How to Treat Urticaria

Urticaria, commonly known as hives, is a condition where raised welts appear on the skin, accompanied by intense itching. These red marks vary in size, typically ranging from 0.5 cm or more in diameter. In most cases, they will subside within a day if treated properly at home. However, if the hives persist for several days, it is important to consult a doctor for further examination.

It is advisable to eliminate potential food triggers from your diet. Keeping a food diary of everything you've eaten before and after the rash can help you pinpoint which foods might be causing the issue. Several types of foods are known to contribute to the onset of hives, including:

• Foods containing amine substances, which trigger the release of histamine, leading to the outbreak of hives. Such foods include shellfish, fish, tomatoes, pineapples, strawberries, and chocolate.
• Foods with salicylates, compounds similar to aspirin, often found in tomatoes, raspberries, orange juice, spices, and tea.
• Other allergenic foods include peanuts, tree nuts, eggs, cheese, and milk. Some individuals also find that caffeine and alcohol may contribute to the occurrence of hives.

Consider whether you might be allergic to environmental factors in your surroundings. If so, eliminate urticaria by minimizing exposure to them. Some people are prone to hives due to contact with the following substances:

• Pollens. If this is the cause, you may experience hives during pollen season. It’s best to stay indoors during this time and keep windows closed.
• Dust mites and pet dander. If you're allergic to dust mites, maintaining a clean and dust-free environment is essential. Vacuum, sweep, and mop regularly. Change your bedding to ensure you aren’t sleeping on dust-filled or pet-dander-infested sheets.
• Latex rubber. Some individuals develop hives due to contact with latex. If you work in healthcare and suspect latex as the trigger, try wearing non-latex gloves to see if it alleviates your symptoms.

Minimize exposure to insect bites or stings. Some individuals are prone to hives due to chemicals released by insects when they sting or bite. In severe cases, they may require an epinephrine injection. If you work outdoors, here’s how to reduce insect stings or bites:

• Avoid wasp and hornet nests. If you spot a wasp or hornet, don’t provoke them. Slowly move away and wait for them to leave.
• Apply insect repellent on clothing or exposed skin. Ensure no chemicals from insects’ stings get into your nose, eyes, or mouth. Many repellents are available, but choose those containing DEET, as they are usually more effective.

Protect your skin from harsh environmental factors. This includes shielding yourself from temperature changes until your body adjusts to the new climate or adapts to stronger sun protection products. People with sensitive skin may experience hives when exposed to environmental elements such as:

• Heat
• Cold
• Sunlight
• Water
• Pressure on the skin

Discuss with your doctor the medications you're taking. Some medications may trigger urticaria outbreaks. If you suspect that one of your medications is causing an allergic reaction, don’t stop taking it without consulting your doctor. They may recommend alternative medications that treat your underlying condition without causing hives. Some medications linked to hives include:

• Penicillin antibiotics
• Blood pressure medications
• Aspirin
• Naproxen (Aleve)
• Ibuprofen (Advil, Motrin IB, and many others)

Evaluate your overall health status. See your doctor to determine if your hives are a symptom of an underlying condition. Numerous factors can contribute to rashes and itching, including:

• Bacterial infections
• Intestinal parasites
• Viral infections such as hepatitis, cytomegalovirus, Epstein-Barr virus, and HIV
• Thyroid disorders
• Autoimmune disorders like lupus erythematosus
• Lymphoma
• Blood transfusion reactions
• Rare genetic disorders that affect the immune system and protein levels in blood

Relieve itching with a cold compress. This simple method can help ease the itch and prevent constant scratching. You can:

• Soak a washcloth in cold water and place it over the affected area. Leave it there until the itching lessens.
• Use an ice pack. If you prefer ice, wrap it in a washcloth to prevent direct contact with your skin, which could cause a cold burn. If ice isn’t available, a bag of frozen vegetables can serve as a substitute. Apply the cold compress for 10 minutes before gently warming the skin.

Soak in a cold bath with natural, itch-free remedies. This traditional remedy helps soothe persistent itching. Fill your bathtub with refreshing cold water, and then add one of the following ingredients, following the package instructions. Soak for several minutes or until the itching gradually fades away. The ingredients include:

• Baking soda
• Unprocessed oatmeal
• Colloidal oatmeal (such as Aveeno oatmeal bath or other similar products)

Wear soft and loose-fitting clothing to keep your skin cool and dry. Urticaria can result from tight clothing that irritates the skin and traps sweat. Loose clothing allows the skin to breathe and prevents hives caused by overheating and excessive friction.

