Hives also medically termed urticaria is a common skin condition, affecting 1 in 5 people at some point of their lives. Hives are made up of itchy pink or white bumpy areas of skin resembling nettle rash, or mosquito bites. We commonly described them as itchy wheals. The wheals can be round shaped, or appear as lines over the skin that is firmly stroked.  The rash can appear anywhere over the body. One typically notice the rash disappear spontaneously without leaving a mark within 24 hours, although in some, the rash can last longer.

Angioedema is used to describe tight swelling, with mild tenderness and some degree of itchiness that occurs over the mouth, lips, tongue or even the eye lid. Angioedema can occur on its own, or occur together with hives. This usually takes more than 24 hours to resolve.

How is Hives diagnosed?

Very often, the history and appearance of the rash is sufficed for your doctor to make the diagnosis. If a certain trigger is suspected, specific blood test to detect antibodies, skin prick test may be offer. Speak to your doctor to find out more.

What is the treatment of Hives?

In most individuals of hives, the course of rash is unpredictable. In half of the cases, the rash lasts for 6-12 months then slowly disappear.

During active rash period, the treatment options are as below

  • Antihistamine tablets such as cetirizine, telfast, levocetirizine, bilastin
  • Oral steroids
  • Medication to lower the immune system such as cyclosporine
  • Injection biologics therapies such as omalizumab
What can I do if I have Hives?
  • Write a hives diary- to find out possible triggers
  • If there is any trigger, avoid the triggers that worsen urticarial
food allergy
When should I see a Doctor?
  • If you are uncertain of your rash
  • If you are distressed by the itch and appearance of your rash
  • If you have hives symptoms that last longer than 24 hours, and rashes that are tender and bruised in appearance.
Rare Health Alert and Emergency

If you develop symptoms of angioedema, difficulty breathing, wheezing and feeling unwell, you are advised to sought medical attention immediately in view of possible allergic reaction that may be life threatening.

What causes Hives and Angioedema?

Hives is caused by the release of histamine from the cells underneath the skin called mast cells.

In some, common specific triggers for the release of histamine include

  • Infection
  • Change of temperature- cold or heat
  • Sun exposure
  • Water exposure
  • Exercise and sweating
  • Tight fitting cloths
  • Alcohol
  • Dust mite
  • Animal fur
  • Food allergens including food coloring agent, preservatives
  • Medicine such as blood pressure medicine (ACE inhibitor)

Frustratingly, often, the underlying triggers are not able to be identified.

Medical conditions such as anemia or thyroid disease can exacerbate hives, and should be excluded.

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