(BPT) - If you've had hives, you know how challenging they can be. But you may not know that there is more than one type of hives, or urticaria, and that treatments are available. A brief episode of hives is a nuisance, but when symptoms persist for weeks, months or years, it can take a physical and psychological toll.
What is urticaria?
Urticaria is a rash causing round, swollen areas on the skin. It can be tender, itchy and/or painful. People with light skin may see red, raised bumps or welts. In people of color, hives may match the color of surrounding skin or appear slightly lighter or darker. They may appear all over your body or in one area.
Urticaria occurs when chemical compounds involved in the body's inflammatory and immune responses are released. One of these chemicals is histamine, which is released by mast cells and basophils. When this release happens in the skin's outer layers, it results in hives.
Most hives resolve quickly, but they can become chronic. Acute urticaria refers to hives lasting one day to six weeks. Chronic urticaria means the hives have lasted for six weeks or longer. For many people, the cause is unknown.
Chronic urticaria is a rare condition that occurs in only 23 out of 10,000 people, though the actual number may be higher, since many people do not report or recognize the symptoms. Chronic urticaria is most common in adults aged 40-59. More women than men are affected, and more Black Americans and other ethnic groups are affected. There are two types:
- Chronic idiopathic urticaria (also called chronic spontaneous urticaria) is not triggered by external factors. In many cases, the cause could be an autoimmune condition, another systemic disease like cancer, or unknown.
- Chronic inducible urticaria is caused by certain environmental and physical factors.
Identifying urticaria triggers
Common triggers include:
- Allergens, including certain foods
- Exposure to heat/cold
- Tight clothing
- Insect stings and bites
- Infections and viruses
- Medications such as antibiotics and NSAIDs
- Diseases including asthma, celiac disease, diabetes, lupus, rheumatoid arthritis, thyroid disease, vasculitis and vitiligo
- Stress
Diagnosis and treatment
The cause of your chronic urticaria may be hard to identify. It's best to see a specialist such as a board-certified allergist or dermatologist for diagnosis and treatment.
Your doctor may perform allergy tests, lab tests or a skin biopsy to rule out other conditions that involve or resemble hives. You can help by keeping a diary that tracks your symptoms.
Chronic urticaria eventually goes away by itself. Management focuses on the most appropriate treatment to control symptoms, usually starting with the first line of treatment: a long-lasting antihistamine.
Antihistamines block production of histamine to reduce or eliminate hives and ease itch and swelling. Ask your doctor for a non-sedating antihistamine.
Topical itch creams may provide mild relief for hives that do not cover the entire body.
Corticosteroids: Topical corticosteroids reduce inflammation, irritation and itching. By reducing inflammation, they also promote healing. For a severe hives flare-up, a short course of oral corticosteroids (prednisone) can help reduce inflammation and itching. These medications can cause serious side effects, especially if taken long-term. It's important to follow your doctor's instructions when taking oral corticosteroids.
Advanced treatments
It's important to work closely with your doctor if your hives don't respond to treatment. If antihistamines alone do not help, your doctor may recommend combining them with other medications, including leukotriene modifiers or H2 blockers. New advanced treatments are available, and more are in clinical trials or undergoing FDA review.
Biologics: Omalizumab is a biologic medication used to treat chronic urticaria when antihistamines haven't worked. Two more biologics are in development as chronic urticaria treatments: dupilumab is in FDA review and briquilimab is in clinical trials. Biologics work by targeting cells and interrupting the inflammatory process. This stops or reduces symptoms. Biologics are injectable medications typically given once per month.
Cyclosporine: This is an oral medication that calms the immune system to prevent hives from occurring. It can be taken along with antihistamines. Since cyclosporine is an immunosuppressive, it can decrease the body's ability to fight infections. Talk with your doctor about side effects and the benefits vs. risks of taking this medication.
Bruton's tyrosine kinase (BTK) inhibitor: Remibrutinib is an oral medication in clinical trials. It works by blocking the activation of mast cells and basophils. These cells release histamine and other inflammatory mediators that cause hives, swelling and itching. By blocking this process, remibrutinib can reduce or eliminate symptoms.
Hives and mental health
It's important not to blame yourself for your hives. If you're feeling anxiety, depression or embarrassment about your skin condition, talk with your healthcare provider or a mental health specialist. Support groups for people with urticaria also let you share experiences and know you are not alone.
Don't let chronic urticaria impact your quality of life. Talk to your doctor. Check out the Chronic Urticaria Toolkit at ChronicHives.info.