Hives and Angioedema

Overview

Hives and angioedema are skin reactions that cause itchy welts and swelling, respectively. Hives, also known as urticaria, result in itchy welts that range in size from small spots to large blotches. They can be triggered by various situations and substances, including foods and medications. Angioedema, on the other hand, causes swelling in the deeper layers of the skin, often around the face and lips. Both conditions can be short-lived and harmless, but in some cases, they can last longer and be more severe. Hives and angioedema are usually treated with antihistamine medication. If swelling blocks the airway, it can be life-threatening. To lower your risk of experiencing hives or angioedema, avoid known triggers, bathe and change your clothes after exposure to potential triggers, and seek emergency care if you experience severe swelling or difficulty breathing.

Understanding the disease

Symptoms

The symptoms of hives include itchy welts that range in size from small spots to large blotches on the skin. These welts can be skin-colored, reddish on white skin, or purplish on black and brown skin. Hives are usually short-lived and harmless, clearing up within a day without leaving any lasting marks. However, chronic hives can last for months or years. Angioedema, a reaction similar to hives, affects deeper layers of the skin. Symptoms include swelling, especially around the eyes, cheeks, or lips, welts that form in minutes to hours, and mild pain and warmth in the affected areas. Angioedema can be life-threatening if swelling of the tongue or in the throat blocks the airway.

Risk Factors

Risk factors for developing hives and angioedema include:

1. Having had hives or angioedema before
2. Having had other allergic reactions
3. Having a family history of hives, angioedema, or hereditary angioedema

Development

Hives and angioedema develop when the body releases histamine, a chemical that causes inflammation and blood vessels to widen. This leads to the characteristic symptoms of hives, such as itchy welts on the skin, and angioedema, which is characterized by swelling in the deeper layers of the skin. Hives can be triggered by many situations and substances, including certain foods and medications. Angioedema can arise with hives or alone and is often associated with swelling in the face and lips. Short-lived (acute) hives and angioedema are common and usually resolve within a day without any lasting marks. However, hives that last longer than six weeks are called chronic hives. In some cases, hives and angioedema can be life-threatening, particularly if swelling blocks the airway.

Assessment and Diagnosis

Triage

You should see a doctor if hives and angioedema are suspected when:

1. Symptoms persist for more than a few days.
2. The condition is severe and interfering with daily activities.
3. You experience difficulty breathing, swelling of the tongue or throat, or chest tightness.
4. You suspect a known allergy to food or medication, and your symptoms may be an early sign of an anaphylactic reaction.
5. Self-treatment with over-the-counter antihistamines does not provide relief. Remember, if you experience a life-threatening reaction, such as difficulty breathing or swelling of the tongue or throat, seek emergency care immediately.

Diagnosis

To diagnose hives or angioedema, your doctor will typically examine the welts or areas of swelling and ask about your medical history. They may also recommend blood tests or an allergy skin test to confirm the diagnosis.

Management and Treatment

Complications

Complications of hives and angioedema can include:

1. Anaphylaxis: A severe, life-threatening allergic reaction that can cause swelling of the tongue or throat, difficulty breathing, and a drop in blood pressure.
2. Airway obstruction: Swelling of the face, lips, or tongue can block the airway, making it difficult to breathe. This can be a life-threatening situation.
3. Skin infections: Prolonged itching and scratching from hives can lead to skin infections.
4. Emotional distress: Persistent or recurrent episodes of hives and angioedema can cause emotional distress, anxiety, and depression. While most cases of hives and angioedema are harmless and resolve on their own or with treatment, it is essential to seek medical attention if symptoms persist, worsen, or are accompanied by difficulty breathing, swelling in the face or throat, or chest tightness.

Prevention

Preventive measures for hives and angioedema may include:

1. Avoiding known triggers: If you know what has triggered your hives or angioedema in the past, try to avoid exposure to those substances.
2. Bathing and changing clothes: If pollen or animal contact has caused your hives before, take a bath or shower and change your clothes after being exposed to pollen or animals.
3. Medications: Some medications that are known to cause hives or angioedema may be avoided or replaced with alternative treatments under your healthcare provider's guidance.
4. Allergy testing and immunotherapy: If you have identified food or medication allergies as triggers, your healthcare provider may recommend allergy testing and immunotherapy to help reduce the likelihood of future reactions. Please consult your healthcare provider for personalized advice on how to prevent hives and angioedema, as individual cases may vary.

Home Remedies

Home remedies for hives and angioedema include:

1. Antihistamines: Over-the-counter antihistamine medications can help relieve itching and reduce swelling. Be sure to follow the instructions on the label or as advised by your healthcare provider.
2. Cool Compresses: Applying a cool compress to the affected area can help reduce itching and swelling. You can use a damp cloth or cold, wet towels.
3. Calamine Lotion: Calamine lotion can help soothe itchy skin. Apply it to the affected area using a clean cotton pad.
4. Oatmeal Bath: Taking a bath with colloidal oatmeal can help relieve itching and reduce skin irritation. Add 1-2 cups of oatmeal (unsweetened) to a cool bath and soak for 15-20 minutes.
5. Aloe Vera Gel: Applying aloe vera gel to the affected area can also help soothe itchiness and reduce inflammation.
6. Avoiding Triggers: Identify and avoid known triggers, such as certain foods or chemicals, to prevent future episodes.
7. Hydration: Drinking plenty of water can help flush out toxins and reduce inflammation in the body. It's important to note that while these home remedies can help alleviate symptoms, they may not be sufficient for severe cases or cases that persist for an extended period. Consult your healthcare provider for proper evaluation and treatment recommendations.

Treatment

Treatment for hives and angioedema typically involves antihistamine medications. These medications help to relieve itching and reduce swelling. In some cases, a healthcare provider may prescribe a stronger medication for more severe reactions. In addition to medications, follow the precautions mentioned to lower the likelihood of experiencing hives or angioedema. If symptoms continue for more than a few days or you suspect an anaphylactic reaction, consult a healthcare provider.

Preparing for medical consultation

To prepare for an appointment for hives and angioedema, follow these steps:

1. List your symptoms: Make a record of when and where the hives or angioedema occurred, what you were doing, and if you were eating anything at the time. This information will help you and your healthcare provider identify possible triggers.
2. List medications: Make a list of all medications, vitamins, herbs, and supplements you are currently taking. Bring along the original bottles and a list of doses and directions, if possible.
3. Prepare questions for your doctor: Compile a list of questions to ask your healthcare provider about your condition, treatment options, and any concerns you may have.
4. Keep a symptom diary: Track your symptoms by maintaining a diary that includes details of when and where hives occur, their frequency, and any changes in intensity or appearance. This information will help your healthcare provider in their assessment and treatment recommendations.
5. Seek necessary referrals: If your primary care provider believes a specialist's input is needed, they may refer you to an allergy specialist or a dermatologist with experience in diagnosing and treating skin conditions. Remember to be honest and open with your healthcare provider about your symptoms and concerns. This information will help them provide the best possible care for your condition.