Urticaria: Acute and Chronic Hives…

Urticaria is also known as Hives.  It is a vascular reaction of the skin characterized by the appearance of wheals that are often surrounded by a red halo or flare.  It is associated with severe pruritus or itching, stinging and/or a pricking sensation.  These wheals are caused by localized edema.  Clearing of the central portions may occur and some areas may coalesce producing an annular or polycyclic pattern (see above and below).

Subcutaneous swellings, also known as angioedema, may occur, particularly around the mouth.  If the urticaria is accompanied by other symptoms, such as fever, malaise and joint/bone pain the diagnosis of autoinflammatory conditions should be entertained.

Acute Urticaria evolves over days to weeks, producing evanescent wheals that individually, rarely last more than 12 hours.   Daily episodes may occur up to 6 weeks in duration, but in the acute phase the urticaria resolves.

Chronic Urticaria is defined as hives that persist for longer than 6 weeks.  Chronic urticaria mostly affects adults and is twice as common in women as in men.

More than 55% of chronic urticaria are of unknown causes.  Another interesting category is what is referred to as the Physical Urticarias which represents up to 35% of the chronic forms of hives…this class includes dermatographic, cold, heat, cholinergic, aquagenic, solar, vibratory, galvanic and exercise-induced urticaria.

ETIOLOGY:  The causes of Acute and Chronic Urticaria are vast, ranging from infections (viral), ingestants (food allergies), inhalants and drugs (medications oral and injectable or intravenous).  Needless to say, the list of causes is vast, ranging from upper respiratory tract infections, chocolate, strawberries, tomatoes, peanuts, pork, cheese, garlic, food additives, preservatives, house dust mites, feathers, formaldehyde, and a variety of medications to include antibiotics and NSAIDs.  Reviewing all of the potential causes is beyond the scope of this brief review.  To read more about Urticaria click HERE, HERE and HERE.

TREATMENT:  The basis for all forms of Acute and Chronic urticaria is the release of histamine by unstable mast cells.  For this reason the main stay of treatment is antihistamines, such as Claritin, Zyrtec, Hydroxyzine, etcSystemic steroids may provide some immediate and short term relief.  A variety of injectables (Xolair) and JAK inhibitors are also therapeutic.  The treatment is complicated and requires an extensive history and evaluation.  If you are having problems with hives I strongly suggest you see your local dermatologist for evaluation.