What are hives and angioedema. How do they differ from each other. What triggers these skin conditions. How can they be diagnosed and treated effectively. What are the key symptoms to watch out for. When should you seek medical attention for hives or angioedema.

What Are Hives and Angioedema?

Hives, also known as urticaria, are swollen, pale red bumps or welts that appear suddenly on the skin. They can vary in size from as small as a pencil eraser to as large as a dinner plate. On darker skin tones, hives may appear skin-colored and can be more difficult to detect. These raised patches typically itch, but they may also burn or sting.

Angioedema, on the other hand, involves swelling beneath the skin rather than on its surface. It commonly affects areas around the eyes, lips, genitals, hands, and feet. While angioedema generally lasts longer than hives, the swelling usually subsides within 24 hours.

Key Differences Between Hives and Angioedema

• Location: Hives appear on the skin’s surface, while angioedema occurs beneath the skin
• Duration: Hives often clear up within hours, while angioedema can persist for up to 24 hours
• Affected areas: Hives can appear anywhere on the body, whereas angioedema typically affects specific areas like the face and extremities

Common Causes and Triggers of Hives and Angioedema

Both hives and angioedema can be triggered by various factors, causing the body to release histamine, which leads to the characteristic symptoms. Some common causes include:

1. Allergic reactions to foods, medications, or insect stings
2. Exposure to certain chemicals or environmental factors
3. Viral, bacterial, or fungal infections
4. Physical stimuli such as pressure, cold, heat, or sunlight
5. Stress or emotional factors

In some cases, the exact cause of hives or angioedema may remain unknown, a condition referred to as idiopathic urticaria or angioedema.

Food Triggers for Hives

Certain foods are more likely to trigger hives in susceptible individuals. These include:

• Nuts
• Chocolate
• Fish
• Tomatoes
• Eggs
• Fresh berries
• Soy
• Wheat
• Milk

Interestingly, fresh foods tend to cause hives more frequently than cooked foods. Additionally, certain food additives and preservatives may also trigger hives in some people.

Types of Urticaria and Angioedema

Urticaria and angioedema can be classified into several types based on their duration and specific triggers:

Acute Urticaria and/or Angioedema

This type lasts less than 6 weeks and is often caused by identifiable triggers such as foods, medications, latex, or infections. Insect bites or certain diseases may also be responsible.

Chronic Urticaria and/or Angioedema

When hives or swelling persist for more than 6 weeks, it’s classified as chronic. The cause is typically more challenging to identify and may involve factors such as the immune system, chronic infections, hormonal disorders, or even tumors.

Physical Urticaria

This type is triggered by direct physical stimulation of the skin, such as exposure to cold, heat, sunlight, vibration, pressure, or even sweating and exercise. Physical urticaria usually appears within an hour of exposure and is localized to the affected area.

Dermatographism

A unique form of physical urticaria where hives develop after firmly stroking or scratching the skin. Individuals with this condition may also experience other types of hives.

Hereditary Angioedema

This is a rare genetic condition characterized by painful swelling under the skin. It runs in families and requires specialized management.

Diagnosis of Hives and Angioedema

Diagnosing hives and angioedema typically involves a comprehensive approach:

• Detailed medical history: Your doctor will ask numerous questions to identify potential triggers or underlying causes.
• Physical examination: A thorough skin inspection helps assess the extent and nature of the hives or swelling.
• Allergy tests: Skin prick tests or blood tests may be conducted to identify specific allergens.
• Blood work: Additional blood tests can help rule out underlying conditions or identify potential triggers.

In some cases, especially for chronic urticaria, identifying the exact cause can be challenging and may require extensive investigation.

Treatment Options for Hives and Angioedema

The primary goal in treating hives and angioedema is to alleviate symptoms and prevent recurrence. Treatment strategies may include:

Antihistamines

These medications are often the first line of defense against hives and angioedema. They work by blocking the effects of histamine in the body, thereby reducing itching and swelling. Both over-the-counter and prescription antihistamines may be used, depending on the severity of symptoms.

