The Rash of Hives

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What are hives?  In medical terms, hives is known as urticaria just to confuse everyone. This is a very common disorder affecting up to 20% of people sometime in their lifetime. A typical rash is very itchy, along with red plaques (patches of skin). Individual lesions (the bumpy stuff) appear within minutes, come together to coalesce and then disappear within minutes. Other lesions may stay around longer and then disappear after a few hours.

Can hives be dangerous?  There is a particularly severe form of urticaria called angioedema that is defined by swelling deeper in the skin. This can involve the tongue, lips and throat. Needless to say, this can be a medical emergency. The triggers of such can be a drug, foods, insect bites or stings, or infection. These triggers would be possible for new onset urticaria but usually no cause is found in many cases, especially when the condition persists for weeks or months.

Urticaria is classified as acute( less than six weeks) or chronic ( more than six weeks). The rash is present on most days of the week, not necessarily daily. For both, the rash looks the same.

Some of the rashes look quite large:

There may be different presentations. Some are called cholinergic urticaria which is triggered by rapid changes in body temperature( such as taking a shower) that feels like a burning. There is something called dermatographism where the skin is hardened appearing where the skin has been firmly stroked or scratched:

What causes hives?  There are so many possible causes of hives although no specific cause can be identified in many people. All of them, however appear to have some sort of allergic trigger causing the release of mast cells. Of the possible food triggers, reactions typically occur within 30 minutes. Milk, egg, peanuts, tree nuts, soy, and wheat are the most common foods to cause rash in children. For adults, fish, shellfish, tree nuts, and peanuts are most common. Other foods, such as tomatoes, and  strawberries can cause generalized rash through an non-allergic mechanism, especially in younger kids.

These are round bumps on the skin called papules that appeared within 30 minutes of exercise.

There are some factors or warning signs to look out for in addition to angioedema: the rash that is recurrent, persistent, and difficult to treat. Definitely see your doctor about this. 

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Dr. Frank Marinkovich owns and operates Eastside Family Health Center in Kirkland, WA. Serving Kirkland and the Eastside, Seattle, Bellevue, Renton and the surrounding local communities. Specializing in Primary Care, Automobile Accidents and FAA physicals. Visit them online at Eastside Family Health Center or call them at (425) 899-2525.
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