How Are Hives And Swelling Diagnosed
Your doctor can diagnose hives and swelling by looking at your skin. Allergy tests can help identify whats triggering a reaction. Knowing the cause can help you avoid allergens, hives and swelling. Allergy tests include:
- Skin tests: During this test, healthcare providers test different allergens on your skin. If your skin turns red or swells, it means youre allergic to that substance. This type of allergy test is also called a skin prick or scratch test. Skin testing is not commonly done if hives are chronic in nature.
- Blood tests: A blood test checks for specific antibodies in your blood. Your body makes antibodies to fight off allergens. The process is part of your immune system but if your body makes too many, it can cause hives and swelling.
Favorite Resource To Find An Allergist
Generally, youll visit a primary care doctor first, but he or she may recommend you schedule an appointment with an allergist. The AAAAIs Find an Allergist tool can help you find an allergist or immunologist close to where you live.
How To Diagnose Hives
Your doctor will perform a physical exam and look at your skin to confirm that your skin rash is really hives. Your doctor may also want to run some tests, such as a blood test or skin prick test. These will help identify if there is an underlying problem.
Doctors will ask a lot of questions to explore possible triggers and determine the exact cause of hives. Have you eaten a new food? Started a new medication? Has there been a recent infection? Is there anything upsetting your body system that suggests an autoimmune disease? The history of symptoms is very important in figuring out what is causing hives.
If there is no obvious trigger or the trigger is unknown, this is called idiopathic urticaria.
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Causes And Risk Factors Of Hives
Although hives can have many causes, they all get their start when immune cells in your body called mast cells are activated. In many cases, those mast cells release a chemical called histamine that can cause swelling, itching, and redness. Although not all hives are the result of histamine being released, the vast majority are, Dr. Elmariah says. Heres the real question, though: Whats causing those mast cells to react in the first place?
Thats a relatively easy question to answer if you have acute hives. We can generally identify about 50 percent of the triggers after taking a good history of the patient and getting the full story behind the incident, Dr. Friedman says.
Chronic hives, however, often have different outcomes, and unfortunately, although about 50 percent of hive cases will be resolved within a year of entering the chronic phase, some people will have hives their entire life. With chronic hives, we can rarely identify why theyre happening, and the longer somebody has hives, the less likely it is that theyll go away, says Friedman, adding that 20 percent can continue for longer than 10 years.
Nonallergic causes consist of bacterial and viral infections exercise stress pressure on or scratching the skin chemical contact exposure to sun, heat, or cold and autoimmune disorders like thyroid diseases and lupus, especially in the case of chronic hives.
What Are Hives Or Urticaria
Hives or urticaria are a type of rash consisting of itchy, swollen, red welts. The itching may be mild or severe. Foods, medications, infections, exercise, scratching, alcoholic beverages, emotional stress and many other factors may worsen hives. The condition affects an estimated 20 percent of the population at one time or another in their lives.
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Treatment For Urticaria And Angioedema
There are two important aspects of treatment for urticaria: avoidance of any reasonably suspected trigger, and treatment with medication.
Individuals who have urticaria due to aspirin may need to avoid foods that contain high levels of salicylates. As well as this, antihistamines are the mainstay of medication treatment for urticaria and angioedema. They may be taken just when required or regularly to prevent episodes occurring in chronic spontaneous urticaria.
Other prescription medication are used to treat urticarial and angioedema symptoms if ordinary antihistamines do not control the symptoms effectively.
For more detailed information about urticaria and angioedema and for more useful tips on management and treatment, please find further useful resources above.
Favorite Tool To Virtually Identify An Allergy
Sometimes hives can be part of an allergic reaction. This interactive tool from AAAAI can help pinpoint the issue. Just click through a series of questions and mark where on the body the allergy is occurring and the symptoms youre experiencing, and youll be presented with possible issues.
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Causes Of Rashes In Children
Children are particularly prone to rashes that develop as a result of illnesses:
- Chickenpox is caused by a virus, and the rash is characterized by small itchy bumps and blisters that form all over the body.
- Measles is a viral respiratory infection that causes a widespread rash consisting of itchy, red bumps.