Corticosteroids

For severe cases or when antihistamines alone are insufficient, short courses of oral corticosteroids may be prescribed to reduce inflammation and provide relief.

Biologic Drugs

In cases of chronic urticaria that don’t respond to antihistamines, biologic medications such as omalizumab may be considered. These drugs target specific components of the immune system involved in the allergic response.

Epinephrine

For severe angioedema, especially if it affects the airways, an epinephrine injection may be necessary as an emergency treatment.

Trigger Avoidance

Identifying and avoiding triggers is crucial in managing hives and angioedema. This may involve dietary changes, medication adjustments, or lifestyle modifications.

Self-Care Measures for Managing Hives and Angioedema

While waiting for hives or angioedema to subside, several self-care measures can help alleviate discomfort:

• Use cool compresses or wet cloths on affected areas to soothe itching and burning
• Take lukewarm baths or showers, avoiding hot water which can exacerbate symptoms
• Wear loose-fitting, lightweight clothing to minimize skin irritation
• Keep your environment cool and well-ventilated
• Apply over-the-counter anti-itch medications like calamine lotion
• Use fragrance-free moisturizers to prevent skin dryness
• Practice stress-reduction techniques, as stress can trigger or worsen hives in some people

When to Seek Medical Attention for Hives or Angioedema

While most cases of hives and angioedema are not life-threatening, certain symptoms warrant immediate medical attention. Contact your healthcare provider or seek emergency care if you experience:

• Difficulty breathing or wheezing
• Swelling of the tongue, lips, or throat
• Dizziness or lightheadedness
• Chest tightness or pain
• Severe abdominal pain or vomiting
• Signs of anaphylaxis, a severe allergic reaction

These symptoms may indicate a more serious condition that requires prompt medical intervention.

Living with Chronic Urticaria and Angioedema

For individuals dealing with chronic hives or angioedema, managing the condition can be challenging. Here are some strategies to help cope with long-term symptoms:

Develop a Treatment Plan

Work closely with your healthcare provider to develop a comprehensive treatment plan. This may involve a combination of medications, lifestyle changes, and regular follow-ups to monitor your condition.

Keep a Symptom Diary

Maintaining a diary of your symptoms, potential triggers, and response to treatments can help identify patterns and refine your management approach.

Join Support Groups

Connecting with others who have similar experiences can provide emotional support and practical advice for living with chronic urticaria or angioedema.

Stay Informed

Keep up-to-date with the latest research and treatment options for chronic hives and angioedema. New therapies are continually being developed, and staying informed can help you make the best decisions for your health.

Manage Stress

Since stress can exacerbate symptoms in some individuals, incorporating stress-reduction techniques into your daily routine can be beneficial. This may include practices such as meditation, yoga, or regular exercise.

Living with hives or angioedema, whether acute or chronic, can be challenging. However, with proper management, most individuals can effectively control their symptoms and maintain a good quality of life. By working closely with healthcare providers, identifying triggers, and adhering to treatment plans, those affected by these conditions can minimize their impact on daily activities and overall well-being.

Hives, Urticaria, and Angioedema: Symptoms, Causes, and Treatment

Written by WebMD Editorial Contributors

• Causes
• Types
• Diagnosis
• Treatment
• 7 Simple Tips
• When Should I Call the Doctor?
• More

Hives are swollen, pale red bumps, patches, or welts on the skin that appear suddenly. On darker skin tones, they can appear skin-colored and can be more difficult to see. They can happen because of allergies or other reasons. Your doctor may call them urticaria.

Hives usually itch, but they may also burn or sting. They can show up anywhere on your body, including the face, lips, tongue, throat, and ears. Hives can change size rapidly and move around, disappearing in one place and reappearing in other places, often in a matter of hours. Hives can often appear and then clear up within a few hours. Some people have one flare-up and never get hives again. It’s also possible to have many flare-ups.

