic reactions.

Physical causes include:

• Cold
• Heat
• Pressure
• Sunlight
• Vibration
• Water

Allergic reactions can cause hives or swelling in response to:

• Pollens
• Dander
• Mold spores
• Foods
• Drugs
• Insects

Nonallergic causes of hives include:

• Infections
• Idiopathic reasons (no cause is found)
• Autoimmune conditions
• Other conditions

Diagnosis of Hives & Swelling

As a first step to diagnosing the cause of hives and swelling, the allergy doctors at Riley at IU Health will ask about your child’s medical history and do a physical exam. The focus will be on exposures that may be contributing to the problem.

Allery specialists will often perform an evaluation if the problem is chronic (for example, a child is has hives daily for two to three months). It can be extremely difficult to identify and confirm causes of chronic hives, but the allergy specialists at Riley at IU Health are trained to review your child’s medical history to help determine a possible cause and direct any further testing.

In the case of acute hives, there may be an obvious food or substance such as peanuts or a medicine that acts as a trigger. Acute hives may not require further evaluation or allergy testing unless a food is part of the history or there is anaphylaxis.

If your child’s allergist suspects a food allergy based on your child’s history, the doctor may perform a food allergy test and may suggest a food challenge to confirm the diagnosis.

Treatments

Treatments

An allergy specialist can treat both hives and angioedema. As with all allergic disorders, avoidance (keeping your child away from allergens) is the only sure therapy. If your child’s doctor is able to determine the cause of the hives, he or she can help you create a plan to avoid your child’s triggers.

Antihistamines are the most common medicines used for treating hives and swelling. These medicines work by blocking the chemicals in the skin that cause hives and swelling. Non-drowsy antihistamines are available. Your child’s allergist may also suggest other treatments.

Key Points to Remember

Key Points to Remember

• Hives are an inflammation of the skin that causes red, raised welts or bumps.
• Hives may appear with angioedema (swelling of the deeper tissue of the skin).
• Hives can have physical, allergic and nonallergic causes.
• Hives may occur suddenly as a reaction to a specific trigger (acute hives), or they may occur repeatedly or for long periods of time (chronic hives).
• Avoiding triggers and taking antihistamine medicines are the most common treatments for hives and swelling.

Support Services & Resources

Support Services & Resources

Learn more about hives and swelling by visiting the trusted websites below.

Riley at IU Health offers a broad range of supportive services to make life better for families who choose us for their children’s care.

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American Academy of Allergy, Asthma & Immunology

Learn more about hives and how the symptoms are different from other allergic skin reactions.

American College of Allergy, Asthma & Immunology

Learn more about the causes of hives and treatment options.

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Treatments, symptoms, causes, and outlook

Hives can appear all over the body, including the face. Allergens and environmental factors can often trigger an outbreak of hives. Hives are not usually dangerous, but anyone who thinks that they may be having a severe allergic reaction should contact a doctor.

Hives are raised, itchy welts that vary in size and can appear suddenly. This type of rash, also known as urticaria, is not contagious.

As the skin on the face is very sensitive, it is a common area of the body for hives to affect.

Hives can occur due to irritation and allergies or because of certain physical triggers, such as pressure.

This article looks at the symptoms, causes, and treatment of hives. It also considers the outlook for someone experiencing hives and explains when to contact a doctor.

Hives do not only affect the face, but the face is a common location for hives because the skin there often comes into contact with allergens and other irritants.

Hives happen when the body releases histamine in response to an allergen. This chemical release causes inflammation and the distinctive rash.

The appearance of hives can vary among individuals, and they can look different depending on the color of the skin.

Sometimes, they appear as tiny raised bumps. In other cases, hives look like raised welts that have different shapes. The welts or bumps can be big or small.

Hives are usually very itchy and often come on suddenly. The rash typically lasts only a few hours, but people with chronic hives can have flare-ups on a regular basis.

