Hives: causes and treatment, what usually works?

Urticaria is the medical term for hives that are usually itchy and appear in outbreaks. In many cases, it's a temporary episode, but when it persists or recurs, it's advisable to change course and rule out other causes.

Hives: causes and treatment in a nutshell

Hives can last from hours to weeks, and the first major clue to understanding them is how long they persist. This duration helps differentiate between a one-off outbreak and hives that become a recurring problem.

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In an acute episode, it may sometimes be linked to allergies, recent infections or certain medicines, and in other cases a single cause is not identified. The AEDV guide summarises this well and also notes that some anti-inflammatories may worsen certain cases.

There are also forms triggered by physical factors (for example, cold, heat, or pressure), which tend to repeat themselves when the stimulus appears.

Hives: causes and treatment when they last more than 6 weeks

If hives or swelling appear repeatedly and last for more than 6 weeks, it is considered chronic urticaria. In this case, there is often no clear cause, and it is not always a classic allergy.

Within chronic urticaria, it can be spontaneous (without an obvious trigger) or inducible (when a specific stimulus, such as friction, exercise, or temperature changes, triggers an outbreak). This distinction is important because it determines what questions to ask and what measures are usually most appropriate.

The diagnosis relies primarily on the patient's medical history: the appearance of the hives, their duration, whether there is swelling, and what seems to worsen outbreaks. Tests, when ordered, are usually targeted, because performing numerous analyses without a clear hypothesis rarely yields useful answers.

How to recognize hives and when it can be an emergency

The typical lesions are itchy, raised welts (hives) that appear and disappear, each usually lasting only a short time before fading away. Between outbreaks, the skin may return to normal, which helps to distinguish it from other, more persistent skin conditions.

Sometimes it is accompanied by angioedema, a deeper swelling under the skin that usually affects the lips or eyelids and may take longer to resolve than hives. Although alarming, it does not always indicate a serious condition in itself, but it does change the clinical assessment.

If, in addition to hives, there is difficulty breathing, chest tightness, severe dizziness, or swelling of the tongue or throat, the condition may be serious and requires urgent medical attention. In these situations, it is not advisable to wait for it to "go away on its own.".

What treatments are used and why are they not all the same?

In clinical practice, the most common treatment for controlling itching and lesions is H1 antihistamines, especially second-generation antihistamines, because they are considered less sedating than older ones for many people. The goal is to reduce the impact of outbreaks on daily life, not to "cure" the condition with a single measure.

In chronic urticaria, some specific antihistamines (e.g., cetirizine or loratadine) are listed in their official documentation as being indicated for symptomatic relief. When the condition is not controlled, specialists may adjust management in a stepwise manner and, in selected cases, consider biologic therapies.

Oral corticosteroids are reserved for specific situations and for a limited time due to their potential adverse effects. In addition to pharmacological treatment, identifying patterns is often key: what worsens the condition, such as friction or pressure on the skin, temperature changes, or a medication that coincides with the onset of the problem.

This text is for informational purposes only and does not replace medical advice. Always check the package leaflet and follow the instructions of your doctor or pharmacist.

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