They range in size from a pencil eraser to a dinner plate and may join together to form larger areas known as plaques. They can last for hours, weeks, or even years.

Angioedema is different. The swelling happens under the skin, not on the surface. It’s marked by deep swelling around the eyes and lips and sometimes of the genitals, hands, and feet. It generally lasts longer than hives, but the swelling usually goes away in less than 24 hours. It’s rare, but angioedema of the throat, tongue, or lungs can block your airways, making it hard to breathe.

Allergic reactions, chemicals in foods, insect stings, sunlight, and medicines can make your body release a chemical called histamine. Histamine sometimes makes blood plasma leak out of small blood vessels in the skin, causing hives or angioedema.

Sometimes, doctors don’t know exactly why hives have formed.

Urticaria, also known as hives, is a skin rash of raised, itchy bumps. The welts may also burn or sting. They often last hours or days, can move around, and don’t leave lasting skin changes. Viral, bacterial, or fungal infections may trigger hives, and they frequently happen again.

Acute urticaria and/or angioedema: With these conditions, hives or swelling lasts less than 6 weeks. The most common causes are foods, medicines, latex, and infections. Insect bites or a disease may also be responsible.

The most common foods that cause hives are nuts, chocolate, fish, tomatoes, eggs, fresh berries, soy, wheat, and milk. Fresh foods cause hives more often than cooked foods. Certain food additives and preservatives may also be to blame.

Drugs that can cause hives and angioedema include aspirin and other NSAIDs (such as ibuprofen), high blood pressure medications (such as ACE inhibitors), and painkillers such as codeine.

Chronic urticaria and/or angioedema: Hives or swelling that lasts more than 6 weeks. The cause is usually harder to find than in acute cases. The causes can be similar to those of acute urticaria but can also include your immune system, chronic infections, hormonal disorders, and tumors.

Physical urticaria: Hives caused by direct physical stimulation of the skin – for example, cold, heat, sunlight, vibration, pressure, sweating, and exercise. They usually happen right where the skin was affected and rarely appear anywhere else. Most appear within 1 hour after exposure.

Dermatographism: Hives that form after firmly stroking or scratching the skin. You may also have other forms of hives.

Hereditary angioedema: Painful swelling under the skin. It runs in families.

Your doctor will ask you many questions to try to find the cause of hives or angioedema. You’ll also get a checkup.

Your doctor may give you skin tests to find out if you’re allergic to something. You may get blood tests, too.

The best treatment is to identify and remove the trigger. But that’s not always easy.

Your doctor may prescribe antihistamines to ease your symptoms or help prevent them.

If you have chronic hives, you may need antihistamines or a combination of medications, such as steroids or a biologic drug.

For severe hives or angioedema, you may need a shot of epinephrine or a steroid medication.

While you wait for the hives and swelling to disappear:

1. Avoid hot water. Use lukewarm water instead.
2. Use gentle, mild soap.
3. Apply cool compresses or wet cloths to the affected areas.
4. Try to work and sleep in a cool room.
5. Wear loose-fitting lightweight clothes.
6. Use anti-itch medication that you can get without a prescription, such as an antihistamine or calamine lotion.
7. Apply a fragrance-free moisturizer several times a day to keep your skin from getting dry.

If you have hives or angioedema and any of the following symptoms, call your doctor right away:

• Dizziness
• Wheezing
• Trouble breathing
• Tightness in the chest
• Swelling of the tongue, lips, or face

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Hives, Urticaria, and Angioedema: Symptoms, Causes, and Treatment

Written by WebMD Editorial Contributors

• Causes
• Types
• Diagnosis
• Treatment
• 7 Simple Tips
• When Should I Call the Doctor?
• More

Hives are swollen, pale red bumps, patches, or welts on the skin that appear suddenly. On darker skin tones, they can appear skin-colored and can be more difficult to see. They can happen because of allergies or other reasons. Your doctor may call them urticaria.

