Hives is an inflammatory skin disorder primarily characterized by the formation of itchy bumps—called wheals—on the skin. Hives can also cause swelling under the skin, or angioedema. The clinical term for hives is urticaria. While all people can be affected by hives, it is most commonly seen in children, those assigned female at birth, and people with allergies.
This condition is relatively common. It’s estimated that up to one in five of all people develop hives in their lifetimes. However, some types can be prevented, something which begins by understanding and avoiding the factors that trigger it.
Who Is Most at Risk?
There are several major types of hives, which are categorized based on the cause of the condition as well as the duration of the symptoms. Acute urticaria refers to cases where symptoms resolve on their own within six weeks, whereas chronic urticaria lasts longer. Furthermore, inducible urticaria is the term for cases that have identified triggers, while spontaneous cases have no identified cause.
Several risk factors for hives have been identified:
- Age: Children and infants younger than five experience hives at a higher rate, likely due to their immune systems being less able to fight off viruses.
- Sex: Adults assigned female at birth are more likely to experience hives. This is likely due to hormone allergy, an autoimmune reaction to estrogen.
- High population density: Researchers have identified higher rates of hives among those who live in densely populated urban areas. This is due to this population having increased chances of exposure to triggers.
- Allergies: A personal history of allergies or previous outbreaks of hives increases your overall risk. Allergies and hives share underlying mechanisms.
- Autoimmune diseases: Certain autoimmune disorders—in which the immune system mistakenly attacks healthy cells in your body—are also risk factors; this is especially the case with rheumatoid arthritis and thyroid disease.
- Stress: Living with high levels of stress can induce a physical reaction in the skin that causes hives, sometimes called stress rash.
Having a family history of hives increases your chance of developing it. Though it’s not the only factor, genetics plays a distinct role in the condition. Researchers have identified specific genes associated with both acute and chronic cases.
Studies on twins (which are done to compare genetics and outcomes in people with the same DNA) have shown a susceptibility to acute hives to be partially, though not completely, related to several genes. Specifically, variations in the structure of three genes—TNFRS11A, TBXA2R, and PLA2G4A37—have been found to raise your chances of developing acute hives.
For chronic hives, a wider set of genes have been identified. Among these are genes associated with an increased risk of autoimmune diseases, which have been found to increase your chances of developing chronic spontaneous hives. For instance, variations of a gene known as HLA-DR4 have been identified for hives and both rheumatoid arthritis and type 1 diabetes mellitus. People assigned females at birth with chronic spontaneous urticaria were found to be 20 times more likely to have rheumatoid arthritis and 23 times more likely to have type 1 diabetes.
Genetic tests can help determine your susceptibility to autoimmune diseases, and, by extension, hives. This may help determine your best course of action for treatment and prevention.
How to Reduce Risk
Depending on the type you have, hives most commonly occur due to allergic reactions, exposure to certain triggers, and infections or autoimmune diseases. Preventive strategies for hives can be effective in reducing how often they occur and how severe your symptoms are. These can include medical evaluations and tests, adapting lifestyle habits, tracking triggers and avoiding them, and tending to your mental health.
If you’re experiencing hives, a key to prevention is to seek out a medical evaluation to confirm your diagnosis. You may need a consultation with a specialist, such as an allergist (a doctor who specializes in allergic conditions) or dermatologist (a doctor who specializes in skin conditions). Primarily, a diagnosis is made by assessing your medical history as well as completing a physical evaluation of your symptoms.
A physical evaluation involves a visual assessment of affected areas, as your healthcare provider will want to ensure that your case is indeed hives and not another skin disorder. The individual wheals that form due to hives usually disappear within 24 hours. Your provider may circle individual wheals with a pen and ask you to come back the next day to look for changes.
Most hives cases resolve on their own within a few days to a couple of weeks; therefore, symptoms may not be present by the time of your consultation. It’s a good idea to take photos of your hives in case you need to show them to your healthcare provider.
