Hives (Urticaria)

Overview of Hives (Urticaria)

Urticaria (Chapaki / چھپاکی) is a common allergic reaction that can cause swelling of the skin. This Histamine (a protein) is released when an allergic reaction occurs. This causes the capillaries to leak fluid which then accumulates in the skin. Hence, a rash is formed.

Urticaria is an allergic response that causes a red, itchy, and raised rash on the skin. It is not contagious. About 20% of people are affected by urticaria in their life. 

Urticaria is also known as hives, welts, weals, or nettle rash.No sores or blisters are formed.  The chemical under the skin causes the appearance of raised edges.

Since it is a vascular reaction, the swelling goes away on its own in a few minutes to a few hours. The rash does not leave scars.

Urticaria Occurrence

Hives usually go away in 24 hours. Acute urticaria affects 15-20 percent of individuals while chronic urticaria affects 2-3 percent of individuals in a lifetime.

In Pakistan, the prevalence rate of urticaria is 24.04%. The main affected areas are Islamabad, Khyber Pakhtunkhwa, and Sindh.

Signs and Symptoms of Hives (Urticaria)

The symptoms are usually similar to any other allergen reaction.

  • Swelling of the skin
  • Appearance of rash
  • Pink or red rash in many shapes and sizes
  • Non-itchy to an itchy rash
  • Wheals occurring in batches
  • The most prominent area being; face, arms, legs
  • Wheal that are few millimetres to centimetres in diameter
  • Wheals that last for a few minutes up to a few hours

A person with urticaria can go into anaphylactic shock as well.

Urticaria can last for several weeks or several minutes depending upon the severity of the reaction.

Types of Hives (Urticaria)

Urticaria is of two types depending on the severity:

  1. Acute Urticaria

This is the most common type. This type of urticaria lasts less than 6 weeks. The most affected area is the face, neck, fingers, toes, and male genitalia.  

  1. Chronic Urticaria 

If urticaria lasts more than 6 weeks, it is considered to be chronic. 10 in every 10,000, suffer from chronic urticaria. 


The chronic condition needs to be treated at the earliest.

Causes of Hives (Urticaria)

An allergen produces an allergic reaction. The body reacts to the presence of an allergen and causes inflammation.

Anything can trigger urticaria in the body. The most possible triggers are as follows:

  • Food allergens
  • Medication allergens
  • Cold or Flu
  • Viral infections
  • Bacterial infections
  • Changes in the environment
  • Pet dander
  • Latex allergy
  • Pollen allergy
  • Dust allergy
  • Intestinal parasites
  • Temperature change
  • Chronic illness
  • Insect bites
  • Scratching
  • Sunlight exposure
  • Blood transfusions
  • Exercise
  • Chronic Infection
  • Autoimmune disease

Risk Factors of Hives (Urticaria)

The following factors can increase the chances of developing this condition:

  1. Drugs 
  2. Long-term exposure to cold habitats or conditions 
  3. Prolonged exposure to hot environments 
  4. Common cold or influenza
  5. Sudden changes in the environment of a person
  6. Stress
  7. Unhealthy food choices

Health Complications of Urticaria

Complications of urticaria may include the following:

  • Swelling Of the Throat

This can cause the trachea and the vocal cords to block. A person may suffer from airway blockage. This can also lead to respiratory issues

  • Anaphylaxis

In this condition, the whole body reacts aggressively to allergic reactions. This can also make the breathing process difficult.



If a person is developing this condition often, they should keep a record of the triggers. In the meanwhile, make sure to :

  • Maintain a safe distance from any possible trigger. At first, the reaction may be mild. But a recurrent attack can be much more severe.

  • Avoid consumption of any food or medicine that has served as a trigger previously. Make sure to read the labels carefully. 



A diagnosis given depending on the type of urticaria is as follows:.

Acute Urticaria 

Acute urticaria is diagnosed by examining the rash on the skin. A history of triggers can narrow down the cause of acute urticaria. 

Doctors ask:

  • Medical history
  • Family history
  • How the episode began
  • Any prior medication being taken
  • Looks for an insect bite
  • Possible allergies

In case, the trigger is unclear, a blood sample is taken to find out the possible allergies that might trigger the condition.

Chronic Urticaria 

Since chronic urticaria indicates long term symptoms, it clears out external triggers. Tests are done to find the underlying cause.

Alcohol, caffeine, and stress might worsen the condition.

Treatment of Hives (Urticaria) | When to Consult a Doctor

As diagnosis depends on the type of urticaria, so does the treatment. 

Home Remedy

The best home remedy is to avoid triggers. Triggers can aggravate the symptoms. It is important to identify the known triggers.

Some of the home remedies are:

  • Using hypoallergenic soaps and detergents
  • Avoiding food that causes an allergic response
  • Avoiding medication that might trigger hives
  • Avoiding alcohol and cigarettes
  • Avoiding stress
  • Avoid tight clothing
  • Taking a cold shower to cool the area

Medication According to Type of Urticaria 

Acute Urticaria 

Since histamine is the protein that causes the allergic reaction in the first place, oral second-generation antihistamines are prescribed. A few of them are:

  • Cetirizine
  • Bilastine
  • Levocetirizine
  • Fexofenadine
  • Loratadine
  • Desloratadine
  • Rupatadine

A standard dose is administered to treat the condition. If there is no change, the dose is increased. 

During Pregnancy and breastfeeding, the dose varies.

First-line antihistamines are no longer recommended due to many side effects.

Chronic Urticaria

For chronic urticaria, a different route is preferred as many complications may arise.

  • Antibiotics can reduce inflammation and redness. For instance, the immunoglobulin E suppressant Omalizumab reduces the symptoms of chronic urticaria. 
  • Acupuncture might be effective for a more natural approach.

Note: All medication is to be taken as prescribed by the doctor.


Urticaria can be irritating and can often cause stress. If you suffer from this condition immediately get yourself checked by a certified dermatologist or cosmetologist.