- Scarlet fever is an infection due to group A Streptococcus bacteria that produces a toxin, causing a bright red or skin-tone-colored, sandpaper-like rash.
- Hand, foot, and mouth disease is a viral infection that can cause red lesions on the mouth and a rash on the hands and feet.
- Fifth disease is a viral infection that causes a red, flat rash on the torso, arms, and legs.
- Kawasaki disease is a rare but serious illness that triggers a rash and fever in the early stages and can lead to heart complications.
- Impetigo is a contagious bacterial infection that causes an itchy, crusty rash and yellow, fluid-filled sores on the affected area, such as the face, neck, or hands.
You can treat most contact rashes, but it depends on the cause. Follow these guidelines to help ease discomfort and speed up the healing process:
Hives Caused By Infection
Heather L. Brannon, MD
Hives are often idiopathic, meaning that they can develop spontaneously for no known reason.
If a cause can be found, it is most often the result of a reaction to one of the following:
- Allergic reactions to food, medications, or insect bites
- Bacterial or viral infections, including strep throat, colds, and mononucleosis
- Physical triggers like cold temperatures, pressure, scratching, or vibrations
- Sweating events like exercise or being in an overheated environment
- Psychological stress
This photo is an example of hives caused by a viral infection. Hives caused by an infection tend to be generalized rather than localized .
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When To See A Healthcare Professional About Rashes
If you dont already have a physician, you can use the Healthline FindCare tool to find a professional near you.
Go to the hospital immediately if you experience a rash along with any of the following symptoms:
- increasing pain or discoloration in the rash area
- tightness or itchiness in the throat
- difficulty breathing
- swelling of the face or limbs
- fever of 100.4°F or higher
- severe head or neck pain
- repeated vomiting or diarrhea
Your healthcare professional may also:
- take your temperature
- order tests, such as an allergy test or complete blood count
- perform a skin biopsy, which involves taking a small sample of skin tissue for analysis
- refer you to a specialist, such as a dermatologist, for further evaluation
Your healthcare professional may also prescribe medication or medicated lotion to relieve your rash. Most people can treat their rashes effectively with medical treatments and home care.
Follow these tips if you have a rash:
- Use home remedies to soothe mild contact rashes.
- Identify potential triggers for the rash and avoid them as much as possible.
- Carefully follow any treatments your doctor prescribes. Speak with a healthcare professional if your rash persists or gets worse despite treatment.
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Can Hives Be Prevented
Simple changes to your lifestyle may be able to help you prevent hives from reoccurring in the future. If you have allergies and you know which substances are likely to cause an allergic reaction, your doctor will suggest that you avoid any possible exposure to these factors. Allergy shots are another option that may help you reduce the risk of experiencing hives again.
Avoid being in high-humidity areas or wearing tight clothing if you have recently had a hives outbreak.
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When To Seek Emergency Medical Help
If you notice hives on face or swelling in your tongue or lips or face difficulty in breathing, it can be an early symptom of anaphylaxis, a potentially fatal allergic reaction that can cause problems in breathing and send your body into shock.
You must also contact your doctor immediately if you notice any of the following symptoms –
Check If You Have Hives
DR P. MARAZZI/SCIENCE PHOTO LIBRARY https://www.sciencephoto.com/media/694159/view
This image shows white skin with the hives rash. The rash is on a child’s leg and hand. Their groin, in the top left of the photo, is not affected by the rash.
The skin on most of their thigh is pink, raised and bumpy. At the side of their thigh are deep creases in the skin.
Their hand is pink with some red patches between their thumb and finger and at their fingertips.
