Hives (Urticaria)

Urticaria (colloquially hives or nettle rash) is a skin condition that manifests itself with pale to intense red bumps on the skin. The name hives is based on the fact that the skin appears as if it has come into contact with nettles. The medical term is wheals.

Urticaria causes severe itching. Hives and urticaria usually subside within a day. The rash may occur once, but in some cases it may occur daily.

Sufferers experience urticaria when exposed to certain internal or external stimuli. Examples include:

• Certain foods, such as nuts, strawberries or shellfish.
• water
• Cold
• Sunlight
• Pressure
• insect bites (especially bee and wasp stings)
• certain medications (often salicylates)
• certain diseases caused by viruses or bacteria

If there is a hypersensitivity to one of these stimuli, histamine and other mediator substances (substances that regulate inflammation) are released by the body on contact. These cause the blood vessels in the affected area to dilate and become more permeable, so that fluid can accumulate in the tissue - causing the cushion-like wheals. The intense itching is the result of histamine release.

There are different forms of urticaria:

• Acute urticaria: If the rash and itching last for only one to two days, it is called acute urticaria.
• Chronic urticaria: In this case, the hives occur not only once, but more frequently and regularly.
• Idiopathic urticaria: This is hives that cannot be attributed to a specific trigger.

Urticaria characteristically causes the following symptoms:

• At the beginning, the appearance of itching.
• Subsequently, hives or wheals appear. The reddish elevations of the skin can be up to the size of a hand.
• The symptoms often subside within a few hours. In chronic urticaria, however, the symptoms can last longer than six weeks.
• Typically, the rash appears on the extremities (arms, legs, toes and fingers), head and neck and, in men, sometimes on the genitals.

Urticaria is usually easy to diagnose due to the characteristic wheals. Already by describing the symptoms, the doctor can conclude that it is hives. However, it is much more difficult to determine the triggers that cause the rash.

First of all, the doctor takes a detailed medical history (anamnesis). This is followed by a physical examination to determine the type of urticaria. In the case of acute (temporary) urticaria, no further clarification is usually necessary.

However, if it is chronic urticaria, the following tests may be performed to determine the stimuli that trigger the disease:

• Prick test: In this, certain allergen extracts are dripped onto the skin. The skin is then lightly pricked to see if allergic reactions take place.
• Epicutaneous test: In this, allergens are fixed on the skin for several days using plasters.
• Urine and stool tests for parasites and germs
• Blood test: Inflammation parameters in the blood are examined as well as special IgE antibodies against substances that can trigger urticaria.
• Physical examination of the skin: Heat, cold and pressure applications are used to check whether these can trigger hives.
• Oral provocation test: If there is a suspicion that urticaria is triggered by a certain food intolerance, an oral provocation test is performed. The food is eaten - if hives develop afterwards, the triggering stimulus has been successfully determined.
• Allergy addiction tests: Here, the patient must adhere to a specific dietary program, which is expanded over time. In this way, food intolerances can be determined.

The most successful therapy for acute and chronic urticaria is to identify and avoid the triggering stimuli (such as foods, allergens, cold, sunlight).

If the hives are triggered by infections or chronic inflammations, these causes are treated.

Antihistamines are an effective remedy for the intense itching caused by urticaria. These can also prevent the formation of new wheals.

In very severe forms of urticaria, anaphylactic (allergic) circulatory shock can occur - this manifests itself in an acute drop in blood pressure and breathing difficulties. Cortisone is used to treat these severe cases.

If the urticaria is triggered by an allergy to bee or wasp venom, hyposensitisation (specific immunotherapy) can improve the symptoms. The aim is to accustom the immune system to the venom so that the strong hypersensitivity reactions are less severe in the future.

In the case of chronic idiopathic (unknown trigger) urticaria, numerous positive results have already been achieved using naturopathic therapy approaches. At the centre of these therapies is the restoration and promotion of a natural and functioning intestinal flora.

In some cases, no cause for urticaria can be determined despite medical examination.

In about 50 percent of cases, hives resolve on their own after six months. Sometimes it changes into a wave-like course of the disease, in which the frequency and severity of the symptoms increase from time to time and then subside again.