The following symptoms and complaints may indicate urticaria (hives):
Leading symptoms
- Urticae (wheals), usually on reddened skin (elevated erythema) [wheal duration usually up to one day].
- Painful/burning angioedema (sudden swelling of the skin or mucous membranes; seen in about 50% of cases of acute urticaria) [symptomatic for up to two (three) days]
- Severe pruritus (itching).
Macroscopically (“visible to the naked eye”), the following forms of urticaria can be distinguished:
- Urticaria bullosa – hives associated with blistering.
- Urticaria circinata – polycyclic limited foci.
- Urticaria cum pigmentatione – associated with hyperpigmentation.
- Urticaria gigantea – foci the size of the palm of the hand.
- Urticaria haemorrhagica – associated with hemorrhages.
- Urticaria pigmentosa – benign generalized proliferation of tissue mast cells.
- Urticaria porcellanea – whitish edematous wheals.
- Urticaria profunda – associated with deep edema formation.
- Urticaria rubra – bright red discoloration of the wheals.
Other indications
- In acute spontaneous as well as chronic spontaneous urticaria, the occurrence of urtica on the entire integument is possible.
- In inducible/physically triggerable urticaria, the efflorescences that occur are often limited to the site of contact, but may also be generalized. In some cases, extracutaneous symptoms also occur, such as fever, pruritus (itching), nausea (nausea), cephalgia (headache), vertigo (dizziness), dysphagia (difficulty swallowing), and dyspnea (shortness of breath).
- Angioedema occurs mainly on the face and in the head and neck area. Other complaints include painful abdominal discomfort / abdominal cramps nausea (nausea / vomiting, diarrhea (diarrhea) as well as dyspnea (shortness of breath), dysphagia (difficulty swallowing) and pruritus (itching) [see below Quincke’s edema, also known as angioedema].
Warning signs (red flags)
- Wheal duration > 24 hours → think of: Urticarial vasculitis (clinical presentation: small-spotted, maculo-papular (“nodular-spotty”) exanthema (rash) reminiscent of urticaria that is pruritic or painful; associated with lupus erythematosus in up to 50%.
- Fatigue, fatigue + fever + night sweats (night sweats) → think of: chronic lymphocytic leukemia (CLL).
