Urticaria (Hives)

Overview

It is also known as urticaria, welts, weals, or nettle rash.

Generalized Urticaria

• When an allergic reaction occurs, the body releases a protein called histamine.
• When histamine is release, the tiny blood vessels known as capillaries leak fluid.
• Moreover, The fluid accumulates in the skin and causes a rash.
• It is not contagious. [2]
• Hives usually cause itching, but may also burn or sting.
• They can appear anywhere on the body.
• Besides this, Hives vary in size (from a pencil eraser to a dinner plate), and may join together to form larger areas known as plaques.
• They can last for hours, or up to one day before fading.
• Urticaria (‘hives’) is cause by localise dermal oedema secondary to a temporary increase in capillary permeability.
• Lastly, If oedema involves subcutaneous or submucosal layers, the term angioedema is use.

Other factors

• Angioedema is similar to hives, but the swelling occurs beneath the skin instead of on the surface.
• Angioedema is characterize by deep swelling around the eyes and lips and sometimes of the genitals, hands, and feet.
• It generally lasts longer than hives, but the swelling usually goes away in less than 24 hours.
• Rarely, angioedema of the throat, tongue, or lungs can block the airways, causing difficulty breathing & may become life threatening. [3]
• Acute urticaria may associate with angioedema of the lips, face, tongue, throat and, rarely, wheezing, abdominal pain, headaches and even anaphylaxis.
• Urticaria present for less than 6 weeks is considered to be acute, also chronic if it continues for more than 6 weeks.
• Individual weals last for less than 24 hours; additionally if they persist, urticarial vasculitis needs to be considered. [1]b

Indian epidemiology then other

Causes of Acute & Chronic Urticaria:

• Autoimmune: Due to antibodies that cross-link the IgE receptor on mast cells
• Allergens: In foods, medications and inhalants
• Drugs
• Contact: e.g. latex, animal saliva
• Physical: e.g. heat, cold, pressure, sun, sweat, water
• Infection: e.g. intestinal parasites
• Others: e.g. systemic lupus erythematosus (SLE), pregnancy
• Idiopathic: Chronic spontaneous urticaria and angioedema

Causes of Urticarial Vasculitis:

• Hepatitis B
• SLE
• Idiopathic [1]

Risk factors are things that make you more likely to develop a disease in the first place.

Pathogenesis refers to the development of a disease. It’s the story of how a disease gets started and progresses.

This is the entire journey of a disease, encompassing the cause but going beyond it.

Pathophysiology, on the other hand, focuses on the functional changes that occur in the body due to the disease. It explains how the disease disrupts normal physiological processes and how this disruption leads to the signs and symptoms we see.

Imagine a car accident. Pathogenesis would be like understanding how the accident happened – what caused it, the sequence of events (e.g., one car ran a red light, then hit another car). Pathophysiology would be like understanding the damage caused by the accident – the bent fenders, deployed airbags, and any injuries to the passengers.

In simpler terms, pathogenesis is about the "why" of a disease, while pathophysiology is about the "how" of the disease’s effects.

Acute urticaria:

• They are hives or swelling lasting less than 6 weeks.
• The most common causes are foods, medicines, latex, also infections.
• Insect bites or a disease may also be responsible.
• The most common foods that cause hives are nuts, chocolate, fish, tomatoes, eggs, fresh berries, soy, wheat, and milk.
• Fresh foods cause hives more often than cooked foods.
• Certain food additives also preservatives may also be to blame.

Chronic urticaria:

• They are hives or swelling that lasts more than 6 weeks.
• The cause is usually harder to find than in acute cases.
• The causes can be similar to those of acute urticaria but can also include your immune system, chronic infections, hormonal disorders, and tumors.

Physical urticaria:

• These are hives caused by direct physical stimulation of the skin; for example, cold, heat, sunlight, vibration, pressure, sweating, and exercise.
• They usually happen right where the skin was affected and rarely appear anywhere else. Most appear within 1 hour after exposure.

Dermatographism:

• These are hives that form after firmly stroking or scratching the skin.

Hereditary angioedema:

• It is painful swelling under the skin.
• It runs in families. [3]

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• Batches of red or skin-colored welts (wheals), which can appear anywhere on the body.
• Welts that vary in size, change shape, move around, disappear and reappear over short periods of time.
• The bumps; red or skin-colored “weals” with clear edges usually appear suddenly and go away just as quickly.
• Itching, which may severe.
• Painful swelling (angioedema) of the lips, eyelids and inside the throat.
• A tendency for signs and symptoms to flare with triggers such as heat, exercise and stress. [3]

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Diagnosis will depend on the type of urticaria.

A health professional can diagnose acute urticaria by examining the rash on the skin.