Hives usually itch, but they may also burn or sting. They can show up anywhere on your body, including the face, lips, tongue, throat, and ears. Hives can change size rapidly and move around, disappearing in one place and reappearing in other places, often in a matter of hours. Hives can often appear and then clear up within a few hours. Some people have one flare-up and never get hives again. It’s also possible to have many flare-ups.

They range in size from a pencil eraser to a dinner plate and may join together to form larger areas known as plaques. They can last for hours, weeks, or even years.

Angioedema is different. The swelling happens under the skin, not on the surface. It’s marked by deep swelling around the eyes and lips and sometimes of the genitals, hands, and feet. It generally lasts longer than hives, but the swelling usually goes away in less than 24 hours. It’s rare, but angioedema of the throat, tongue, or lungs can block your airways, making it hard to breathe.

Allergic reactions, chemicals in foods, insect stings, sunlight, and medicines can make your body release a chemical called histamine. Histamine sometimes makes blood plasma leak out of small blood vessels in the skin, causing hives or angioedema.

Sometimes, doctors don’t know exactly why hives have formed.

Urticaria, also known as hives, is a skin rash of raised, itchy bumps. The welts may also burn or sting. They often last hours or days, can move around, and don’t leave lasting skin changes. Viral, bacterial, or fungal infections may trigger hives, and they frequently happen again.

Acute urticaria and/or angioedema: With these conditions, hives or swelling lasts less than 6 weeks. The most common causes are foods, medicines, latex, and infections. Insect bites or a disease may also be responsible.

The most common foods that cause hives are nuts, chocolate, fish, tomatoes, eggs, fresh berries, soy, wheat, and milk. Fresh foods cause hives more often than cooked foods. Certain food additives and preservatives may also be to blame.

Drugs that can cause hives and angioedema include aspirin and other NSAIDs (such as ibuprofen), high blood pressure medications (such as ACE inhibitors), and painkillers such as codeine.

Chronic urticaria and/or angioedema: Hives or swelling that lasts more than 6 weeks. The cause is usually harder to find than in acute cases. The causes can be similar to those of acute urticaria but can also include your immune system, chronic infections, hormonal disorders, and tumors.

Physical urticaria: Hives caused by direct physical stimulation of the skin – for example, cold, heat, sunlight, vibration, pressure, sweating, and exercise. They usually happen right where the skin was affected and rarely appear anywhere else. Most appear within 1 hour after exposure.

Dermatographism: Hives that form after firmly stroking or scratching the skin. You may also have other forms of hives.

Hereditary angioedema: Painful swelling under the skin. It runs in families.

Your doctor will ask you many questions to try to find the cause of hives or angioedema. You’ll also get a checkup.

Your doctor may give you skin tests to find out if you’re allergic to something. You may get blood tests, too.

The best treatment is to identify and remove the trigger. But that’s not always easy.

Your doctor may prescribe antihistamines to ease your symptoms or help prevent them.

If you have chronic hives, you may need antihistamines or a combination of medications, such as steroids or a biologic drug.

For severe hives or angioedema, you may need a shot of epinephrine or a steroid medication.

While you wait for the hives and swelling to disappear:

1. Avoid hot water. Use lukewarm water instead.
2. Use gentle, mild soap.
3. Apply cool compresses or wet cloths to the affected areas.
4. Try to work and sleep in a cool room.
5. Wear loose-fitting lightweight clothes.
6. Use anti-itch medication that you can get without a prescription, such as an antihistamine or calamine lotion.
7. Apply a fragrance-free moisturizer several times a day to keep your skin from getting dry.

If you have hives or angioedema and any of the following symptoms, call your doctor right away:

• Dizziness
• Wheezing
• Trouble breathing
• Tightness in the chest
• Swelling of the tongue, lips, or face

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