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They’re red and itchy. They may last for a few hours or days. They can appear anywhere in the body. They’re hives and they can make your life miserable.

Hives are raised , red, itchy areas on the skin brought about by the release of histamines and other chemicals in the body during an allergic reaction. Their size and number varies in different people and they may last for a few hours or several days. These skin changes may appear anywhere on the body, including the scalp, lips, palms and soles.

"A simple hive is usually a reaction to an outside irritant, such as an insect bite. Multiple hives, called urticaria, are usually an allergic reaction to some internal agent. Hives can be due to many causes: foods (especially shellfish, nuts and berries); medications; heat, cold or sunshine; infections; insect bites; and emotional stress. When the hives continue for an extended period of time (chronic urticaria), there are probably multiple trigger factors," according to Dr. Robert R. Walther, associate clinical professor of dermatology, in "The Columbia University College of Physicians and Surgeons Complete Home Medical Guide."

"Food additives, especially colorings and preservatives, can cause hives, as well as other allergic reactions. In recognition of this, some countries require listing of all additives and their quantities on food labels. Common culprits include tartrazine (yellow dye # 5) and the preservative sodium benzoate," added Kurt Butler and Dr. Lynn Rayner of the John A. Burns School of Medicine, University of Hawaii in "The Best Medicine."

Aside from being uncomfortable, hives can be dangerous. If they are caused by a particular medication which a person is sensitive to, they usually disappear within hours or days. More serious cases are caused by insect bites or stings that can lead to an anaphylactic shock. This is a life-threatening condition which is characterized by the swelling of the larynx, difficulty in breathing, cold sweat, abdominal cramps and low blood pressure.

"Without  prompt treatment  (in the form of adrenaline injections and corticosteroids), coma and cardiac arrest can occur," according to Dr. H. Winter Griffith, a Fellow of the American Academy of Family Practice, in "The Complete Guide to Symptoms, Illness & Surgery."

The best way to prevent hives and its complications is to avoid the substance you are allergic to. If you haven’t pinpointed that cause of your problem, the following measures were suggested by Griffith:

Don’t take drugs (including aspirin, laxatives, sedatives, vitamins, antacids, pain killers or cough syrups) not prescribed for you.

Don’t take hot baths or showers.

Decrease activities until several days after hives disappear. Avoid getting sweaty or excited.

If foods are suspected as a cause, keep a food diary to help identify the offending food.

Avoid alcohol and coffee or other caffeine containing beverages. These may trigger outbreaks.

"The first line of therapy is to find and eliminate the trigger factor or factors. For symptomatic treatment until the cause can be found, the doctor may suggest cool compresses, soaking baths or lotions to alleviate itching. He or she will undoubtedly prescribe some type of antihistamine," Walther said.

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Approximately one out of six people develop hives once in their lifetime.  Urticaria or hives  can be very distracting if not very serious; partly on account of its symptoms and partly due to the uncertainty in duration of cure.

Hives is an allergic immune reaction developed like a skin rash in response to environmental allergens. Skin is an important organ of immunity that acts as defense barrier to factors perceived as toxic whether internal or external. Generally chronic hives do not lead to complications and shouldn’t be a major concern as its an allergic reaction produced to something that would otherwise be non-toxic.

Symptoms of Urticaria

Raised warm itchy areas on the skin can describe all forms of urticaria. Non-contagious rash may appear suddenly on any part of the body, last for few hours and disappear. Symptoms tend to increase at night and sleep deprivation may worsen the condition. Bee sting and drug allergy can lead to severe complications like breathlessness and shock in addition to skin problems. Swelling of lips and tongue are some grave signs that would need immediate medical help.

Causes of Urticaria

• Certain foods or newly introduced medicine can produce a surprise allergic reaction. Foods causing allergy could be nuts, seafood, dairy products, tomatoes, berries, eggs or gluten (wheat intolerance)
• Inhaling air borne allergens like dust, pollen and mold
• Stress and altered immunity can be inter-related and though ambiguous are more important factors
• Animal fur, cosmetics and synthetic material
• Insect bite and wasp sting
• Extreme cold or hot climate
• Rise in body temperature due to heat or exercise
• Physical stimulus like pressure or tight clothing
• Viruses may trigger hives
• Illnesses like hepatitis and lupus can cause skin allergies and treatment of the disease relieves the rash
• Hereditary causes of urticaria express themselves in childhood and need to be diagnosed and treated accordingly. Multiple allergens usually complicate the diagnosis

Urticaria Treatment

• Systemic illness needs to be excluded before treating urticaria
• Cold water shower
• Loose-fitting clothing
• Heavy physical exercises should be avoided
• Sunscreens and warm clothing can be used in solar and cold urticaria respectively.
• Identify and eliminate exposure to environmental factors
• Gradual diet elimination is a proven way to detect sensitivities
• Stress reduction by meditation and yoga
• Antiallergics like H1-antihistamines (e.g. Cetrizine) should be preferred due to its non-drowsy effect and can be safely used without side effects or addiction
• Steroids and epinephrine are used in severe cases with anti-histaminics to suppress the immune reaction. Steroids can help in acute attack but aren’t recommended for long-term use.
• Lacto calamine application, milk of magnesia and aloe vera gel can be used as topical creams.
• Dietary supplements and anti-oxidants to increase the immunity.

Living with Urticaria

The probable causes and definite cure has definitely left the specialists too scratching their heads. Recurrent hives in absence of any detectable factor should direct towards stress as the cause. Thus, an effort to identify trigger factors, effective stress management and symptomatic treatment for an unknown duration is the main key to relieve symptoms.

Prevention of Urticaria

Finding out such allergens can actually be an impossible task. Avoid exposure to any food, medicine, or physical agent that could possibly cause the rash. A daily diary can help monitor and diagnose the food allergy. Though emotional and physical stress is unavoidable, it should be dealt with appropriate relaxation therapies like exercise, yoga, meditation and social support groups. Self-evaluation after stress management could help, as it would be difficult to assess stress thresholds and hence stress recovery on the part of the physician.

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When you get an  itchy skin rash  you can’t tell often what you have. You may not know if it is a hives rash, atopic dermatitis, heat rash or reaction to bug bites. Urticaria symptoms (or hives) can be small bumps, patches and vary in sizes. Very often the underlying cause is not discovered.

One distinguishing feature of a  hives rash  is that they won’t usually last more than 24 hours in that formation. You still may have more hives afterwards but their locations won’t e the same. Another feature of hives is that they can morph or change shapes. For instance, you may have a small red patch or pink rings. These can become much larger later in the day. Histamine is released ad that is why taking antihistamines is helpful to relieve hives symptoms. You may have raised welts which at another point during the day become flat. Sometimes this can be due to taking an antihistamine as well, due to reducing the inflammation.

Because the hives can appear and disappear, migrate and change shape , it’s important to note the progressions. When you see your doctor, things may not appear the same way that you saw them earlier in the day. Let him hear your description in detail so he can help make the best diagnosis. The itchy red welts on your trunk or arms and legs can be due to an allergic reaction , but not necessarily.

In addition to antihistamines, your physician may recommend creams to stop the itching as well as taking oatmeal baths. Some people find that using a cool wash cloth on the skin area helps to relieve it. Don’t irritate your skin by wearing wool but instead dress in cotton clothing that is not tight against your body. Hives usually resolves within a couple of weeks, but it’s important to ascertain if your rash is indeed hives rather than another diagnosis.

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