The doctor will probably ask about:

• When and where the episode began
• Whether there has an insect bite
• Whether the patient lives or works in a place where potential triggers may exist, such as latex gloves, chemicals, or animals
• Any medications the patient has taking, including herbal supplements
• Patient’s medical history
• Any family history of urticaria

Allergy tests of patient’s blood and skin should done to find out whether there is an allergy to specific substances, such as chemicals, dust mites, or some food.

Investigations should guide by the history and possible causes but are often negative, particularly in acute urticaria.

Some or all of the following may be appropriate:

• Full blood count: Eosinophilia in parasitic infection or drug cause.
• Erythrocyte sedimentation rate (ESR) or plasma viscosity: Elevated in vasculitis.
• Urea and electrolytes, thyroid and liver function tests, iron studies: May reveal an underlying systemic disorder.
• Total IgE and specific IgE to possible allergens: e.g. shellfish, peanut, house dust mite.
• Antinuclear factor: Positive in systemic lupus erythematosus (SLE) and often positive in urticarial vasculitis.
• Complement C3 and C4 levels: If these are low due to complement consumption, C1 esterase inhibitor activity should be measured.
• Skin biopsy: If urticarial vasculitis is suspect.
• Challenge tests: To confirm physical urticarias. [1]

Complications are what happen after you have a disease. They are the negative consequences of the disease process.

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Treatment

• Removal or treatment of any trigger is essential, although this may not identified in the majority of cases.
• Urticaria may precipitate by aspirin, NSAIDs, codeine and opioids, and it is advisable to suggest alternatives such as paracetamol.
• In chronic urticaria, non-sedating antihistamines, such as fexofenadine, loratadine or cetirizine, are usually beneficial.
• If, after 2 weeks, there is lack of response, an alternative non-sedating antihistamine should be used and an H2-blocker, such as cimetidine or ranitidine, is often added.
• Mast cell stabilisers or leukotriene receptor antagonists, such as montelukast, may added for more recalcitrant disease.
• For chronic urticaria, narrowband UVB phototherapy is valuable.
• Systemic corticosteroids are widely prescribe for urticaria, but often need to use at high doses and are only appropriate for occasional short courses.

Other treatments

• Patients with a history of life-threatening anaphylaxis, as in peanut or wasp sting allergy, should carry a self administered adrenaline (epinephrine) injection kit. [1]
• Antidepressants: The tricyclic antidepressant doxepin (Zonalon), use in cream form, can help relieve itching. This drug may cause dizziness and drowsiness.
• Asthma drugs with antihistamines: Medications that interfere with the action of leukotriene modifiers may helpful when used with antihistamines. Examples are montelukast (Singulair) and zafirlukast (Accolate).
• artificial (monoclonal) antibodies: The drug omalizumab (Xolair) is very effective against a type of difficult-to-treat chronic hives. It’s an injectable medicine that’s usually given once a month.
• Immune-suppressing drugs. Options include cyclosporine (Gengraf, Neoral, others) and tacrolimus (Astagraf XL, Prograf, Protopic). [4]

Lifestyle and home remedies:

Chronic hives can go on for months and years.

They can interfere with sleep, work and other activities.

The following precautions may help prevent or soothe the recurring skin reactions of chronic hives:

• Wear loose, light clothing.
• Avoid scratching or using harsh soaps.
• Soothe the affected area with a bath, fan, cool cloth, lotion or anti-itch cream.
• Keep a diary of when and where hives occur, what you were doing, what you were eating, and so on. This may help you and your doctor identify triggers.
• Avoid known triggers.
• Apply sunscreen before going outside. [4]

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Homeopathic treatment for Urticaria is  natural, safe and without any side-effects, and one can enjoy immense relief from these frustrating symptoms.

It is a patient-oriented science and medicines are prescribe on the characteristics of the individual rather than just the symptoms of the disease.

Apis Mellifica – top grade medicine for urticaria:

• Apis Mellifica is best prescribe for urticaria when symptoms include marked itching also burning.
• A characteristic stinging pain in the urticarial eruptions is also observed.
• The skin is extremely sensitive to the touch.
• This is one of the best medicines for urticaria that gets triggered in heat.
• Going out in the either open air or cold applications bring some relief.
• And is also a top-rated medicine for urticaria that arises following an insect bite.

Natrum Muriaticum – for urticaria triggered by exercise and sun exposure:

• For treating urticaria triggered by exercise, Natrum Mur is a great option.
• The person who needs Natrum Mur will get large hives on the skin from exertion.
• This is attend with violent itching also burning.
• Natrum Mur is also one of the most effective medicines especially for solar urticaria that arises from exposure to the sun.

