Urticaria is a condition where ‘hives’ or ‘wheals’ appear on the skin. Hives can have the appearance of white lumps, surrounded by redness (often looking like mosquito bites) or, more commonly, larger plaques of thickened skin. These areas tend to be very itchy and individual bumps last less than 24 hours. When they disappear, marks are not left behind. Sometimes urticaria is associated with angioedema, where there is swelling around the lips and eyes. 

Urticaria is very common (affecting 1:5 people during their lifetime) and is more likely in people that suffer from atopic conditions, such as atopic eczema (see atopic eczema).

Urticaria is usually divided into two types, dependent upon the timescale:

  • Acute urticaria – lasts for less than 6 weeks.
  • Chronic urticaria – lasts for more than 6 weeks.

Urticaria occurs when a triggers stimulates the release of the chemicals including histamine in the body. The many different causes of urticaria include:


Acute urticaria

Chronic urticaria

Viral infection

Chronic infection (e.g. helicobacter pylori)

Bacterial infection

Physical triggers: pressure, heat, sunlight, sweat, cold and water

Food allergy

Autoimmune conditions (thyroid or connective tissue condition)

Drug allergy

Idiopathic

Food additives or preservatives

 

Insect stings (e.g. bees, wasps)

 

Frequently the cause is never found. These so called cases of ‘idiopathic urticaria’ make up more than half of all who suffer with chronic urticaria.

At The Skin Hospital
Your specialist will ask you detailed questions to try to understand whether there are any obvious triggers for your hives. Often no tests are needed to confirm the diagnosis. Blood tests may sometimes be required to look for underlying causes and to distinguish urticaria from other conditions (especially if wheals are present for over 24 hours at a time).  A skin biopsy is not normally needed, but may be requested to rule out other causes.

General measures:

  • If a trigger is found, avoidance of the trigger is helpful. Drugs such as aspirin, non-steroidal anti-inflammatories (NSAID, e.g. ibuprofen) and opiates (e.g. morphine, codeine) can worsen or cause urticaria, so should be avoided if possible.

Oral treatments:

  • Non-sedating anti-histamine tablets are the mainstay of treatment. These should be taken regularly rather than ‘as and when required’ for the greatest benefit; the specialist will recommend an appropriate dose.
  • In severe cases that do not respond to an adequate dose of anti-histamines, other medications can be tried. For short-term control only, oral steroids may be used.

Other systemic treatments:

  • The injectable biologic medication Omalizumab is newly available to treat this condition. Such medications should only be used under the direct supervision of a specialist.

None of these medications cure urticaria, but can suppress the symptoms effectively. Lastly, urticaria is not predictable and can resolve spontaneously.

Dermatologists at The Skin Hospital to consult about your urticaria:

  • Dr Penny Alexander (Darlinghurst)
  • Dr Keng Chen (Darlinghurst)
  • Dr Monisha Gupta (Darlinghurst)
  • Dr Esther Hong (Darlinghurst)
  • Dr Joseph Krivanek (Darlinghurst and Westmead )
  • Dr Hanna Kuchel (Darlinghurst)
  • Dr Eddie Lobel (Darlinghurst)
  • Dr Roland Nguyen (Darlinghurst)
  • Dr Nicholas Stewart (Darlinghurst and Westmead)
  • Dr Sarvjit Sohal (Darlinghurst and Westmead)
  • Dr Kavita Enjeti (Westmead)
  • A/Professor Pablo Fernandez-Penas (Westmead)
  • Dr Claire Koh (Westmead)
  • Dr Brian Wallace (Westmead)
  • Dr Supriya Venugopal (Westmead)

 

Further information about urticaria can be obtained from the following trusted sites:
http://dermnetnz.org/reactions/urticaria.html
http://www.bad.org.uk/shared/get-file.ashx?id=184&itemtype=document

 

Authors: Dr Charlotte Thomas & Dr Nick Stewart, last updated 16th November 2015

 

Hives (Urticaria)

Dr Kavita Enjeti

Dr Kavita Enjeti currently works at the Skin & Cancer Foundation Australia at Westmead providing a general dermatology clinic as well as a refugee skin clinic one day a

Dr Eddie Lobel

Dermatologist Dr Eddie Lobel graduated in Medicine (Sydney University) in 1964, and then completed his residency at Canterbury Hospital and the Royal Hospital for

Dr Sarvjit Sohal (nee Virdi)

Dr. Sarvjit Kaur Virdi completed her graduation in medical school in 1996 and Post graduate studies, M.D in Dermatology, Venereology and Leprology in 2000 from Punjab,

Dr Esther Hong

Dr Esther Hong is a highly regarded dermatologist by peers and patients. She has 7 years of experience working in clinical and research dermatology across New South Wales. This includes experience at…

Dr Joseph Krivanek

Dr Joe Krivanek graduated from Sydney University in 1966. He worked as a general practitioner in Blacktown until 1972 when he trained at St Vincent's Hospital as first clinical assistant, then…

Dr Penny Alexander

Fully qualified dermatologist working at The Skin Hospital

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