Description, Causes and Risk Factors:

An eruption of itching wheals, usually of systemic origin; it may be due to a state of hypersensitivity to foods or drugs, foci of infection, physical agents (heat, cold, light, friction), or psychic stimuli.

Alternative Names: Hives, urtication.

ICD-9-CM: 708.0-708.9 (depending on type).

Urticaria are also known as hives, welts, wheals, or nettle rash. It is a red, raised, itchy skin rash that is sometimes triggered by something that produces an allergic reaction - an allergen. When there is an allergic reaction the body releases a protein called histamine. When histamine is released our capillaries (tiny blood vessels) leak fluid. The fluid accumulates in the skin and causes a rash. Urticaria is not contagious - you cannot pass it on to another person.

The most likely triggers for acute urticaria are allergies to pets, horses, latex and foods, such as shellfish and nuts in adults and eggs and cow's milk in children. Acute urticaria may be caused by an allergy and can last between several hours and six weeks. Chronic urticaria isn't usually caused by an allergy and persists beyond six weeks.

Other possible causes include bee or wasp stings, and allergies to medicines such as antibiotics, blood pressure pills and aspirin.

Viral infections, such as glandular fever and herpes, dental and sinus infections, fungal infections, blood transfusions and vaccines can also cause acute urticaria.

The cause of chronic urticaria is often more difficult to identify. Most cases are called chronic idiopathic urticaria, which means they are caused by the body's unexplainable development of antibodies to itself (auto-antibodies). When symptoms last less than 6 weeks it is called acute urticaria. This is by far the most common type. 25% of people with acute urticaria also have angioedema. Angioedema is similar to urticaria, but occurs deeper inside the skin. The swelling causes a burning sensation and typically occurs on the face and neck, fingers, toes, and in the genitals of males.

Chronic urticaria is often accompanied by coexistent physical urticaria, triggered by environmental exposure to heat, cold, sunlight, vibration, pressure on the skin or even exercise.

Most people with urticaria have such sensitive skin that any rubbing will cause raised red lines to develop. This is called dermatographism.

If symptoms of urticaria continue for more than six weeks it is called chronic urticaria. Dermatologists say that about 1 in every 1,000 people suffers from chronic urticaria. Experts are not completely sure what the causes of chronic urticaria are. However, most agree that it is closely linked with our immune system. In some cases, chronic hives may be related to an underlying autoimmune disorder, such as thyroid disease or lupus. 50% of people with chronic urticaria also have angioedema.


    Raised red and white patches appear on the skin.

  • Intense burning, itching, and stinging.

  • Other symptoms include fever, digestive disturbances, and prostration.


A GP can easily diagnose acute urticaria by examining the rash on the skin. The doctor will attempt to find out what the trigger was, as this may help the patient prevent recurrences.

If the urticaria continues for more than six weeks the likelihood of there being some external trigger is extremely small; which is why allergy tests are not recommended. Nevertheless, the GP will be interested in factors which may exacerbate the existing urticaria, such as alcohol, caffeine intake, mental health (stress), etc. If there are any underlying causes for the chronic urticaria the doctor may order the following tests:

    A blood test to find out whether the patient is suffering from anemia.

  • A stool sample to check for parasites.

  • ESR (erythrocyte sedimentation rate) test - this can identify problems with the patient's immune system.

  • Thyroid function test - this identifies either hyperthyroidism (overactive thyroid) or hypothyroidism (underactive thyroid).

  • Liver function tests - these can identify whether the patient has any liver problems.

Treatment Options:

Try to avoid general urticaria triggers such as stress, alcohol, aspirin, hot baths, rapid temperature changes, tight clothing and junk or processed foods containing sulphur dioxide, sodium benzoate, salicylate and tartrazine.

Avoid tomatoes, strawberries, strong cheese, dark fish and fermented foods. Although these 'pseudo-allergens' are not the primary cause of urticaria, they do tend to aggravate it.

The new leukotriene receptor antagonist medications used in asthma may also help urticaria if used in conjunction with antihistamines.

If there is no response to conventional treatment, a specialist should investigate other possible underlying illnesses, such as lupus, thyroid disease and chronic infections.

Home Remedies: Haridra or haldi has long been recognised as the best remedy for urticaria. Regular use of it can prevent attacks of urticaria. A paste made of haridra, ground with a little water, may be given to the patient in two teaspoonful doses thrice a day. If the patient finds it unpalatable, it may be mixed with milk and sugar. The affected parts should be rubbed with mustard oil with which powdered rock salt has been mixed. The body should then be exposed to the sun and rubbed with a piece of copper.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.


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