Urticaria testing is one of the important steps that specialists take in their efforts to diagnose and treat hives. When hives testing is successful, the trigger of the condition can be determined and the appropriate form of treatment started. This is more desirable than dealing with chronic idiopathic hives, for which a trigger is undeterminable.

When a patient first consults an allergist/ immunologist about ongoing hives, a number of steps follow. The specialist asks the patient questions about the condition, examines the patient and then requests that, for the duration of the urticaria, the patient should keep a diary of activities, foods and drinks taken and of medications, supplements and herbs used. The diary should also indicate when the hives appear, on which body parts they appear, and how long they last. Subsequently, depending on what the specialist surmises from the consultation, he or she will order urticaria testing for the patient.

Different Approaches to Urticaria Testing

Hives testing could include blood tests to help the doctor determine the levels of specific components of the blood. X-rays may also be ordered, as well as urine tests. The doctor may order allergy skin testing. In the case of suspected vasculitis, a skin biopsy is more typical. The doctor can also order special tests to rule out health conditions like hepatitis and thyroid disease, which have been known to trigger or exacerbate hives.

For suspected food allergies, the doctor may order one of two tests. One, the elimination diet, involves the patient avoiding the food that might be responsible for triggering the hives. If the symptoms go away, only to return when the patient eats that food again, then the trigger has been identified. The test can extend from 2 weeks to 2 months.

The second possible test is the oral food allergy challenge. In this test, the patient ingests a variety of foods while the doctor observes for reactions. This is a good way to diagnose food allergies, but it comes with a risk. If the patient develops an adverse allergic reaction, then symptoms like anaphylaxis could ensue. It is for this reason that the test is carried out under a doctor’s observation.

At any given moment, a doctor’s decisions about hives testing will depend on the circumstances surrounding the hives. A patient in anaphylactic shock will require immediate evaluation to determine the trigger. A patient with mild urticaria, on the other hand, can follow the slower route described in the previous paragraphs.

The urticaria (hives) skin condition is relatively common. For this reason, it is not difficult to find information about it on the internet.

Hives typically present as wheals: smooth, flat-topped, reddish bumps on the skin. They may be accompanied by itchiness, stinging, tingling or a burning sensation. Hives often stay in one location for a short while before vanishing and then ultimately appearing elsewhere. They do not usually leave scars behind.

In addition, they do not have the capacity to become life-threatening unless they are complicated by angioedema and result in anaphylaxis, a deadly medical condition. Hives and anaphylaxis make for a frightening experience. If the anaphylaxis is not addressed immediately, it can lead to severe injury or death.

The nature of hives varies according to the circumstances. To give an example, hives can be triggered by an autoimmune disease, in which case, they might be thought of as a symptom of this medical condition. Hives can, conversely, be thought of as constituting a distinct autoimmune condition. In this latter situation, hives are more than just a skin condition: hives are, rather, a disease that is characterized by the dysfunction of the immune system.

Hives can also be triggered by various bacterial, viral, fungal and parasitic infections. The hives condition of a patient suffering from one of these infections can typically be resolved with the infection’s successful treatment. These infections often affect the digestive system, the upper respiratory system, the dental area and the ENT area. Thus, a patient suffering from one of them experiences additional discomfort to the urticaria skin condition.

The Presentation and Treatment of the Urticaria Skin Condition

The hives skin condition can present in different ways. In some cases, the hives appear solely at the site of contact between the skin and the factor that triggers them. This form of hives is referred to as contact urticaria. When it develops in response to a latex glove, it is the patient’s hand that gets covered in wheals. When it is makeup that triggers the hives, it is the patient’s face that develops the localized hives.

Hives can also present as a generalized skin condition. Hives of this kind can appear anywhere on the body, especially on parts of the body that have not been exposed to the triggering factor. One might develop this form of hives in response to an allergen like ingested food.

Various medications can be taken to manage the symptoms of hives. They include topical creams for the itching skin, antihistamines to prevent the action of the skin’s mast cells, and steroids for the inflammation.

Hives can be triggered by various factors. These include allergens such as medical drugs, to which a patient’s body responds by breaking out in hives (urticaria). Side effects of various drugs, as listed on drug information websites, include allergic responses such as hives.

