Hives: when the skin rebels

Hives affect approximately 15–20% of the global population and are caused by an excessive immune response triggered by a variety of factors, such as foods, medications, and insect stings. This reaction leads to skin symptoms like itchy welts and swelling (Cleveland Clinic, 2022). But what exactly is behind this skin condition? This article is intended to help you better understand hives – from the causes and symptoms to effective treatment methods.

Table of Contents

• What are hives?
• What are the symptoms of urticaria?
• What causes urticaria?
• How is hives diagnosed?
• How is hives treated?
• Summary

What are hives?

Hives, medically known as urticaria, is a skin condition characterized by the sudden appearance of welts or swelling on the skin. Urticaria occurs when the immune system reacts to a stimulus and releases histamine and other inflammatory substances into the skin. This leads to swelling and fluid accumulation beneath the skin, which appears as welts (Cleveland Clinic, 2022).

Acute and chronic hives

Hives can be divided into two main types:

Source: Cleveland Clinic, 2022; Mayo Clinic, 2023

What are the symptoms of urticaria?

Hives are characterized by episodic skin symptoms that can vary in intensity and duration. The main symptoms are:

• Welts: Raised, well-defined swellings on the skin that itch.
• Swelling (Angioedema): Deeper swellings affecting the eyes, lips, and extremities.
• Itching, redness, burning: Often occur together with the welts.
• Transient nature of welts: Disappear within a few hours and reappear in other areas.

What causes urticaria?

Hives can be triggered by a variety of causes that stimulate the immune system to release histamine and other chemical substances. These include:

Allergic Reactions

One of the most common causes of hives is allergic reactions. These can be triggered by a variety of allergens, including: 

• Foods: Some of the most common foods that cause allergic reactions include nuts, shellfish, eggs, dairy products, and certain fruits such as strawberries.

• Medications: Aspirin, other nonsteroidal anti-inflammatory drugs (NSAIDs), and antibiotics such as penicillin can trigger hives in susceptible individuals.

• Insect stings or bites: Stings from bees, wasps, and other insects can cause severe allergic reactions in some people.

• Animal hair and dander: In individuals prone to allergies, animal hair and dander from pets like dogs, cats, and rodents can trigger symptoms of hives.

Source: PennMedicine, 2023

Non-Allergic Reactions

Hives can also be triggered by non-allergic factors. These include:

• Infections: Bacterial or viral infections can occasionally trigger hives.

• Physical stimuli: Heat, cold, sunlight, pressure on the skin (e.g., tight clothing), and excessive sweating can also trigger urticaria.

• Stress: Emotional stress can influence hives by triggering the release of the stress hormone cortisol. Cortisol stimulates inflammatory processes and the release of histamine, which intensifies the typical symptoms of hives, such as welts and itching.

Source: Mayo Clinic, 2023

Autoimmune Reactions

In rare cases, hives can be caused by autoimmune processes in which the immune system mistakenly attacks the body’s own cells or tissues. This can play a role especially in the chronic form of hives (Mayo Clinic, 2023).

How is hives diagnosed?

Diagnosing hives can be challenging because the symptoms are fleeting and can be caused by a wide variety of triggers. The physician will first take a detailed medical history and ask questions about the frequency, duration, and appearance of the welts, as well as possible triggers and any family history of allergies. The next step is a physical examination, during which the skin changes will be observed, and signs of allergic reactions will be assessed. The two most commonly used allergy tests to identify allergens that may trigger hives are the prick test and the specific IgE antibody test.

• Prick Test: In the prick test, allergen solutions are applied to the skin, which is then lightly pricked to allow minimal exposure; the appearance of an itchy, red welt indicates an allergy.

• Specific IgE Antibody Test: The specific IgE antibody test is a blood test that measures the concentration of IgE antibodies directed against specific allergens. An elevated IgE level against a particular allergen indicates a possible allergic reaction.

Source: PennMedicine, 2023

Want to get an overview yourself?

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How is hives treated?

The goal of treating hives is to relieve the symptoms. The treatment approach can vary depending on the severity and frequency of the symptoms as well as the underlying causes.

What medicinal treatment options are available?

• Antihistamines: These medications are the first choice for treating hives. They block the effect of histamine, which is released during allergic reactions and causes symptoms like itching and swelling.

• Corticosteroids: In cases of severe hives outbreaks, corticosteroids may be prescribed to reduce inflammation. However, they are generally used only for a short time, as long-term use can lead to side effects.

• Leukotriene Inhibitors: These drugs, commonly used to treat asthma, can also help relieve symptoms of hives.

What non-medicinal treatment options are available?

• Avoiding triggers: An important part of treating hives is identifying and avoiding known triggers. This can be done through allergy testing, keeping a diary, and eliminating certain foods or medications.

• Cool compresses: Applying cool compresses to the affected areas of the skin can help reduce itching and swelling.

• Relaxation techniques: Since stress can be a trigger for hives, stress-reduction techniques such as meditation, yoga, and other forms of stress management can be helpful.

Sources: NHS, 2021; Silver, 2023

Summary

Hives, also known as urticaria, result from an overreaction of the immune system triggered by a variety of causes such as foods, medications, insect stings, or physical stimuli. The condition manifests as itchy welts and swelling on the skin and can be either acute or chronic. Diagnosis is carried out through tests such as the skin prick test or the specific IgE antibody test, which help identify specific allergens. Treatment involves medicinal approaches such as antihistamines and, if necessary, corticosteroids, complemented by non-medicinal strategies like avoiding known triggers and applying stress management techniques.