Hives is an allergic immune reaction developed like a skin rash in response to environmental allergens. Skin is an important organ of immunity that acts as defense barrier to factors perceived as toxic whether internal or external. Generally chronic hives do not lead to complications and shouldn’t be a major concern as its an allergic reaction produced to something that would otherwise be non-toxic.

Symptoms of Urticaria

Raised warm itchy areas on the skin can describe all forms of urticaria. Non-contagious rash may appear suddenly on any part of the body, last for few hours and disappear. Symptoms tend to increase at night and sleep deprivation may worsen the condition. Bee sting and drug allergy can lead to severe complications like breathlessness and shock in addition to skin problems. Swelling of lips and tongue are some grave signs that would need immediate medical help.

Causes of Urticaria

• Certain foods or newly introduced medicine can produce a surprise allergic reaction. Foods causing allergy could be nuts, seafood, dairy products, tomatoes, berries, eggs or gluten (wheat intolerance)
• Inhaling air borne allergens like dust, pollen and mold
• Stress and altered immunity can be inter-related and though ambiguous are more important factors
• Animal fur, cosmetics and synthetic material
• Insect bite and wasp sting
• Extreme cold or hot climate
• Rise in body temperature due to heat or exercise
• Physical stimulus like pressure or tight clothing
• Viruses may trigger hives
• Illnesses like hepatitis and lupus can cause skin allergies and treatment of the disease relieves the rash
• Hereditary causes of urticaria express themselves in childhood and need to be diagnosed and treated accordingly. Multiple allergens usually complicate the diagnosis

Urticaria Treatment

• Systemic illness needs to be excluded before treating urticaria
• Cold water shower
• Loose-fitting clothing
• Heavy physical exercises should be avoided
• Sunscreens and warm clothing can be used in solar and cold urticaria respectively.
• Identify and eliminate exposure to environmental factors
• Gradual diet elimination is a proven way to detect sensitivities
• Stress reduction by meditation and yoga
• Antiallergics like H1-antihistamines (e.g. Cetrizine) should be preferred due to its non-drowsy effect and can be safely used without side effects or addiction
• Steroids and epinephrine are used in severe cases with anti-histaminics to suppress the immune reaction. Steroids can help in acute attack but aren’t recommended for long-term use.
• Lacto calamine application, milk of magnesia and aloe vera gel can be used as topical creams.
• Dietary supplements and anti-oxidants to increase the immunity.

Living with Urticaria

The probable causes and definite cure has definitely left the specialists too scratching their heads. Recurrent hives in absence of any detectable factor should direct towards stress as the cause. Thus, an effort to identify trigger factors, effective stress management and symptomatic treatment for an unknown duration is the main key to relieve symptoms.

Prevention of Urticaria

Finding out such allergens can actually be an impossible task. Avoid exposure to any food, medicine, or physical agent that could possibly cause the rash. A daily diary can help monitor and diagnose the food allergy. Though emotional and physical stress is unavoidable, it should be dealt with appropriate relaxation therapies like exercise, yoga, meditation and social support groups. Self-evaluation after stress management could help, as it would be difficult to assess stress thresholds and hence stress recovery on the part of the physician.

By Dr. Meenaz M Published: 11/27/2007

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