Examples of antibiotic drugs that have been known to trigger allergic hives in some patients are Amoxicillin, a penicillin antibiotic drug, and Minocycline, a tetracycline antibiotic drug. These drugs have the capacity to trigger more than just hives. Side effects that result from their use have included both hives and angioedema, which, in their most extreme form, can send patients into anaphylactic shock.

The symptoms associated with anaphylaxis include hives, itchiness, labored breathing, swelling of the face, lips and tongue, and a tight chest. Anaphylaxis is a life-threatening condition. Hence, when patients experience it, they should seek emergency medical care, which will entail the administration of epinephrine.

The above paragraph describes the most appropriate way to address these extreme Minocycline side effects. Hives can be treated afterwards by changing the antibiotic prescription and applying a topical cream to the wheals. Of course, the same applies when one is dealing with Amoxicillin side effects: Hives left over after the anaphylaxis has been addressed can be treated with topical cream or other hives remedies.

The Side Effects of Hives Medication

If there is anything to be learnt from the foregoing paragraphs, it is that the medications so often taken to provide relief from ill health can result in adverse side effects like urticaria. Side effects of this kind can range from mildly uncomfortable conditions to life-threatening ones.

In the same way that antibiotics like Minocycline and Amoxicillin can trigger hives, the corticosteroids taken to relieve the inflammation of hives can provoke their own set of side effects. The side effects of hives medication, and more specifically of corticosteroids, are serious: These medications suppress the immune system, thus increasing one’s vulnerability to infection.

Ultimately, all medication comes with side effects. Some people just happen to respond better than others. Hence, as long as medication is necessary for the treatment of a given condition, it is not possible to eliminate all side effects.

However, there are steps that one can take to reduce the damage or suffering brought on by medication: It is important to use medication only when necessary and as prescribed by one’s doctor. Any problems that develop along the way should be shared with the doctor immediately. He or she will be best placed to make changes to the dosage or to prescribe an alternative form of treatment.

Hives (urticaria) in adults are triggered by some of the same factors that trigger hives in children and teenagers. Among these triggers or causes of hives in adults are allergic reactions. Adults may have allergies to such substances as medication, food, preservatives and pet dander. In allergic responses to these triggers (either from ingesting or touching the allergens), these adults develop hives on their skin within any amount of time between a few minutes and a few hours.

Allergic hives typically present as acute hives. As long as one is able to remove the allergen from his or her environment, the hives symptoms ultimately resolve and do not recur. If one should fail to identify the substance, then it is possible to be exposed to it again and again, resulting in hives episodes without relief. This could easily happen with a substance like food coloring or a food preservative. Most people are unaware that they ingest these substances when they eat processed foods. Hence, they are not likely to know which foods contain them or that they are repeatedly exposing themselves to allergens.

Autoimmune disease is another cause of hives in adults. Various autoimmune disorders, including lupus and thyroid disease, are associated with outbreaks of chronic hives. Some studies on the connection between hives and thyroid disease have shown greater prevalence of thyroid autoantibodies among patients with hives. Upon treatment for thyroid disease, these patients’ hives have cleared. The studies, therefore, indicate a definite connection between autoimmune disease and the development of hives, even though the mechanisms behind such a connection remain largely mysterious.

Stress and Infection as Triggers of Hives in Adults

Stress is yet another common trigger of hives in adults. This should not come as a surprise, given the high levels of stress endured by adults at their places of work and in other aspects of life. Younger age groups do experience stress. However, children tend to be shielded from the extremes of stress by the adults in their lives.

When urticaria in adults is associated with stress, it tends to present as a chronic condition. If the stress is not addressed, then the urticaria endures. In addition, chronic stress weakens the immune system, increasing patients’ vulnerability to infection and to psoriasis, an autoimmune disease which manifests as a skin condition.

Various infections, including viral, bacterial, fungal and parasitic infections can also be considered reasons for hives in adults. These infections vary. They may include urinary tract infections, infections of the gastrointestinal tract, ENT infections, upper respiratory tract infections and infections of the dental area. When these infections are successfully treated, the associated hives vanish, indicating that there is a connection between infection and the prevalence of hives.

Hives wheels are reddish, whitish, or skin colored raised welts that appear on the surface of the skin. Hives wheels develop on the skin when histamine and other chemicals are released into the blood stream causing the leakage of fluid under the skin leading to swelling and the characteristic raised welts of hives. Hives wheels can pop up for no apparent reason and disappear without any form of treatment. Factors such as stress level, emotional wellbeing, heat, cold, sweat, and sun can all cause a case of hive wheels. Because these factors are somewhat immeasurable it is likely that most people who suffer from acute attacks of hives will never know what caused them.

