Urticaria: causes, symptoms and treatment

Hives (urticaria) is an allergic body reaction in which affected people suddenly experience intense redness, wheals and itching. Skin symptoms can be acute or chronic and can be triggered by various stimuli.

When red, swollen spots that itch almost unbearably itch suddenly appear, patients experience real shock at first. Itching in particular drives many people crazy and makes them jump in the cold shower several times a day. These bodily reactions can be signs of a severe allergic reaction. What are the symptoms of urticaria and what exactly triggers the skin symptoms?

What are the symptoms of urticaria?

Hives or urticaria are expressed through characteristic symptoms such as:

  • Itchy rash similar to contact with nettle that makes you want to rub or squeeze the areas
  • Development of one or more angioedema, which is a pad-like swelling of the skin of tissues in which fluid collects under the tissues of the face, hands, feet or around the larynx or mucous membranes, which can also cause swelling of the language .
  • Red, itchy hives that often go away after a few hours

More rarely, angioedema occurs without being accompanied by wheals or itching. Sudden symptoms of hives can be an indication of anaphylaxis. An allergic shock, which in turn manifests itself through severe symptoms such as circulatory weakness to collapse, nausea and diarrhea, shortness of breath, tachycardia and anxiety.1.2

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Acute and chronic urticaria

To die acute spontaneous urticariaIt is triggered, for example, by an infection or pain relievers. The characteristic symptoms come out of nowhere, remain for a few hours or days, and completely disappear after up to six weeks. The exact trigger of the allergic reaction often remains unclear, as it is no longer worth clarifying after symptoms have disappeared.

symptoms of a chronic spontaneous urticaria in turn they persist for more than six weeks or recur from time to time in episodes (chronic-recurrent urticaria). Other than that, there are those physical urticaria, which denotes urticaria induced by physical or mechanical stimuli. This means through heat, cold or friction, eg. B. due to scratchy clothes.

How do skin reactions occur?

Urticaria occurs when certain triggers stimulate mast cells. These are endogenous cells that belong to leukocytes and help fight pathogens. If activated, they send pro-inflammatory messenger substances, primarily histamine, into the surrounding tissue. The messenger expands the blood vessels and thus makes them more permeable to water. This causes the skin to become red and swollen. In addition, the messenger substances bind to the nerve fibers, which is why the areas also start to itch. Angioedema can also be triggered by histamine in deeper tissues.3.4

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What are the possible causes and risk factors?

Possible stimuli that can activate mast cells can be:

  • Infections with certain viruses, such as rota or common cold viruses
  • bacteria such as streptococci
  • Food, such as cow’s milk or a certain fruit
  • Insect bites such as bee stings or mosquitoes
  • pollen and animal hair
  • some medications, such as for rheumatism
  • cold hot
  • friction

An autoimmune reaction due to the formation of immunoglobulin E (IgE) antibodies, which activate mast cells, can also cause hives. Some diseases, such as inflammation of the gallbladder, can also increase the risk of hives.

How to diagnose urticaria?

When you visit a doctor, the doctor treating you first examines the skin irritation and takes a detailed medical history. A doctor asks when exactly the symptoms first appeared, how long they have existed, and most importantly: what possible stimuli could be behind them. If skin reactions are clear, a doctor usually diagnoses hives quickly.

In the case of acute urticaria, which has been triggered, for example, by taking a certain drug, no further treatment is given after symptoms have been relieved and it is simply recommended to avoid the trigger if known. In the case of chronic urticaria, the first thing to do is to investigate the causes, as this is the only way chronic urticaria can be effectively treated.

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What is a possible treatment?

Depending on the duration of the symptoms and which triggers underlie, different treatment measures are chosen. The ultimate goal is to become symptom-free. Usually, the symptoms are treated first and then the cause is sought. In the case of acute urticaria, this is often not necessary at all, as skin reactions sometimes disappear as quickly as they came.

For very severe symptoms, a doctor may prescribe a second generation antihistamine that can help relieve skin reactions. If that doesn’t help, the dose may be increased or a drug that slows the body’s immune system is recommended. Refreshing and refreshing and anesthetic creams help against local acute rash. However, these measures should only be taken in consultation with a pharmacist or attending physician.5.6


  • 1. healthy urticaria. (accessed 14/06/2022)
  • 2. University Hospital of Zurich. urticaria. (accessed 14/06/2022)
  • 3. Association of the American Academy of Dermatology. Urticaria. (abgerufen 14.06.2022)
  • 4. Urticaria network eV Forms of urticaria. (accessed 14/06/2022)
  • 5. Inform the SSN. Hives (urticaria). (accessed 14/06/2022)
  • 6. Information on hives. Causes. (accessed 14/06/2022)

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