Astacus Fluviatilis & Urtica Urens – excellent homeopathic medicine for urticaria:

• Urtica Urens also Astacus Fluviatilis work wonders in treating urticaria.
• The choice between the two is made based on unique symptoms.
• Urticaria that appears every year, in the same season, is best treated with Urtica Urens.
• Another key symptom associated with Urtica Urens is urticaria with intense burning and formication on the skin.
• Urtica Urens also shows great results in urticaria that alternates with rheumatism.
• Apart from this, urtica is also the ideal medicine for treating urticaria from eating shellfish.
• Astacus Fluviatilis is well indicated where urticaria is attended with liver complaints.
• The person prescribed astacus will have itching over his entire body, with a marked stinging sensation on the skin.

Rhus Tox & Sepia Succus – for urticaria from cold exposure (cold-induced urticaria):

• Both are highly effective medicines for treating urticaria resulting from exposure to cold.
• Marked sensitivity to cold is found in persons needing rhus tox also sepia succus.
• Key symptoms that will decide in favor of medicine rhus tox is urticaria from cold exposure with itching and smarting sensation.
• Warm applications provide some relief especially from itching.
• The characteristic symptom to look out for while prescribing Sepia Succus is urticaria from going in cool open air.
• Being in a warm room brings relief.
• Urticarial eruptions with itching, which is not relieve especially by scratching, is another guiding feature for use of Sepia Succus.

Sulphur & Apis Mellifica – for urticaria triggered by heat:

• Persons with urticaria that gets triggered by exposure to heat will benefit greatly from Sulphur and Apis Mellifica.
• In detail, Sulphur is select for urticarial eruptions arising from heat exposure and attended with itching and burning.
• Scratching worsens the itching.
• In some cases, even washing may worsen the itching.
• Most persons prescribed Sulphur will notice a worsening of itching towards the evening.
• It is also the best solution for urticaria cases that have been suppressed with ointments in the past.
• Apis Mellifica is rate among the best medicines for urticaria triggered specifically by heat, with marked itching, burning, also stinging in the eruptions.
• Cold applications may bring relief from symptoms in some cases.
• Lastly, Some persons prescribed Apis for urticaria will feel better by going out in the open air.

Bovista Lycoperdon & Calcarea Phosphoricum – for urticaria triggered by water:

• Generally, Bovista Lycoperdon and Calcarea Phos are prominently indicated medicines for treating urticaria set off by coming into contact with water (water induced urticaria).
• Furthermore, Some features unique to bovista lycoperdon are urticaria on waking in the morning time and attended with diarrhea.
• Homeopathic medicine calcarea phosphorica is suggest where contact with cold water leads to urticarial eruptions.

Rhus Tox & Dulcamara – For urticaria from scratching (dermatographic urticaria)

• For urticaria from severe scratching, Rhus Tox also Dulcamara are very useful Homeopathic medicines.
• Where urticaria leads to red, swollen skin with itching, burning and smarting, you know Homeopathic medicine Rhus Tox will show best results.
• Rubbing worsens the symptoms in this case.
• Rhus Tox is also well indicate for urticaria resulting from getting wet.
• Dulcamara is the best choice in case of violent itching in the urticarial eruptions.
• Use of Dulcamara is also suggested for urticaria arising from exposure to cold and that which gets triggered in wet weather. [5]

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1. Davidson’s Principles and Practice of Medicine (22nd edition) Ch. 28
2. https://www.medicalnewstoday.com/articles/157260.php
3. https://www.webmd.com/skin-problems-and-treatments/guide/hives-urticaria-angioedema#1
4. https://www.mayoclinic.org/diseases-conditions/chronic-hives/diagnosis-treatment/drc-20352723
5. https://www.drhomeo.com/skin-problem/urticaria-and-homeopathic-treatment/

Frequently Asked Questions

What is Urticaria (Hives)?

Urticaria, also known as hives, is an outbreak of swollen, pale red bumps or plaques (wheals) on the skin that appear suddenly; either as a result of the body’s reaction to certain allergens, or for unknown reasons.

Homeopathic Medicines used by Homeopathic Doctors in treatment of Urticaria (Hives)?

• Apis Mellifica
• Natrum Muriaticum
• Urtica Urens
• Rhus Tox
• Sepia
• Sulphur
• Bovista Lycoperdon
• Dulcamara

What are the main causes of Urticaria (Hives)?

• Autoimmune
• Allergens
• Drugs
• Contact
• Physical: e.g. heat, cold, pressure, sun, sweat, water
• Infection: intestinal parasites
• Others: systemic lupus erythematosus (in other words, SLE), pregnancy
• Idiopathic

What are the symptoms of Urticaria (Hives)?

• Batches of red or skin-colored
• Welts that vary in size, change shape, move around, disappear and reappear
• The bumps; red or skin-colored “weals”
• Itching, which may severe.
• Painful swelling of the lips, eyelids and inside the throat.
• Flare with triggers

Give the types of Urticaria?

• Acute urticaria
• Chronic urticaria
• Physical urticaria
• Dermatographism
• Hereditary angioedema