Urticaria Welts and Food

Hives can also be directly linked to allergies. For example, people who suffer from hay fever are also more susceptible to urticaria welts. If you suspect that your hives are being caused by a food allergy or reaction you can try a low histamine diet. Histamines occur in food naturally, and particularly in fermented foods when, during fermentation, the amino acid histidine is converted to histamine. Examples of foods that are high in histamines due to fermentation are cheeses, sausage, fermented soy products, fermented alcoholic beverages such as wine and beer, and vinegar. According to Jeffrey Tulin-Silver, M.D. and Suchetha Kinhal, M.D., high amounts of histamines occur naturally in eggplant, spinach, mushrooms, tomatoes, and finfish. Additionally, eggs, strawberries, tomatoes, fish, shellfish, chocolate, bananas, pineapple, papaya, chocolate, strawberries, milk, and fermented alcoholic drinks release histamine directly from mast cells. In addition to avoiding foods that may contain histamines it is likely your allergist will put you on a restricted diet if an allergy test has been administered and certain foods are suspected to cause allergies or intolerance.

Hives Wheels – What You Can Do About Them

Acute cases of hives wheels can be treated with over the counter remedies with the goal of reducing the release of histamines (antihistamines such as Benadryl and Claritin), alleviating itchiness, and reducing swelling. For mild cases of hives cool baths/showers and compresses can help as can keeping the skin moisturized with a lotion formulated for sensitive skin. For individuals who suffer from chronic hives (those that last longer than six weeks sometimes up to several years) researchers at the University of Nebraska Medical Center have found that vitamin D supplements can significantly reduce chronic hives and alleviate the symptoms. Researchers found that nearly half of the patients observed who suffered from chronic hives also had low vitamin D levels. The recommended dose is a supplement of 1,000 to 2,000 international units (IU) per day.

Urticaria or hives can occur almost anywhere on the body. Hives on buttocks can therefore be treated as a normal case of body hives. Most cases initiate on a single part of the body such as the trunk, chest, arms, legs, and can seem to spread over several hours as old hive welts fade and new ones develop. Hives welts can be distinguished from other rashes by the raised circular forms they take.  Welts can be small or grow in size to join with other welts creating large patches of raised skin. Their color can be whitish or red with a red inflamed area surrounding the welt. It is common for a case of hives to last several hours and sometimes several days. In the more extreme cases of acute urticaria, hive welts can last up to several weeks. Anything exceeding six weeks is considered chronic hives. In incidences of long-term acute urticaria, the cause can usually be isolated to an allergy with repetitive exposure, a changed mental state such as stress, illness, or immune disorder rather than cold, heat, exercise, or sun exposure.

Welts on Buttocks

In addition to acute hives caused by histamine reaction, there are several forms of hives with different triggers. Pressure urticaria is caused by the blood flow to a certain part of the body and the application of pressure.  Sitting for too long in a single posture can cause hive welts on the buttocks and similarly those who wear tight pants or belts may experience pressure urticaria around the waist. Welts on the buttocks can also develop as a reaction to the detergent you use to launder your underpants or the chemicals used to clean toilet seats. If you have a case of contact dermatitis you might change your detergent to an allergy-free formula to prevent further irritation. Keep in mind that welts on buttocks differ from other rashes that may occur on the buttocks.

Hives on Buttocks – Could It Be Something Else?

In order to properly address your skin rash it is best to confirm that what you have is indeed hives. In addition to the raised welts characteristic of hives, urticaria tends to appear over the entire surface of the skin rather than in specific areas such as skin folds and joints. When examining your rash take note of the type of outbreak – welts, bumps, pustules, lesions, etc. If the condition persists you should visit your doctor as a bacterial, fungal, or viral infection may be to blame. Common examples of rashes on the buttocks are diaper rash caused by prolonged exposure of feces and urine on the skin, yeast infection, and cellulitis.

Hives that come and go over extended periods of time are considered to be chronic hives. All forms of hives, both chronic and acute can come in waves making them appear to spread from one body part to the next or clear and then return. Hives that come and go are thus common and are a telltale sign of this type of rash. Patients should keep in mind however, while a case of hives can last anywhere from an hour to several weeks, individual urticaria welts should not last for more than 24 hours.