• Avoid fabrics that cause itching, especially wool. If you want to wear wool, make sure it doesn’t touch your skin directly. For instance, wear a thin shirt underneath a wool sweater.
• Just as sweat can trigger hives, hot showers or baths can also irritate the skin and worsen itching.

Learn ways to manage stress. Some people experience hives outbreaks when under extreme stress. Consider whether you’ve faced stressful life events such as job changes, the loss of a loved one, emotional vulnerability, or relationship issues. If stress is a factor, learning how to manage it can help eliminate the itchy rash. You can try:

• Meditation. Meditation is an excellent way to relax by clearing your mind. Find a quiet moment to close your eyes, relax, and let go of tension. Some people repeat a specific word or mantra during meditation.
• Deep breathing. Focus on inflating your lungs slowly. This practice helps you relax, prevents shortness of breath from rapid or shallow breathing, and calms your mind.
• Visualizing peaceful scenes. This technique involves imagining a serene location, real or imagined. Once you picture it, immerse yourself in that place and focus on how it looks, smells, and sounds.
• Exercise. Regular physical activity can help you relax, improve your mood, and boost overall health. The U.S. Department of Health and Human Services (HHS) recommends at least 75 minutes of physical activity each week, such as walking, jogging, or sports. They also advise strength training, such as weightlifting, twice a week.

Call emergency responders if you're having difficulty breathing. Occasionally, people experience breathing issues or a feeling of their throat closing when hives flare up. If this happens, it's an emergency situation and you should call for an ambulance immediately.

• At this point, emergency responders will administer an epinephrine shot. This medication, also known as adrenaline, works quickly to reduce swelling.

Try antihistamines. This type of medication is widely available over the counter or by prescription. Antihistamines are often the first treatment for hives, and they're highly effective in reducing itching and swelling.

• Common antihistamines include Cetirizine, Fexofenadine, and Loratadine. Additionally, Diphenhydramine (Benadryl) is a popular over-the-counter antihistamine.
• These medications may cause drowsiness, so be sure to ask your doctor if it's safe for you to drive while using them. Avoid consuming alcohol while taking antihistamines, and always follow the manufacturer’s instructions and your doctor’s advice.
• If you're pregnant, inform your doctor as some antihistamines may not be safe during pregnancy.

Ask your doctor about corticosteroids. These medications are often prescribed when antihistamines are ineffective. They work by suppressing the immune response to alleviate hives. A common prescription treatment is Prednisolone for a period of 3 to 5 days.

• Before using corticosteroids, inform your doctor if you have any of the following conditions to ensure it's safe for you: high blood pressure, glaucoma, cataracts, or diabetes. Also, notify your doctor if you're pregnant or breastfeeding.
• Possible side effects include weight gain, mood swings, and insomnia.

If your hives persist, you may want to try additional treatments. If your itchy rash doesn't respond to standard treatments, your doctor may recommend seeing a dermatologist. At that point, you might be given the option of trying supplemental medications. Be sure to inform your doctor if you're on any other medications or if you're pregnant or breastfeeding.

• Menthol cream. This topical cream can be applied directly to the skin to relieve itching.
• H2 antihistamines. These differ from typical antihistamines and work by narrowing blood vessels to reduce swelling and redness. Side effects may include headaches, diarrhea, and dizziness.
• Leukotriene receptor antagonists. These may be prescribed instead of corticosteroids because they tend to have fewer side effects, typically only headaches and nausea.
• Cyclosporine. This drug works by suppressing the immune system. Side effects may include high blood pressure, headaches, kidney issues, elevated cholesterol, chills, and increased risk of infections. This medication should generally be used for no more than a few months.

Consult with your doctor about light therapy treatments. Some cases of hives may respond well to narrowband ultraviolet B (UVB) phototherapy. For this treatment, you will need to stand in a small room for several minutes while being exposed to the light.

• Results may not be immediate. You may require 2 to 5 treatments per week, and it could take up to 20 sessions before significant improvement is seen.
• This treatment may cause skin darkening and increase the risk of skin cancer.