Hives (urticaria), also known as nettle rash, is a complicated and complex skin condition. It develops as a result of a hypersensitivity reaction to various chemical and natural substances or external stimuli to the skin. Approximately 10 to 20 percent of people in Germany have experienced hives at some point in their lives. Hives are not contagious, but should be examined and treated by a doctor as soon as possible, because in some cases it can lead to circulatory shock and then a life-threatening situation can occur.
What is hives (urticaria)?
Hives are pinpoint-like elevations of the skin that occur after insect bites or can be symptoms of allergy or hives. Click to enlarge. Hives are referred to as urticaria in medical terminology and are characterized by characteristic red wheals on the skin that develop from smaller, reddened elevations. These can basically occur on any part of the body, some are more prone to them than others. Acute urticaria is a form that lasts for 6 weeks in the longest case and then resolves. If the symptoms last longer, it is called chronic hives.
Causes
Most often, hives are triggered by histamines released by the mast cells of the skin. This initially causes the formation of the small elevations that gradually spread to form wheals. The causes for the release of the histamines are different. For example, it may be an autoimmune reaction. In this case, the body does not tolerate the substances it secretes itself. Hives develop as a reaction to this. It can also be a hypersensitivity to a substance that either comes into direct contact with the skin or passes through the digestive tract. This can be dyes or flavorings, but also pathogens such as bacteria, which are expressed exclusively by this symptom. In rarer cases, there is a true allergy that manifests itself as hives. The other two major causes of hives include the physically induced and the psychologically induced condition. External stimuli such as pressure or scratching can cause red welts to appear on the affected area, which may resolve over time or only after a prolonged healing process. Stress or psychological stress can also be the trigger of hives.
Symptoms, complaints, and signs
Hives are first manifested by itching and the typical wheals. As a result of the water retention, the skin surface swells and inflamed areas develop that are sharply defined and painful on contact. These wheals can be white to reddish and a few millimeters to two centimeters in size. Several wheals can join together to form an extensive skin lesion. This can lead to bleeding and, in individual cases, to the development of ulcers. Typical accompanying symptoms are also feelings of tension and skin irritation, for example sensory disturbances or overheating. Occasionally, the wheals are accompanied by so-called angioedema. This is cushion-like swollen subcutaneous tissue, which is normally painless. However, redness, itching and a feeling of tension may occur. Angioedema occurs mainly on the face, palms and soles of the feet. In individual cases, the mucous membranes are also affected. Hives regress within a day. In chronic hives, the skin changes can persist for weeks, months or even years and affect large areas of skin. If hives occur as part of an allergy, anaphylactic shock can occur, which is associated with shortness of breath, sweating, rapid heartbeat, and eventually circulatory shock.
Course of the disease
The course of hives depends on the form of the disease. Thus, in the acute form, the disease usually lasts only a few days or a few weeks. The maximum duration of acute hives is six weeks. Typical symptoms are, as already mentioned, a very itchy rash with reddish wheals and, in rare cases, painful swelling of the skin. Chronic urticaria, however, can last up to several years or appear again and again. However, the symptoms of acute hives occur less frequently.Chronic hives should always be treated by a doctor to investigate the cause and thus find out potential allergies, or hypersensitivities to certain foods that are responsible for chronic hives.
Complications
In most cases, those affected by hives suffer from various skin complaints. These are very uncomfortable and can mean a significantly reduced quality of life for the sufferer. In most cases, this involves the formation of a rash on the skin. This rash is also associated with itching, so that scars can form from scratching. Children in particular scratch themselves constantly, so that bleeding can also occur. The skin itself is white in color in the affected areas and in some cases also slightly swollen. Furthermore, the hives can also spread to the tongue or to the mucous membranes. This can also lead to shock and, in the worst case, heart failure. However, this case occurs very rarely. As a rule, hives can be limited again relatively easily with the help of medication. The patient may be dependent on light therapy. However, no particular complications occur. Hives do not usually have a negative effect on the patient’s life expectancy.
When should one go to the doctor?
If the skin symptoms remain unchanged for days, this should be clarified by a doctor. If skin changes increase, a visit to the doctor is advisable in the next few days. If itching occurs, antipruritic medication may be necessary. Which medications can be considered or what alternative there is to drug therapy can be clarified with the family doctor. If shortness of breath, circulatory problems occur or there is swelling on the body, emergency action is required, as a life-threatening condition may develop. If swelling occurs, for example in the face, a specialist in emergency medicine can quickly relieve the symptoms with medication. In the case of chronic courses, urticaria counseling can be sought in special treatment centers. The focus here is on helping people to help themselves. Frequent visits to the doctor, which can reduce the quality of life, are thus avoided. If there is any uncertainty as to whether a visit to the doctor is necessary, it is advisable to make it as a precaution. Accompanying psychological complaints, which are e.g. a consequence of the itching, can also be addressed by the family doctor. A further referral to specialists who are specialized in psychological accompaniment or skin diseases is made by the family doctor.