A telltale sign of hives is that pressing down on a welt will turn its center white. However, this effect may be less apparent in people with darker skin tones.

Learn about the appearance and diagnosis of hives on Black skin here.

According to the American Academy of Dermatology (AAD), hives can appear because of:

• an allergic reaction
• a physical trigger, including exposure to cold or hot temperatures
• a medical condition

The AAD note that known triggers for hives include:

• food and food additive allergies
• medications, such as antibiotics
• cold
• heat
• sunlight
• stress
• pressure
• certain chemicals

Sometimes, there is no obvious trigger, and the cause of hives remains unknown.

Treating hives involves avoiding contact with or exposure to the offending trigger or allergen.

Hives usually go away on their own and only last a short time. However, the itchy sensation can be very uncomfortable.

The AAD recommend that people relieve itching by using a cold compress (except in the case of cold-related hives) or applying over-the-counter (OTC) anti-itch medication that contains antihistamines.

People may also find OTC topical corticosteroids useful. In some cases, doctors may prescribe stronger corticosteroids to treat flare-ups quickly.

People with chronic hives may wish to take extra steps to minimize the symptoms. These can include:

• avoiding overheating
• keeping the skin moisturized
• using fragrance-free, non-irritating skin care products

Hives can be a symptom of some autoimmune disorders and, less commonly, certain malignancies.

People can also get hives when they have a severe allergic reaction, known as anaphylaxis. Anaphylaxis does not subside on its own and requires emergency treatment. Anyone experiencing the signs and symptoms of this reaction — which can include difficulty breathing, tightness of the throat, dizziness, and a sense of impending doom — should seek medical care immediately.

Contact dermatitis and hives are similar but not the same. Both can happen when the skin touches an irritant or allergen. However, a contact dermatitis rash may not appear until 1–2 days after the contact, and it can take time to heal.

Angioedema is another condition that is very similar to hives. It often results from an allergic reaction. Symptoms include:

• facial swelling around the mouth or eyes
• breathing trouble
• stomach cramps
• swelling of the extremities
• swelling of the throat

If hives happen alongside other symptoms, such as swelling and difficulty breathing, a person should seek emergency medical attention. They may be having a severe allergic reaction.

Severe itching can cause a person to scratch hard and break the skin. As a result, bacteria can enter the body and cause an infection.

People should also see a doctor if they notice any skin changes that may signal an infection, such as discoloration or the area feeling warm to the touch.

In about 5% percent of people who experience hives, it can be a sign of an underlying condition such as liver or thyroid disease.

Some risk factors for hives include having:

• asthma or a family history of asthma
• eczema
• hay fever

Staying away from triggers can help prevent future rashes from developing.

For example, people with sensitive facial skin should avoid products with fragrances. Gentle, non-irritating products can sometimes still cause hives, though. To avoid unexpected reactions, people can perform patch tests to check for potential skin reactions.

However, it is not always possible to avoid triggers. Sometimes, people cannot identify what has triggered a flare-up.

Some triggers are also challenging to avoid. Steering clear of cold weather, for example, is difficult for someone who lives in a cold climate. Wearing facial protection such as a scarf or neck gaiter may help, but it will not guarantee that hives will never occur.

Hives are not usually severe, and the rash will typically resolve on its own. Most people can avoid any known triggers fairly easily.

If a person does not know what is triggering the hives rash on their face, they may be unable to prevent it, but managing the symptoms is relatively simple.

Hives can happen almost anywhere on the body, including the face. Some people may feel self-conscious about hives on the face, and they can be uncomfortable.

As hives sometimes happen due to an allergic reaction, people with chronic facial hives should see a doctor or allergist.

It is possible for hives to develop into a severe allergic reaction.

