Hives are small swellings of the skin and are one of the most common symptoms of human skin reactions based on a complicated series of chemical body processes. Up to 20% of the population suffers from the harmless wheals at least once in their lives.
What are wheals?
Wheals are dot-like elevations of the skin that occur after insect bites or can be symptoms of allergy or hives. Click to enlarge. Wheals are circular, red spongy lesions of the skin and develop over minutes to hours. Usually, they are surrounded by an area of redness. Wheals can vary in size from a few millimeters to huge swellings that can cover an entire limb. They can be found on any skin surface, but usually the palms and soles are not affected. Usually wheals disappear after some time, so depending on the length of the infestation, acute or chronic wheals are distinguished. The skin swelling results from an increased storage of fluid in the cells due to an increased permeability of blood vessels in the skin, caused by an increased histamine release. Therefore, wheals are usually also associated with severe itching.
Causes
Allergy-caused wheals are due to foods, plants, insect bites, medications, or cosmetics. Foods that cause wheals include eggs, milk, nuts, fish and shellfish, berries, chocolate, or tomatoes. While coffee, alcohol and tobacco are less likely to trigger acute conditions, these substances can exacerbate them in people with chronic wheals. Almost any medication can cause wheals, often including anti-inflammatory drugs (e.g., ibuprofen or acetylsalicylic acid), antibiotics such as penicillin, antiepileptic drugs, or anesthetics. Soaps, perfumes, and lotions can cause reactions, as can jewelry containing nickel or latex. Since wheals are external effects of bodily defense processes, they may also appear as a result of various infections. About 5% of the population is also prone to wheals due to physical skin irritation, i.e., as a result of scratching or sun exposure.
Diseases with this symptom
- Hives (Urticaria)
- Contact allergy
- Cat allergy
- Histamine intolerance
- Nickel allergy
- Sun allergy
- Food allergy
- Lice infestation
- House dust allergy
Diagnosis and course
Acute wheals are usually not visible for more than 24 hours, but in some cases the condition can last up to 6 weeks. A condition is called chronic only beyond this period. Mattness, headache, and elevated temperature sometimes accompany the condition. The more histamine and other endogenous anti-inflammatory agents are released into the layers just under the skin, the greater the swelling of the wheals, itching may turn into mild pain. This condition is called angioedema and may appear as swelling of the mucous membranes of the mouth, intestines, genitals or throat. Diagnosis of wheals will mostly refer to clarification of possible causes of the allergic reaction (detailed questioning). Chronic wheals may refer to diseases of the thyroid gland or rheumatoid arthritis. In this case, specific routine tests are performed for diagnosis.
Complications
Hives arise from a variety of causes, but most often they occur as part of an allergic reaction. These can also have various complications. Due to an allergic reaction, in addition to the typical wheals, there is also severe redness of the skin and severe itching. In addition, there is also nausea and vomiting. A swelling of the airways is also characteristic, so that these and the esophagus are constricted. This results in difficulty breathing and swallowing, which can even lead to choking. A feared complication of hives is Quincke’s edema. In this case, there is additional swelling of the deeper layers of the skin, in addition to the face and hands and feet, including the genitals. In the head area, this also leads to severe swelling, and the shape of the face is greatly altered. This also results in life-threatening [[respiratory distress9]]. The most severe form of allergic reaction is anaphylactic shock.The affected person experiences a massive drop in blood pressure and an increase in heart rate. This leads to a lack of blood supply to important organs, which can die in the course of the disease. In addition, dizziness and even a fainting spell can occur, which can even lead to death. Some infectious diseases such as measles can also cause wheals. Complications of measles include middle ear infections (otitis media), pneumonia, and a rare but life-threatening brain infection (encephalitis).
When should you go to the doctor?
The sudden appearance of wheals on the skin can be alarming. In most cases, however, these itchy rednesses are harmless and disappear as quickly as they came. This happens, for example, when they are triggered by stress, insect bites or mild allergic reactions. In some cases, however, a visit to the doctor is necessary. If the hives remain on the skin for weeks, they may be a sign of chronic hives. In that case, a dermatologist should be consulted, who can initiate appropriate treatment. The redness can also indicate a strong allergy, which can sometimes become life-threatening – for example, a reaction to a drug such as penicillin or certain foods. In such a case, a doctor or the hospital should be consulted quickly. An insect bite can also sometimes become dangerous, for example a tick bite. This should be examined by a general practitioner or dermatologist so that no serious diseases such as Lyme disease can develop. If a ring-shaped redness develops around the bite, a visit to the doctor is absolutely necessary. Scratching of wheals must be avoided at all costs to prevent dirt from getting into the wound and causing infections. If inflammation is suspected, a doctor should also be consulted.
Treatment and therapy
Only when wheals appear with dizziness as well as difficulty breathing, associated with throat swelling, should a doctor be consulted immediately. In milder cases, the main thing is to cleanse the bodily fluids and relieve the itching. Itch-relieving ointments or sprays are suitable for this purpose, as are simple home remedies such as lemon juice or cooling. In case of extensive spreading, sweat baths with valerian or chamomile decoction followed by cold pouring are recommended. For detoxification it is recommended to fast and drink plenty of vegetable juices or herbal teas. Since in the majority of cases of chronic wheals the causative factor cannot be determined, antihistamines are the mainstay of treatment for these patients. These must be taken regularly to prevent the release of histamine. Newer drugs such as Zyrtec, Claritin or Allegra are well tolerated and cause hardly any typical side effects such as drowsiness. If antihistamines do not work, oral steroids such as prednisone or Medrol are used. Severe cases of wheals can be treated with epinephrine injections (decongestant effect).
Outlook and prognosis
In most cases, wheals cause itching, resulting in severely reddened skin at the affected area. However, the patient should not scratch under any circumstances, as scratching only intensifies the itching. If the wheals appear due to an allergy or intolerance, they usually disappear on their own after only a few hours and do not cause any further problems. This also applies to contact with plants or in the case of insect bites. Medical treatment is not necessary in these cases. If the wheals remain on the skin longer, a doctor must be consulted. Treatment is usually done with the help of medications or creams. The affected area on the skin may also swell. Cooling can be used to counteract the swelling. If the food in question cannot be avoided in case of intolerance, an allergy remedy must be taken or a substitute found. Surgical intervention is not possible for wheals. Scratching the skin may leave wounds or scars, so it should be refrained from.
Prevention
Prevention is the best treatment for wheals. Once the triggering factors (triggers) for wheals can be determined, these foods, cosmetics, or medications should be avoided. This may mean a complete change of lifestyle in some circumstances.To avoid hives caused by insects or plants (e.g. stinging nettles), adapted clothing is recommended.
What you can do yourself
A number of home remedies and measures help against wheals. First, the irritated skin areas should be cooled with cold compresses. Baking soda relieves the itching and acts against the rash. Mixed with water to form a thick paste, it is applied directly to the wheals and rinsed off with water after 30 minutes. Alternatively, a bath with a cup of baking soda also helps. A natural home remedy for hives is also turmeric. The substance is taken two to three times a day or applied to the hives and should quickly provide relief. Other home remedies include nettle, basil, peppermint and apple cider vinegar. Aloe vera and healing clay are also suitable as a quick self-help remedy due to their anti-inflammatory effect. Further skin irritations can be prevented by clothing made of natural fibers. If an intolerance or allergy is suspected, an organic detergent without optical brighteners and perfume should be used. It is also recommended to reduce stress and psychological strain and to avoid hot baths and direct sunlight. If the hives persist for more than a week, a doctor should be consulted immediately.