Hives: Symptoms, Diagnosis, Treatment

What are hives?

Hives, medically known as urticaria, are red, itchy bumps that suddenly appear on your skin. They can vary in size and appear anywhere on the body. Hives are typically red, pink, or flesh-coloured and may come and go within a short period.

Hives are a common condition, but it is not contagious. You cannot develop hives by touching someone else’s skin or being in proximity to someone who has hives.

Hives vs rash

A rash is characterised by irritated or swollen skin.

Hives are a type of rash that presents as raised or puffy areas of the skin with intense itching.

What are the classifications of hives?

Acute hives

Most hives cases are acute and can persist over a few days to one or two weeks.

Chronic hives

May persist on a daily or near-daily basis, lasting longer than six weeks, and sometimes continuing for years.
They come and go and can disturb your sleep, work, or school. However, they are treatable in most individuals.
They are rarely caused by allergies and are not life threatening.
Chronic hives are rarely permanent; almost 50 percent of people are hive-free within one year.

What causes hives?

Hives occur when an immune response activates mast cells in the skin. These cells release natural chemicals, with histamine being a key one. Histamine leads to itching, redness, and swelling, resulting in the formation of a hive.

Acute hives

Chronic hives

These are the triggers that cause some acute hives to occur:

Infections
Certain medications
Insect stings
Food allergies
Physical contact with certain substances

The cause is unknown however, immune system may have a role to play.

Hives may be an indication of some other medical or autoimmune conditions, which include thyroid or liver diseases, chronic infections, or lupus. Most individuals with one of these conditions will experience other symptoms apart from the hives.

What are the symptoms of hives?

Symptoms of what the rash can appear and feel include:

Raised bumps or patches appear in various shapes and sizes.
Appear in one area or spread across the body.
Itchy, stinging, or burning sensation.
Appears to be pink or red when it impacts someone with a light skin tone; the colour of the rash can be difficult to notice on darker skin.

How are hives diagnosed?

Most individuals with hives do not require any testing. The diagnosis is typically made based on their symptoms and a physical examination.

Skin tests: If there are worries about allergies being a potential cause of symptoms, skin testing for food and drug sensitivities may be recommended. This is usually conducted for individuals with acute hives as chronic hives are seldom caused by an allergy.

Blood tests: Sometimes, blood tests are done if hives persist for six weeks or longer. Blood tests can detect potential signs of underlying diseases such as thyroid problems or an autoimmune disease.

Skin biopsy: A skin biopsy, which involves removing a small sample of skin, can help identify rare causes of hives. It may be recommended for individuals with chronic hives accompanied by other symptoms, such as persistent fever, painful hives, hives that last for days, or hives associated with skin bruising. Additionally, a skin biopsy may be suggested for those with other symptoms or abnormal blood test results.

How are hives treated and managed?

Avoiding triggers
- If a specific trigger is identified such as certain foods, medications, or environmental factors, avoiding it can help prevent hives.
Medications
- Non-prescription antihistamines: Aids in managing the itch and swelling.
- Oral steroids (glucocorticoids) like prednisone: Helps alleviate serious acute hives that do not improve with antihistamines. Once the hives have improved, the steroid dosage eventually decreases and then stops. Oral steroids may be used temporarily to alleviate chronic hives. They are not recommended for long-term treatment due to the potentially severe side effects when consumed for long periods (months or years).
Anti-itch cream or lotion
- For milder cases of hives, your dermatologist may prescribe a corticosteroid that you apply on your skin to help alleviate the itch.
Other treatments
- Omalizumab is a treatment used for very difficult-to-control hives. It is administered as a monthly injection and must be given by specialists.

Can hives be prevented?

Yes, hives can often be prevented by identifying and avoiding the triggers that cause them.

Avoid foods that have been identified to set off your symptoms.
Avoid using products with harsh chemicals.
Refrain from rubbing your itchy skin with a washcloth, loofah, or mesh sponge.
Use lukewarm water when taking a bath or shower and remember to be very gentle with your skin.
Avoid wearing tight-fitting clothing.
Inform your doctor right away if you suspect that a particular medication is causing your hives.

Consult an allergist, who is specially trained to identify triggers to your hives and may recommend medications to stop the hives or alleviate the severity of symptoms. Whether the recommended treatment is available only by prescription or over the counter will depend on various factors, including how much discomfort the hives are giving you.

While it is not always possible to identify the cause, monitoring your flare-ups may assist you in figuring out what potentially triggers your hives.

Make an appointment at Pantai Hospitals

Consult your doctor if your symptoms worsen or if you notice new symptoms of hives. A dedicated and expert team of dermatologists at Pantai Hospitals is available for consultation to provide the best care and assistance.

Pantai Hospitals has been accredited by the Malaysian Society for Quality in Health (MSQH) for its commitment to patient safety and service quality.