What Is Chronic Urticaria?

Introduction

Urticaria is also known as hives, which are itchy and red welts that can be triggered by certain situations or substances. These welts may vary in sizes. They tend to repeatedly appear and fade away as the skin reaction runs its course. Each of these welts is said to characteristically last for no longer than 6-12 hours. The sizes of the hives tend to rapidly change and often disappear from one place and then reappear again in another place in a matter of few hours. If they are ordinary hives, then the flare-ups may come all of a sudden. In the case of occasional hives, they occur due to the direct stimulation of environmental forces such as sunlight, heat, and cold.

What is urticaria?

Hives are medically known as urticaria, which is characterized by the sudden occurrence of red bumps or wheals on the skin. Urticaria is usually caused by body reactions to specific allergens. Sometimes, it happens for unknown reasons. 

The bumps on the skin tend to be itchy. Others report a burning or stinging sensation on their skin. They also tend to appear all throughout the body, but commonly affects the face, neck, arms, back, legs, including the ears, tongue, and throat. They often appear in different sizes and shapes ranging from a few millimeters to several centimeters in diameter. It has been estimated that around 20-30 percent of people develop chronic urticaria at some point in their lives. This condition is commonly observed in females than males.

If swelling happens deeper in the skin along with hives, then it is known as angioedema. The condition would lead to the swelling of the feet, hand, and face, especially the lips and eyelids. 

Chronic cases of hives are often uncomfortable and would tend to interfere with an individual's sleep and daily activities. At times, it may cause embarrassment. For most individuals, the use of antihistamines and anti-itching medications can prove to be a lot of help.

Different Types of Hives

There are different types of hives and they include:

• Acute Urticaria - It is also known as ordinary hives. Acute cases of hives are said to resolve within 6-8 weeks.

• Chronic Urticaria - This type of urticaria continues for a longer period of time, which is more than 6-8 weeks.

• Physical Urticaria - Another type of urticaria, which occurs due to physical stimuli such as sweating, heat, exercise, pressure, exposure to the sun, cold, or vibration.

Causes

When certain cells in the body release histamine and other chemicals into the bloodstream, welts or wheals appear. This skin reaction is possibly triggered by various factors such as:

• Exposure to sunlight
• Certain kinds of infections
• Alcohol abuse
• Certain types of food
• Use of certain pain relief medications
• Stress which can either be mental or physical
• Certain types of insects or parasites
• Constant skin scratching
• Sudden exposure to heat or cold
• High-intensity exercises
• Pressure applied on the skin, which can occur due to wearing a tight waistband

In certain cases, it is said that chronic cases of hives are also related to certain underlying medical conditions, which may include thyroid disorders and cancer in rare cases.

Another common form of physically induced hives is cholinergic urticaria, which is characterized by hundreds of itchy small bumps anywhere in the body. This is known to occur just within 15-20 minutes of carrying out intensive workouts or any physical exertion.

Symptoms

The signs and symptoms experienced by an individual with chronic urticaria are:

• The presence of batches of red-colored welts that tend to appear anywhere on the body.
• Itching can start from mild to severe.
• Different sizes and shapes of welts that suddenly appear and fade away.
• Welts are triggered by heat, stress, or exercise with occasional flare-ups.
• Severe and painful swelling of the eyelids, lips, hands, or feet.
• The condition persists for more than 6 weeks. An individual cannot predict when it would appear and when it would fade away. At times, it can take months or even years for it to go away.

When to seek medical help?

Visit the doctor if the condition tends to become severe or comes back after several days. Chronic cases of hives would not put you at risk of serious allergic reactions such as anaphylaxis. However, if you experience hives due to a severe allergic reaction, then it is ideal to seek emergency help at the earliest. Some of the symptoms of anaphylaxis are finding it difficult to breathe, dizziness, weakness, and swelling of the tongue, lips, and eyelids.

Diagnosis

The doctor would initially carry out a physical examination and at the same time ask a number of questions to know the possible causes of your signs and symptoms. The doctor may also ask you to maintain a diary to keep track of the following:

• Your daily activities
• Medications whether prescribed or over-the-counter
• Herbs or dietary supplements being taken
• Foods and drinks you have consumed throughout the day

Allergy testing and other blood tests would only be occasionally helpful in determining the cause. The correct form of evaluation for this particular condition would require the patients to provide accurate medical information about their oral intake and personal habits.

Sometimes, it would be helpful to limit the intake of certain medications or food items for a certain time to observe if any of them has an effect on your skin condition. Certain forms of systemic infections, as well as diseases, would lead to occasional hives. 

Treatment

Most doctors would likely recommend treating the symptoms of hives using home remedies or over-the-counter medications such as antihistamines. If your condition is not relieved using home remedies, you can consult your doctor about other treatment options that would work best for you.

Antihistamines

Hives can be treated with antihistamines, which help relieve the symptoms of histamine release. However, these medications also have side effects. Some examples of antihistamines are:

• Cetirizine (Zyrtec)
• Loratadine (Claritin)
• Desloratadine (Clarinex)
• Fexofenadine (Allegra)

In case if these non-drowsy types of antihistamines do not show any effects, then the doctor can probably increase the dosage of your medicine or ask you to try other types that can cause drowsiness and will be taken before bedtime. Examples of these medications are doxepin and hydroxyzine pamoate.

It is important to first check with the doctor before trying any of these medications, especially when you're pregnant or breastfeeding, or suffering from a chronic medical condition. These medications are also known to cause drug interactions if they are taken with other drugs. Thus, it is quite important to inform your doctor about the medications you are currently taking to avoid any drug interactions and certain side effects. 

Other drugs such as antidepressants, asthma drugs with antihistamines, histamine blockers, and immune-suppressing drugs can also be suggested by the doctor if antihistamines alone do not work.

Home Remedies and Changes in Lifestyle

Chronic urticaria can be experienced for months or even years. For this reason, the condition tends to disrupt your sleep, work, and other daily activities. You can follow the precautions below to help soothe your skin from chronic hives:

• Avoid wearing tight clothes. Opt for loose and light clothing instead.
• Avoid scratching your skin or using harsh chemical-loaded soaps.
• If you are suffering from an ongoing case of hives, you can soothe the affected area with warm water and mild soap, fan, medicated lotion, or an anti-itch cream.
• Avoid the known triggers of your condition as much as possible. 
• Before going out in the sun, apply sunscreen lotion.
• Always maintain a diary of when and where they have occurred as well as the foods and drinks you have consumed. All of these pieces of information are helpful for the doctor when it comes to identifying the exact cause or triggers of your chronic urticaria.