Not all cases of hives have an easily detectable cause. In some people with hives, there is no clear trigger of the rash. However, various treatments and home remedies can help treat the symptoms.

types, causes, symptoms, signs, diagnosis, first aid, treatment

Classification

Causes and risk factors

Symptoms

Complications

Diagnosis

Treatment

Prevention teak

Urticaria is a common allergic disease characterized by the formation of a rash in the form of blisters or urticaria. Rashes with urticaria are localized mainly on the skin of the neck, face, body and hands. But there are cases when blisters appeared on the mucous membranes.

The disease affects 25% of the world’s population. Urticaria can appear in both children and adults. Signs are noted more often by women than men. The onset of the disease falls on middle age, namely about 35–40 years. 5% of patients are pediatric patients.

Classification

Depending on the duration of the course of the disease, modern medicine distinguishes the following types of urticaria:

1. Acute urticaria is a condition that is characterized by the manifestation of symptoms for at least 6 weeks. Patients also report headache and fever.
2. Acute recurrent – a type of disease with an exacerbation duration of up to 6 weeks. The difference is the duration of remission for 6 weeks.
3. Chronic urticaria is a disease that lasts longer than 6 weeks. This type can be viral, allergic or autoimmune in nature.

According to the rate of development of the disease, the following degrees are distinguished:

1. Mild degree, which is characterized by the appearance of rashes in the amount of less than 20 pieces during the day. In this case, patients note a slight itching, which does not bring much discomfort.
2. The average degree of urticaria, characterized by noticeable itching of the skin and increased formation of urticaria (approximately 30-50 pieces per day).
3. Intensive degree. Itchy sensations disrupt daily life, and the number of rashes exceeds 50 pieces.

Depending on the mechanism of development of pathology, such types of diseases are distinguished as:

• allergic urticaria, which is provoked by immune processes. For example, the secretion of pathogen-specific immunoglobulins or the production of cytokine proteins that enhance the inflammatory response;
• non-allergic, in the development of which immune mechanisms are not involved;
• food, the provoking factor of which are certain foods;
• viral;
• solar, the cause of which is direct contact with the sun’s rays. This type of disease is mainly affected by women with liver pathologies and impaired pigment metabolism;
• contact, which occurs when the skin comes into contact with chemical materials, such as latex or silicone;
• aquagenic – an autoimmune form of the disease associated with interaction with water;
• cold. Occurs when the skin is exposed to low temperature;
• viral, caused by a viral infection;
• idiopathic urticaria is a disease whose cause remains unclear.

Causes and risk factors

The manifestation of an allergic disease can have a different etiology. For example, a clear provocateur of the disease is an insect bite or the use of certain drugs, including antibiotics. Blood transfusion, vaccination, and direct interaction with the allergen through food can also provoke the condition.

Other causes of hives include:

• contact with chemicals such as powders, lotions, home cleaning solutions;
• increased sensitivity of the skin to mechanical stress;
• allergies to cold, sun and heat;
• the use of cosmetics, including shampoos, eyelash and eyebrow dyes, as well as components of formulations used in nail extensions;
• exposure to pollen from flowers and plants, which can provoke an allergic reaction, including rhinitis or hay fever.

Despite the fact that many factors provoking the disease are known, the cause of about 30% of cases of the disease cannot be established.

In addition, many chronic non-allergic diseases can cause urticaria. These include lymphoma, thyroid pathologies, diabetes mellitus, and diseases of the gastrointestinal tract.

Symptoms

The main symptom of urticaria is the appearance on the mucous membranes and skin of rashes in the form of blisters. Urticaria are purplish, pinkish or pale pink in color. As a rule, formations rise above the surface of the skin. The condition is often accompanied by unbearable itching. In exceptional cases, soreness appears in the places of localization of the rash.

Some patients also report symptoms of urticaria such as:

• fever;
• general weakness;
• body aches;
• lowering blood pressure;
• tearing and redness of the eyes;
• severe swelling of the eyelids;
• loss of appetite.

In the case of an allergic type of urticaria, patients develop nasal discharge and nasal congestion, the sense of smell decreases and breathing through the nose is disturbed. These changes often lead to a change in hearing.