Elizabeth Nunn / Alamy Stock Photo https://www.alamy.com/stock-photo-an-urticarial-rash-caused-by-an-allergic-reaction-to-penicillin-111762116.html?pv=1& stamp=2& imageid=261CE1C1-DA64-4EAE-8D55-1794DA842BD3& p=278658& n=0& orientation=0& pn=1& searchtype=0& IsFromSearch=1& srch=foo%3dbar%26st%3d0%26pn%3d1%26ps%3d100%26sortby%3d2%26resultview%3dsortbyPopular%26npgs%3d0%26qt%3dGDR5M4%26qt_raw%3dGDR5M4%26lic%3d3%26mr%3d0%26pr%3d0%26ot%3d0%26creative%3d%26ag%3d0%26hc%3d0%26pc%3d%26blackwhite%3d%26cutout%3d%26tbar%3d1%26et%3d0x000000000000000000000%26vp%3d0%26loc%3d0%26imgt%3d0%26dtfr%3d%26dtto%3d%26size%3d0xFF%26archive%3d1%26groupid%3d%26pseudoid%3d%26a%3d%26cdid%3d%26cdsrt%3d%26name%3d%26qn%3d%26apalib%3d%26apalic%3d%26lightbox%3d%26gname%3d%26gtype%3d%26xstx%3d0%26simid%3d%26saveQry%3d%26editorial%3d1%26nu%3d%26t%3d%26edoptin%3d%26customgeoip%3d%26cap%3d1%26cbstore%3d1%26vd%3d0%26lb%3d%26fi%3d2%26edrf%3d0%26ispremium%3d1%26flip%3d0%26pl%3d
This image shows light brown skin with the hives rash.
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Heat Or Cold Exposure
Heat and sweating or exposure to ice or very cold temperatures on the stomach can lead to hives. Maintaining the skin at a more constant, regular temperature can help whenever possible. Because babies cant regulate their body temperatures as well as adults, they may be especially vulnerable to temperature extremes.
Solutions For Common Skin Problems
Hives can be quite itchy, not to mention irritating. While they bring an obvious physical burden, they can hinder emotional well-being too, often isolating individuals socially and affecting performance at work and school, especially if a person has been struggling with hives for a long time, says Sarina Elmariah, MD, PhD, a board-certified dermatologist at Massachusetts General Hospital in Boston.
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As you may suspect, hives are easily confused with other conditions, but there are a few characteristics that distinguish them. Although many conditions can look like hives, they often dont behave like hives, says Adam Friedman, MD, professor of dermatology at the George Washington University School of Medicine and Health Sciences in Washington, D.C.
Namely, how long they last and how much they move can help you determine if a rash or skin condition is hives. Common symptoms of hives are:
- Red or skin-colored bumps or welts with clear edges that typically clear up within 24 hours, but may reappear in another spot
- Bumps or welts that show up either alone or clumped together, covering a larger area
- Itchiness around the bumps or welts
- Swelling around the bumps or welts
- Sometimes pain or stinging at the site of the bumps or welts
If hives last for six weeks or longer, you may be dealing with chronic hives, which can be a sign that something else is going on.
Learn More About Signs and Symptoms of Hives
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How Are Chronic Hives Treated
Most people with chronic hives manage with appropriate doses of non-drowsy antihistamines such as cetirizine and loratadine. The doses for chronic hives are usually higher than the usually recommended doses. Although referred to as ‘non-sedating’, these medicines may still cause drowsiness especially at higher doses, so take care when driving or operating machinery.
If the cause is a specific food, food additive, shellfish, cosmetic or something else, avoiding those foods or substances will reduce the risk of hives coming back again. Also avoid anything that can make hives worse such as excessive heat, spicy foods or alcohol.Steroid or antihistamine creams are not helpful and may cause skin changes or skin irritation.
People with severe symptoms interfering with quality of life may be referred to a clinical immunology/allergy specialist or dermatologist for assessment and consideration of additional medications.
How Is Urticaria Diagnosed
Urticaria is diagnosed in people with a history of weals that last less than 24 hours with or without angioedema. A medication and family history should be elicited. A thorough physical examination should be undertaken.
Skin prick tests and radioallergosorbent tests or CAP fluoroimmunoassay may be requested if a drug, latex, or food allergy is suspected in acute urticaria.
There are no routine diagnostic tests in chronic spontaneous urticaria apart from blood count and C-reactive protein , but investigations may be undertaken if an underlying disorder is suspected.
The autologous serum skin test is sometimes carried out in chronic spontaneous urticaria, but its value is uncertain. It is positive if an injection of the patient’s serum under the skin causes a red weal.
Inducible urticaria is often confirmed by inducing the reaction eg, scratching the skin in dermographism or applying an ice cube in suspected cold urticaria.
