Urticaria, commonly known as hives, is a skin condition characterised by itchy, pink-red bumps that appear suddenly on the skin[1]. These raised welts can vary in size and shape and are often accompanied by intense itching, red rashes and skin swelling[2]. The symptoms of urticaria can range from mild to severe, with some people experiencing blistering or fluid-filled lesions[3]. The condition can be distressing and uncomfortable for those affected and can lead to a desire to understand its causes and triggers for effective management.

The causes of urticaria can be very diverse, including histamine release, chemical triggers, certain foods, medications, and even stress[2]. The release of histamine or other chemicals in the body plays an important role in the development of hives, leading to characteristic red, raised bumps on the skin[2]. Allergic reactions to various allergens such as white flour, cosmetics and textiles can also trigger urticaria[4]. Understanding the underlying causes of hives is crucial for developing appropriate treatment strategies and identifying potential triggers that should be avoided in the future.

Common triggers of urticaria can be both internal and external stimuli, ranging from allergens to physical factors[1]. Some of the common triggers for hives include: - Allergic reactions to foods such as nuts, shellfish and eggs - Reactions to medications such as antibiotics or non-steroidal anti-inflammatory drugs (NSAIDs) - Exposure to environmental allergens such as pollen or pet dander - Stress and emotional factors - Physical stimuli such as pressure, cold, heat or sunlight Identifying and avoiding these triggers can help individuals with urticaria manage their condition more effectively and reduce the frequency and severity of flares[5]. By taking proactive steps to minimise exposure to known triggers and incorporating appropriate medical interventions, individuals can achieve better quality of life and better control over their urticaria symptoms[6].

 

Diagnosis and treatment options for urticaria

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Diagnosis of urticaria typically involves a thorough assessment of the patient's medical history and a detailed physical examination[3]. By considering the individual's symptoms and health history, healthcare providers can gather valuable information to help determine the underlying causes of hives[10]. During the physical examination, a dermatologist or healthcare professional will examine the skin for characteristic signs of urticaria, such as pale red, raised and itchy bumps[1]. This initial assessment is crucial in determining the appropriate diagnostic approach and treatment plan tailored to the specific needs of the patient.

In cases where the cause of urticaria is unclear or suspected to be due to allergy, further diagnostic tests such as allergy testing and blood tests may be recommended[4]. Skin allergy tests, including prick tests and patch tests, can help identify potential allergens that trigger hives[11]. If skin testing is not possible, blood tests can be used to detect specific antibodies associated with allergic reactions[12]. In addition, for individuals with chronic urticaria triggered by physical factors, specialised tests such as liver enzyme assessments and infection tests may be performed to investigate underlying factors[13]. These diagnostic procedures play an important role in uncovering the root causes of urticaria and guiding treatment decisions.

Once the diagnosis of urticaria is confirmed, the treatment approach usually involves a combination of antihistamines, corticosteroids and lifestyle changes[3]. Antihistamines are usually prescribed as first-line treatment to relieve itching and reduce the appearance of hives[5]. In severe or refractory cases of urticaria, corticosteroids may be recommended to help manage inflammation and symptoms[14]. Furthermore, lifestyle changes such as avoiding known triggers, maintaining a healthy diet and managing stress can complement medical interventions and support the long-term management of urticaria[15]. A comprehensive treatment plan can help individuals effectively manage urticaria and improve their quality of life by addressing both the symptoms and underlying causes of hives.