The severity of cold symptoms varies from patient to patient and may include skin redness, swelling and itching.

To understand what urticaria looks like in children, just look at the skin. In pediatric patients, the symptoms are similar to those in adults: itching, blisters up to 3 mm in size, redness. But, in addition to general signs, digestive disorders appear in the form of vomiting, diarrhea and abdominal pain.

When sick, blisters disappear without a trace 1–2 days after they appear. This is a feature of the disease that distinguishes it from other allergic pathologies.

Complications

Like any allergic disease, hives can lead to complications. Rashes in children often turn into ulcers. This is due to the constant scratching of blisters and infection.

Quincke’s edema is the most serious complication of the pathology. At the same time, patients have swelling of the larynx and face, which as a result can lead to respiratory failure. This is a critical situation that requires immediate medical attention.

Anaphylactic shock, which is often accompanied by a decrease in pressure, clouding in the eyes and heart rhythm disturbance, is another possible complication of the pathology.

Diagnosis

Diagnosis and treatment of urticaria is carried out by a group of doctors, depending on the cause of the disease. A physical examination for visible symptoms is done by a therapist. At the initial examination of the patient, the doctor measures blood pressure, body temperature, heart rate and feels the abdomen and lymph nodes. In the case of an allergic type of disease, an allergist-immunologist and a dermatologist are involved in the treatment.

Depending on the severity of the signs and characteristics of the course of the disease in the patient, the doctor may prescribe one or more diagnostic tests:

1. Complete blood count.
2. Immunoglobulin lgE general.
3. Allergotest.
4. Fecal analysis.
5. Gastroscopy.
6. Ultrasound of the abdominal organs.
7. Ultrasound of the pancreas.
8. Ultrasound of the thyroid gland.
9. Chest x-ray.
10. X-ray of the stomach.

In most cases, the disease stops within the first 14 days, so a special study is not required. After the provoking factor is established, laboratory diagnostics is prescribed.

Treatment

If signs of urticaria appear, it is important for the patient to provide first aid before contacting a doctor. To do this, calm the victim, unbutton the top button of the clothing and give a glass of mineral water to drink.

Symptoms of the disease can appear at any time when interacting with the allergen. Therefore, it is good to have anti-allergic drugs in the form of tablets and drops in the first-aid kit, which must be given to the patient. A cold compress should be applied to the swelling site.

Treatment of urticaria consists of several stages:

1. Exclusion of the allergen – the causative agent of the disease. To do this, you must stop taking medications that could cause pathology. You should also avoid hypothermia and overheating of the body.
2. Detection of foci of infection and their elimination.
3. Compliance with the diet for urticaria. It is important to exclude from the diet foods that can cause allergies: nuts, coffee, chocolate, honey, citrus fruits. The food plate should be filled with hypoallergenic foods, such as vegetable soups, low-fat broth, cereals from cereals, low-fat cottage cheese and yogurt, apples.
4. Use of medications, including antihistamines, immunosuppressants, and antidepressants. It should be remembered that medicines for the treatment of urticaria should be taken only as directed by a doctor.

With the onset of asphyxia against the background of Quincke’s edema, the patient is urgently prescribed a tracheostomy.

Topical ointments and creams for urticaria have not been shown to be effective. Therefore, the use of only these funds will not lead to a complete recovery.

Prophylaxis

In order to prevent urticaria, doctors advise to adhere to the following recommendations:

• in case of a tendency to develop allergies, contact with possible allergens should be avoided;
• it is important to treat diseases in a timely manner in order to avoid complications;
• a balanced diet is recommended;
• It is worth minimizing the physical and chemical effects on the skin.

The rate of recovery of a patient with urticaria is affected by age, cause of the disease, gender and individual characteristics of the organism. With timely access to a doctor, serious consequences can be avoided.

The author of the article:

Ivanova Natalya Vladimirovna

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Why “Urticaria (or Quincke’s Edema)” is the most dangerous allergic disease? Articles