Hives That Come and Go: Chronic Hives

Hives are considered chronic when any given episode lasts for more than six weeks. Unlike acute cases of hives that are usually caused by an allergy to foods, food additives, medication, or stings and bites, chronic hives tend to be without a known origin and are termed idiopathic urticaria. In 50% of these cases the urticaria welts are cause by a histamine reaction within the body resulting in the itchy red welts. In other cases of idiopathic urticaria immune or hormonal functions are to blame and often point towards an infection or disease unrelated to the skin and allergies. In some rare cases of chronic hives welts may last longer than 24 hours causing pain rather than the common itching. When the welts clear they can leave a bruise on the skin. While not all cases of painful hives are caused by vasculitis (inflammation of the blood vessels, http://www.mayoclinic.com/health/vasculitis/DS00513), it is the most common cause of this form of hives.

Dealing with Hives That Come and Go

If you suffer from hives that come and go for more than six weeks you should book an appointment with your allergist or an immunologist so that a series of tests can be run to discover possible causes including any underlying illness. When you visit your doctor it is important to share with him/her your full family medical history, any medications (including vitamins) you are taking, and information about your home and work environment, including the products used in those places. Depending on your particular case a series of test may be necessary. Your allergist may recommend a skin allergy test to determine if you are coming into contact with or ingesting an allergen. Other test may include a skin biopsy, to determine if you have vasculitis, and blood and urine samples. As frustrating as it may seem only 20% of hives cases can be diagnosed with a cause, making patient comfort and itchiness relief the primary treatment. Anti-histamines, steroids, and topical creams are often the best method to treat hives.

Polymorphic eruption of pregnancy (PEP) is a skin condition that usually develops during the third trimester of pregnancy however, in rare cases, women can experience PEP as early as 20 weeks. PEPS effects mostly first-time mothers and women with multi-gestational pregnancies. In a study by researchers in Britain and Austria, data from 505 pregnant women was reviewed revealing 21.6% incidence of polymorphic eruption of pregnancy. PEP, or PUPPS (pruritic urticarial papules and plaques of pregnancy) as it is known in the United States, appears on the belly near the navel, often spreading to the legs, breasts, and arms. Polymorphic eruption of pregnancy usually clears after giving birth. However, some mothers continue to suffer from the rash up to six weeks after delivery with some complaining of recurrent itching during menstruation several years after giving birth. It is suspected that the persistence of the rash after delivery may be due to remnants of the placenta left in the womb. In approximately 7% of cases, women experience PEP during subsequent pregnancies.

Polymorphic Eruption of Pregnancy – Links to Fetal DNA

While the exact cause of Polymorphic eruption of pregnancy is unknown, its occurrence solely during pregnancy suggests an interaction between the mother and the fetus. A study published in The Lancet compared biopsies of women with PEP carrying male fetuses, female fetuses, and non-pregnant women found small amounts of fetal cells in PEP lesions. Using PCR primers to test for male DNA, six of the ten women with PEP were pregnant with male fetuses. Fetal cells can migrate from the uterus to the skin of the mother leading to dermatological disorders. These results suggest chimeric cells change the skin tissue.

Polymorphic Eruption of Pregnancy – General Tips

For women in their third trimester polymorphic eruption of pregnancy can lead to sleepless nights and desperation. There are many remedies however there are some general tips that all women should follow in order to be more comfortable. As difficult as it is, do not scratch. Scratching can worsen the inflammatory response and cause lesions in the skin making it susceptible to infection. Because the rash is feverish, try and stay cool. Heat and sunlight can make PEP more uncomfortable. Take warm to cool showers at least once a day. Women have also found milk baths and oatmeal soaks to be soothing to the skin as well. Using emollients such as creams or ointments are also soothing for the skin.  During the day a cold wet compress can provide spot relief. In general wear loose cotton clothing, or as some women advise, as little clothing as possible.

