Urticaria (Hives) in Adults

Urticaria (Hives) in adults is an itchy skin rash that occurs on the surface of the skin, with a red circumference ranging from a few millimeters to a few centimeters, often pale in the middle. This picture, which we define as urticaria (hives), usually fades within 24-48 hours and does not leave any traces on the skin.

Urticaria can be seen alone, or it can be accompanied by swelling, which is approximately 50% angioedema, which does not collapse when pressed on. When it is associated with angioedema, subcutaneous layers are also affected besides the skin surface. It is important that angioedema usually involves the lips, tongue, around the eyes, hands, feet and genital areas. In addition, there is a feeling of pressure, burning and pain rather than itching. Patients may have itchy red skin swollen lesions on the eyelid with swelling on the lip.

If urticarial lesions last less than six weeks, they are defined as acute. If the lesions last longer than 6 weeks, it is defined as chronic.

Urticaria / angioedema is a very common skin reaction. The risk of occurrence in humans at any time in life ranges from 15-25%. We are likely to have an attack of urticaria throughout our life. Especially acute urticaria is more common in young adults and children. Chronic urticaria is less common, like 1%, and is more common in adults and women.

What is Urticaria (Hives) in adults?

Urticaria, also known as hives, is a raised, itchy rash on the skin that can appear all over the body. It is a common disease that can occur once in a lifetime in one in five people. The redness and swelling may decrease in one area of the body and may appear in another. Angioedema is swelling that occurs in the lower layers of the skin and can most often be seen in the eyes, lips and tongue.

What are the causes of Urticaria (Hives) in adults?

Urticaria (hives) occurs with the release of a substance called histamine from skin cells (mast cells). The most common cause of urticaria in childhood is infections caused by viruses. Less commonly, bacterial infections can also cause urticaria.

Medications are another common cause of urticaria. Penicillin and penicillin-like drugs, pain relievers and antipyretic drugs can often cause urticaria.

Another cause of urticaria is food allergens. In particular, urticaria that occurs within 1-2 hours following the intake of foods such as milk, eggs, nuts, seafood and fish, which are known to cause food allergy, should be considered as food allergy.

Insect bites can also cause urticaria.

What are the types of Urticaria (Hives) disease in adults?

Recurrence of urticaria (hives) for 6 weeks is called acute urticaria, while this condition lasts longer than 6 weeks is defined as chronic urticaria. Chronic urticaria is divided into 2 types within itself. The first group is chronic spontaneous (spontaneous) urticaria and the second group is urticaria that occurs (induced) with chronic stimuli. If urticaria occurs (induced) with chronic stimuli, the following are the types that occur due to the urticaria rash:

1) Dermographism:

It is the excessive response of the skin to simple stimuli such as pressure (such as a trouser belt), scratching and rubbing. It disappears within minutes with the elimination of the causative factor. It is the most common type.

2) Acquired cold urticaria:

It is a type of urticaria that occurs after exposure to cold such as cold weather and cold drinks and is more common in women than in men. Widespread exposure of the body to cold (such as diving into cold water) can cause low blood pressure, shortness of breath, unconsciousness, allergic shock, and even death.

3) Heat induced urticaria:

Limited hives develops on areas of the skin exposed to heat. It is a rare type. Hives usually last 1-3 hours.

4) Delayed pressure urticaria:

They are swelling in areas of the skin that are exposed to pressure. Unlike the rash seen in others of this type, it is a painful, itchy and burning rash that can occur hours after pressure exposure. It can last for hours or even longer than 24 hours. Carrying bags on the shoulder or back, sitting on a hard chair, tight shoes, carrying heavy bags in the hand can cause rashes.

5) Solar urticaria:

Solar urticaria usually occurs with UV-A. It is rare and more common in women.

6) Cholinergic urticaria:

Cholinergic urticaria occurs in situations that cause a sudden increase in body temperature (exercise / exertion, fever, hot bath, emotional stress, hot or spicy food and drink). It is common in young adults and during the winter. It is more common in allergic and sensitive bronchi. Typically, they are short-term, widespread, itchy, 5-6 mm pinpoint rashes.

7) Vibratory (vibratory) angioedema:

In this very rare type, angioedema occurs with local vibration. It can occur during snoring or dental procedures.

8) Contact urticaria:

It is a rash of urticaria that occurs suddenly after contact with a stimulating substance and regresses within a few hours. Common causes are plant components (stems, leaves), latex, cosmetics, industrial chemicals and textiles.

9) Urticaria caused by water (Aquagenic):

After contact of the skin with water, sweat, tears, swelling of 1-3 mm and redness of 20-30 mm occur around it. These short-term rashes usually occur on the trunk and arms, but not on the soles of the feet and hands.

What are the symptoms of hives (urticaria) in adults?

Hives are very fast, white-pink skin rashes that sometimes appear within seconds. Generally, in less than 24 hours, the rash disappears without a trace and occurs in other body parts. These raised rashes are intensely itchy and sometimes accompanied by a stinging and burning sensation. They vary in size and sometimes extensive rashes involving the whole body may occur. Hives can sometimes be accompanied by angioedema or just angioedema. Angioedema is swelling of the tissues under the skin. It can disappear within 24-48 hours without leaving a trace. It is most common in the face, tongue and lips.

What are the triggers of hives in adults?

Infections are the most common cause of acute urticaria (hives) in children. It can be seen during infections with some bacteria or parasites, most commonly viruses. Among the drugs, antibiotics (especially those containing beta-lactam) and pain relievers (most frequently non-steroidal anti-inflammatories).

Hives that occur within 2 hours after intake of food (such as milk, eggs, nuts, fish, wheat) which are known to cause food allergy often suggest food allergy. Especially if shortness of breath, vomiting, intense weakness is accompanied by sudden sneezing and runny nose, it should be evaluated in terms of allergic shock.

Apart from these reasons, food additives (such as benzoate) or colorants (tartrazine) can be caused. Insect bites can also cause urticaria (hives) rash.

Hives that last longer than 6 weeks can be spontaneous (spontaneous) or may occur due to the excessively sensitive structure of the skin (dermographism), cold, heat, pressure, sun exposure, cholinergic (due to body temperature increase), contact or water. Since urticaria lasting longer than six weeks may occur in the presence of autoimmune thyroid disease and rheumatological disease, the patient may need to be evaluated in these terms.

How is the treatment for hives (urticaria) in adults?

The first thing to do in the treatment of urticaria (hives) is to eliminate the cause. In acute urticaria, treatment can be started without the need for examination. However, if it has occurred after food exposure, it may be necessary for food allergy. In chronic urticaria, your doctor asks questions about known triggers and performs a test (such as ice cube test in cold urticaria). In the treatment of hives, allergy medications called anti-histamine are used. Depending on the severity of the complaints, high doses and more than one anti-histamine can be used.

If your child has persistent symptoms of urticaria or signs of allergic shock accompanying urticaria rash (shortness of breath, cough, vomiting, fainting), make an appointment with a pediatric allergist.