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Hives / Urticaria — The Tic-Tac-Toe that we can create on our skin

Ever wondered why there are days we vigorously scratch our rashes
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Ever wondered why there are days we vigorously scratch our rashes or our friends drop comments stating our skin rash resembles a map? Sometimes the mere action of picking up a pen can induce an itch, which then leads to swelling and redness.

This is known as hives. And it’s more common than you would think. Read on to find out more about this itchy situation.

Reaction of hives on the skin

What is hives/urticaria?

Hives, medically known as Urticaria, comes from the term Urtica Dioica, the stinging nettle plant abundantly found in Europe. Hives are your body’s response to irritation and come in the form of little marks on your skin similar to mosquito bites.

Hives are typically represented by an itchy wheal (swelling of the skin) surrounded by the occasional redness. The wheal tends to be slightly paler than your surrounding skin colour, is swollen, very itchy, and with lesions. Thankfully, these will usually resolve within or after 24 hours.

If you notice wheals or have any persistent itchy redness on your skin, consult your doctor for proper treatment and ways to reduce or manage possible symptoms of hives and rashes.

What causes hives/urticaria?

Hives occur when there is a sudden release of a chemical agent (such as histamine) into your skin.

Histamine is a substance that causes blood vessels to dilate and leak, leading to extra fluid accumulation in the tissue. If this has occurred, you may experience swelling, warmness and a slight itch on the affected region.

There are a risk factors that trigger histamine to be released, these are:

  • Change in temperature, both hot and cold
  • Infection
  • Allergic reaction to food
  • Allergic reaction to certain drugs, such as penicillin, NSAIDS, etc.
  • Consumption of alcohol and caffeine
  • Stress
An allergic reaction to food can cause hives.

The cause of your hives may be different from someone else. Determining this will require a medical history and/or physical examination.

Visiting your doctor can help to determine what your skin is reacting to and if you have hives.

What triggers hives/urticaria?

In some cases, patients with hives may have no known direct or obvious trigger for their condition but can be easily identified for others.

Below is a table with common stimuli that can induce hives, and depending on the type of stimuli, the condition can be further sub categorised.

StimuliName of the hives / urticaria
Cold temperature (cold air or water)Cold urticaria
Hot temperature (hot air or water)Heat urticaria
Sweat from to exercising/heightened emotionsCholinergic urticaria
Pressure on the skin surface from heavy bags, seat belts, bra straps, or belt linesDelayed pressure urticaria
Tight clothing or scratching of the skinDermographism
Towel drying after a hot showerVibratory urticaria
Contact with waterAquagenic urticaria
Substance absorbed through the skin from contact with latex, saliva, flour, meat, fish, vegetables, caterpillar, or stinging nettleContact urticaria
Hives can cause the skin to become very itchy.

What are the signs and symptoms of hives/urticaria?

  • Itchy wheals: white, pinkish, or red in colour of various shapes and sizes
  • Lesions: comes and goes within a few hours or 1 day
  • Deeper swelling: occurring on the lip, eyelid(s), genital region (possible angioedema)

It is important to note that these symptoms can sometimes be an early sign of an allergic reaction, which can potentially be dangerous. Always seek medical attention if you suspect you are having an allergic reaction.

You can discuss any concerns with your doctor regarding symptoms of hives for further evaluation and treatment.

Types of hives/urticaria

Hives can be categorised according to the duration of each symptom:

  • Acute urticaria: if symptoms occur for less than 6 weeks
  • Chronic urticaria: if symptoms occur for more than 6 weeks

Chronic urticaria can be further sub categorised into:

  • Chronic spontaneous urticaria: occurs without any known trigger
  • Chronic inducible urticaria: occurs due to a particular trigger

How common are hives/urticaria in Singapore?

Hives are a very common condition in Singapore, affecting 1 in every 5 Singaporeans (42%) at some point in their lives. Although hives are not a life-threatening condition, its wax and wane periods are enough to cause some discomfort and disruption in their daily lives.

Consider discussing any concerns with your doctor if you are experiencing any symptoms of hives.