While most women go through their pregnancy with relatively few complications, one in 160 to 240 women will experience pruritic urticarial papules and plaques of pregnancy (PUPPS). PUPPS rash and pregnancy hormones are not directly related though the rash only develops during pregnancy. The second most common dermatological issue of pregnancy (after atopic eruption of pregnancy) PUPPS normally occurs in 73% of primigravidae (first-time) pregnancies during the third trimester (around 35 weeks) with 11.7% of women who are affected by PUPPS having multi-gestational pregnancies. PUPPS rash and pregnancy dermatological issues should be discussed with a doctor in order to properly diagnose and prescribe an appropriate treatment plan. While most dermatology issues during pregnancy are mere irritants, more severe disorders and illnesses can manifest on the skin making a doctor’s visit important.

PUPPS Rash and Pregnancy – Symptoms

PUPPS usually appears in stretch marks (striae) on the belly near the bellybutton, though the bellybutton is not the cause. Small, red, swollen bumps begin to appear in the skin of the stretch mark, increasing in size until they form larger bumps on the whole of the abdomen. Within a couple of days more severe cases will spread to the lower body, chest, breasts, and arms and may include small blisters. Fortunately, the rash does not spread to the face. PUPPS-related health threats to mother and child are nonexistent, with no side effects caused by the rash. However it is very itchy (pruritic) and can be annoying, causing increased discomfort through the most difficult final weeks of pregnancy. The most intense itching is usually within the first week of the rash, clearing entirely in an average of six weeks and/or after giving birth.

PUPPS Rash and Pregnancy – Cause

The exact cause of PUPPS is unknown. What is known is that it is not a form of autoimmune disorder, hormones, fetal abnormalities, or preeclampsia. There is a statistical correlation between multi-gestational pregnancies and PUPPS. According to Medscape Reference (http://emedicine.medscape.com/article/1123725-overview), of the 11.7% of women with multi-gestational pregnancy and PUPPS, those with triplets (14%) are more likely to develop PUPPS than those with twins (2.9%). One suggestion is that the growth of the belly and subsequent stretch marks cause the body to react with an inflammatory response. There has also been an observed increase in weight gain (leading to stretch marks) of patients with PUPPS versus other pregnancies, which further supports the idea that the skin distension plays a factor in PUPPS development. While approximately 90% of women will development stretch marks during pregnancy they are not an automatic indicator that you will develop PUPPS or another complication.

Acute urticaria, or hives, is the most common form of the skin condition. Chronic urticaria is much more bothersome and autoimmune urticaria is thought to be the culprit in over half of these cases. While acute urticaria is usually not a severe medical concern, chronic cases are. The symptoms are very interruptive for the patient and they sometimes become desperate for help. Autoimmune urticaria is thought to be the cause in about 56% of the chronic cases. Chronic autoimmune urticaria is often difficult to diagnose but it can be done with persistence.

Autoimmune urticaria symptoms

The symptoms of autoimmune urticaria are the same as for acute urticaria. The itchy wheals appearing suddenly are the most common of symptoms and most apparent. It is thought that chronic urticaria autoimmune disease is not caused by the same triggers, however. Autoimmune urticaria usually starts as an autoimmune response where the mast cells of the skin release histamine under the skin, resulting in the swelling and the wheals. It’s not really understood why this happens. In fact, when a doctor diagnoses autoimmune chronic idiopathic urticaria, it is a medical terminology meant to say the cause is unknown.

Autoimmune urticaria diagnosis

If the hives persist beyond six weeks, they are classified as chronic. Chronic cases are not typically the result of any external symptoms, so allergy tests are probably a waste of time. The doctor will want to rule out anemia and parasites and may have some interest in the patient’s intake of caffeine, drugs, alcohol, as well as any mental health issues like depression and anxiety.

An erythrocyte sedimentation rate test, known more commonly as an ESR can help to identify immune system problems, which is the likely cause. Thyroid function and liver function tests are generally helpful because autoimmune chronic urticaria is often a reaction to one of these organ’s problems.

Chronic autoimmune urticaria can go on for years

The most compelling reason to try to treat idiopathic chronic urticaria is that these cases can go on for years. Around half of patients will show improvement after three to five years. But that is a long time to deal with the severe und uncomfortable symptoms. A full 25% of patients will have symptoms that continue for 10 years or longer. This causes many to fall into depression, and understandably so.

A whole body or homeopathic approach to strengthening the immune system seems to make sense to treat autoimmune urticaria. Since the causes are generally unknown and often never discovered, many patients find that treating the entire immune system in a holistic manner makes the symptoms disappear or at least go away to the point where life becomes normal again.