Treatment and therapy
Acute hives are usually not treated. In most cases, the wheals regress on their own. Depending on the cause, this can happen within a few minutes, but it can also take several weeks. Chronic hives are treated with antihistamines and cortisol. However, both agents only suppress the symptom of an underlying disease. Therefore, the reason for the development of chronic hives must be determined at the same time. It can only be eliminated in the long term if the trigger is also eliminated. If there is an underlying bacterial infection of the digestive tract, the hives will only disappear permanently if the bacteria are fought and killed. Accordingly, individual therapy with specific medications for the particular condition is required. In the case of psychological causes, medications do not help. In such cases, the trigger must be identified and eliminated in the long term. In this process, the psychologist can provide support.
Outlook and prognosis
Nowadays, there are already very good treatment options for hives. The most important thing here is to find out the trigger of the disease. This can be done by keeping a diary. If the drug treatment works well, a symptom-free state can be achieved for the patient. The uncomfortable hives are prevented by avoiding the trigger and taking continuous medication. Thus, the prognosis of hives is very good with successful treatment. If left untreated, hives cause spontaneous swelling of the skin, redness, itching and burning. The symptoms are very unpleasant for the affected person.They can last up to 24 hours and greatly restrict the patient’s everyday life and quality of life. Sleep disturbances, a decrease in concentration and performance (at school or work) are not uncommon. Subsequently, the sexual life can suffer and depression, withdrawal and anxiety can massively affect the person suffering from hives. The prospect of a cure or learning to live with the disease is a very good one in these days of modern medicine. There is not only enough specialized literature for an extensive cause research, but also already enough medicinal and homeopathic approaches that allow a symptom-free life with hives.
Prevention
Prevention of hives is possible only if the cause is known. If it is physical, it is important to avoid situations in which it could re-emerge. In case of allergic reactions, the body must be kept away from the substance to which it reacts. The same applies to hives that occur as a result of intolerance. Prevention becomes more difficult if the hives are psychosomatically caused. Since stress, in particular, is unlikely to be effectively avoided in everyday life, the patient must be taught to effectively cope with stressful situations and thus prevent the development of physical symptoms.
Aftercare
Once sufferers have gone through the acute treatment phase, it is important to determine what trigger caused the hives. This may have been indicated by chemical or biological factors such as infections, foods, medications, or insect venoms, or it may be the result of physical irritation by friction, cold, pressure, heat, or light. If the trigger is most likely to be suspected in food, an elimination diet should be followed. This is important to avoid severe complications such as glottic or Quincke’s edema in the future. In this particular form of diet, the sufferer is given only tea, water, potatoes and rice for one week. These foods are generally considered to be minimally irritating, meaning they contain no flavorings, fragrances, dyes or preservatives, which could lead to urticaria. When the immune system is cured after a week of diet, the provocation test series begins in the follow-up. Gradually, the patient is given a food that may be responsible for the hives. By strictly documenting the skin and mucous membrane reaction, the cause can be identified. The provocation test also includes a skin test in which a small area is exposed to various physical stimuli. Here, too, the reactions are precisely documented. If sufferers then know about the causes of urticaria, they can avoid this unpleasant condition in the future.
What you can do yourself
In everyday life, people affected by hives should ideally know exactly what they are allergic to. Thus, it is possible to avoid certain ingredients to the maximum. It is not always easy to find out what one reacts to with hives. It can therefore be helpful to keep a log: When do the hives occur and in what context? Sometimes it is possible to identify a trigger for the itching and the hives by keeping a close-meshed log. Especially when potential triggers of hives are unclear, it is important for sufferers to have necessary medications in their medicine cabinet. Hives can be severe enough to cause the eye to completely swell shut. The airways can also be obstructed in the worst case if the urticaria is severe. Here, self-help is not possible in acute cases. While milder symptoms of hives in everyday life can often be relieved by appropriate antihistamines, respiratory distress is always a medical emergency. Relatives should be familiar with the outward symptoms and know that they must immediately alert an emergency physician in case of shortness of breath. The doctor can quickly stop the allergic reaction with special medication administered intravenously.