Skin Prick Test
Allergies are frequently at the root of hives outbreaks. Your healthcare provider may use a skin prick test to test if this is the case and find out what may be causing them. This involves injecting a small amount of a potential allergen into the skin. After 15 minutes, the provider looks for signs of swelling at the injection site, which indicates that your body is reacting to that allergen.
Blood tests may be called for to assess for underlying causes of hives. They can help rule out other causes of symptoms or identify autoimmune disorders that may accompany hives. In particular, your provider may call for tests that screen for inflammatory reactions, such as the complete blood count (CBC), erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP).
Some cases of inducible urticaria arise due to exposure to specific environmental triggers, such as cold or hot temperatures, water, and physical pressure on the skin. Testing for this type can be critical for prevention, giving you valuable information about what you should avoid. To do so, providers perform what’s called challenge testing. There are several types:
- Ice cube test: To screen for cold urticaria—when you develop hives after exposure to cold temperatures—an ice pack is placed on the skin for 10 to 15 minutes. Symptoms are checked upon removal.
- Water immersion: If wetness is a suspected trigger, your reaction to a part of the body being immersed in water or a warm wet compress will be assessed.
- Hot bath test: Some forms of hives arise due to spikes in body temperature. This is tested by looking for reactions to a hot bath.
- Pressure testing: Dermographism is when wheals form within minutes of the application of pressure on your skin. This is done with the use of the blunt side of a pen or tongue depressor.
Tracking and Avoiding Triggers
Some people get hives in response to certain triggers. As such, tracking what may be setting flares off and working to avoid those things is an integral aspect of prevention. Potential triggers—which set off hives within 12 to 24 hours of exposure—to track and avoid include:
- Certain foods, including shellfish, peanuts, and eggs, among others
- Food coloring and preservatives, certain vitamins, spices, and some cosmetics
- Medications, such as non-steroidal anti-inflammatory drugs (NSAIDs), antibiotics, and others
- Hot or cold
- Tight-fitting clothes
- Physical exertion
Making changes to your lifestyle habits may also prevent hives. They can help manage stress, keep you clear of other potential triggers, and reduce your susceptibility to the condition. This may include:
- Making sure you get regular exercise
- Ensuring adequate and consistent sleep
- Avoiding alcohol
- Stopping certain medications, especially NSAIDs
- Wearing loose-fitting clothing
Alongside lifestyle changes and trigger avoidance, certain practices and supplements may also help you prevent hives. Potentially helpful complementary methods include:
- Vitamin D: Some research shows that taking vitamin D3 supplements may help reduce the severity and frequency of hives outbreaks.
- Vitamin B12: Studies have suggested that people with chronic hives have insufficient levels of vitamin B12. Taking supplements of this vitamin may help.
- Meditation and yoga: Meditation exercises and activities like yoga have a distinct effect on stress levels. They may therefore help prevent stress-related flares.
Editor’s Note: This article informs you about possible observed health changes related to the use of complementary or alternative medicine based on limited available research. Not all complementary and alternative medicines have been evaluated for safety and efficacy in clinical trials. You should consult a licensed healthcare professional for diagnosis and treatment for any health conditions and inform them about any change you make to your regimen.
Discuss With Your Healthcare Provider
If you experience hives, be sure to talk to your healthcare provider about what you can do to manage and prevent this condition. Keep track of your symptoms and be ready to discuss what medications you’re taking, what your diet looks like, and other health factors. Talk to your healthcare provider if you plan on making any major changes to your lifestyle or treatment regimen.
A Quick Review
Hives is a common skin disorder, characterized by itchy bumps and patches of swelling. It’s not always possible to prevent hives, but doing things like avoiding allergic triggers and managing your stress may help. Hives can present similarly to other skin conditions, so ensuring proper diagnosis and seeking medical care are critical for preventing flares.
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