Investigations for a systemic condition or autoinflammatory disease should be undertaken in urticaria patients with fever, joint or bone pain, and malaise. Patients with angioedema without weals should be asked if they take ACE inhibitor drugs and tested for complement C4 C1-INH levels, function and antibodies and C1q.
Biopsy of urticaria can be non-specific. The pathology shows oedema in the dermis and dilated blood vessels, with a variable mixed inflammatory infiltrate. Vessel-wall damage indicates urticarial vasculitis.
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How To Tell If A Rash Needs Medical Attention
- If the rash is growing rapidly or if you have rashes all over your body
- If you have a fever with the rash
- If you notice any oozing or development of bumps/inflammation on or around the rash
- If the rash is painful
- If the rash is oozing colored liquids and is infected
- If you experience any of these, book an appointment with your dermatologist.
Hives Occur In The Skin And Are Common
Up to 20% of people will develop hives at some time during their life. In most cases, hives are not due to allergy. Underneath the lining of the skin and other body organs are mast cells. Mast cells contain chemicals including histamine. When these are released into the skin they irritate nerve endings to cause local itch and irritation and make local blood vessels expand and leak fluid, triggering redness and swelling.
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Is It Hives Or Angioedema
Angioedema swelling of tissue beneath the surface of the skin can be mistaken for, or associated with hives. It can be caused by allergic reactions, medications or a hereditary deficiency of some enzymes. The following symptoms may indicate angioedema:
- Swelling in the eyes or mouth
- Swelling of the hands, feet or throat
- Difficulty breathing, stomach cramps or swelling of the lining of the eyes
The best way to identify your symptoms is to talk to an allergist who can diagnose and treat both hives and angioedema.
Different Types Of Hives
There are different types of hives. These include:
- Acute hives or urticaria These hives persist on the skin for less than six weeks. They are often caused by chemicals in food, infections, or certain medications. Chocolates, tomatoes, fresh berries, eggs, milk, and fish may cause an acute form of hives on the skin. Fresh food generally poses a higher risk of causing hives than cooked food. Even some preservatives or additives in foods can be responsible for hives. Non-steroidal anti-inflammatory drugs, medications given for hypertension, and pain killers like codeine can also cause hives.
- Chronic hives or urticaria This type may remain for more than six weeks. The exact cause of this skin condition is still unknown. The chronic form of hives and angioedema may affect internal organs such as the lungs, muscles, and gut. In some cases, these hives can be caused by thyroid disease, hepatitis, cancer, or other infections.
- Physical hives or urticaria These hives are the result of increased stress on the skin like exposure to sun, vibration, sweating, pressure, cold, heat, and even exercise. In this case, the hives will form only in stimulated regions. In most cases, hives may resolve within 1-2 hours.
- Pseudo-allergic hives or urticaria Some substances labelled as non-specific histamine liberators can cause hives. Several antibiotics and products used in radiology may also cause urticaria or hives.
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What Do Hives Look Like On The Skin
These itchy welts can appear on the skin in many ways, as the following pictures of hives show.
Hives develop in batches
Hives appear suddenly, causing a rash of smooth, raised welts that tend to differ in size and shape. The welts can be small, large, or somewhere in between. Some hives are as big as a hand.
The color of hives varies with skin color
If you have brown or black skin, hives are often the same color as your skin, or slightly darker or lighter than your natural skin color. People who have a light or medium complexion see red or pink hives.
Individual hives come and go quickly, usually within 24 hours
As some hives disappear, new hives may form. Most people have a case of hives for a few days to a few weeks. If new hives continue to appear for more than 6 weeks, you have a condition called chronic hives.
Skin itches, burns, or stings and feels warm to the touch
Hives can itch, sometimes intensely. Some people say that hives burn or sting rather than itch. Because the skin is inflamed, hives often feel warm to the touch.
Hives can cover large areas of skin
Some people get hives in a few places. Its also possible for hives to cover a large portion of the body, which can feel uncomfortable because hives tend to itch.
A telltale sign of hives is blanching
This means that if you have a light or medium skin color, pressing on a hive will cause the red or pink color to disappear while youre pressing on it.
Hives usually appear as distinct raised spots or patches