Is hive/urticaria a serious condition?

Hives are not a self-limiting condition but avoiding proper treatment can lead to anaphylaxis — a life-threatening allergic reaction.

You are advised to monitor your symptoms and resolve them if they do not show any signs of improvement and progresses to spread all over your body and face. This could then lead to a slew of other reactions such as shortness of breath, wheezing, and feeling faint.

If you experience any of the above, please seek medical attention immediately.

Seek immediate medical attention if you are having an allergic reaction

Are hives/urticaria contagious?

Luckily, hives are not infectious, and you will not contract it from someone with hives — be it airborne or through direct contact.

Are hives/urticaria an allergy?

While hives are a subset of allergy, it can occur without the presence of an allergen. Triggers such as dust mites, mould, pet dander, pollen, chemicals, drugs, latex, and food allergens can trigger hives-like symptoms. This can be confusing for both patients and physicians to deduce underlying medical conditions.

You are advised to speak to your doctor for further evaluation of any hives or allergy symptoms.

Can I die from hives/urticaria?

The short answer is there is a low chance of you succumbing to hives.

However, hives can be an early sign of anaphylaxis, which is a severe allergic reaction that can be fatal.

Signs of anaphylaxis include:

  • Hives
  • Swelling of the eyes and lips
  • Difficulty breathing
  • Wheezing
  • Dizziness
  • Loss of consciousness

Anaphylaxis is a treatable medical condition. If you show any signs of anaphylaxis, you should seek immediate medical attention.

Do hives/urticaria suggest underlying medical conditions?

Hives can be a sign of an underlying medical condition, these include:

  • Micromineral deficiency (such as iron deficiency anaemia)
  • Thyroid disease
  • Kidney or liver disease
  • An autoimmune condition (such as vasculitis or SLE)

It is advisable to speak to your doctor if you notice any signs of hives or if symptoms of hives persist and worsen over a long period of time for further evaluation and treatment.

When should I see my doctor for hives/urticaria?

In most cases, hives symptoms are temporary and can be resolved on their own.

However, it is always recommended to see your doctor if symptoms:

  • Do not resolve after 2 days
  • Are widespread and severe
  • Affect and limit your daily routine
  • Cause pain and distress
  • Show signs of bruising and scarring from lesions

What do I expect when I see my doctor for hives / urticaria?

Hives are usually clinically diagnosed by your doctor by viewing your medical history for a better understanding of what could be triggering your hives. Depending on your individual conditions or if your doctor suspects an allergic reaction, you may be offered to do an allergy test followed by allergy treatment. Occasionally, your doctor may also require blood tests to be done to evaluate and rule out any underlying medical condition you may have that could trigger hives.

Find out the causes and triggers of your hives with a doctor

Is there any treatment for hives/urticaria?

Mild or transient hives may resolve their own without any medical treatment. However, if 

the itchiness is troubling you on a daily basis – be it pain or other symptoms – that leads to feeling unwell or a fever, you are advised to seek medical attention for hives treatment.

If you show any signs or symptoms of hives, your doctor will usually prescribe you with antihistamines to reduce symptoms. For severe cases, steroid medication, H2-antagonist Montelukast, or newer injectables such as biologics omalizumab may be prescribed instead.

During your consultation, your doctor will go through some triggers that could possibly be causing hives and ways to reduce the chances of a recurrence.

What are the possible complications of hives / urticaria?

Although hives are not a life-threatening condition on its own, one fourth of patients with hives can have coexisting angioedema.

Angioedema is a medical condition that causes swelling and fluid build-up in the deeper part of the skin. It mainly occurs over the softer, gravitational-dependent regions of the body such as the eyes, lips, genitals, hands, and feet.

More importantly, hives can also be an early sign of an allergic response known as anaphylaxis. If you ever experience lightheadedness, narrowing of your airways, wheezing, swelling of your eyes and lips, feeling unwell or abdominal pain, please call an emergency hotline and seek immediate medical attention as a severe allergic reaction can lead to death.

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