Hives

hives, also called urticaria, a hypersensitive skin reaction characterized by the sudden appearance of very itchy, slightly raised, smooth, flat-topped wheals and plaques that are usually redder or paler than the surrounding skin. In the acute form, the skin lesions generally subside in 6 to 24 hours, but they may come and go and persist much longer in the chronic form.

Several specific causes of hives, as well as variant forms of its typical skin lesions, are denoted by qualifying the term urticaria with a descriptive word. Examples include urticaria bullosa, a rare type of allergic reaction characterized by the appearance of bullae or vesicles (large or small blisters); solar urticaria, produced by exposure to sunlight; and urticaria subcutanea, caused by swelling of the tissues underlying the skin.

Allergy to a specific food is probably the most frequent cause of acute urticaria; fish, eggs, berries, and nuts head the list of common offenders. Hives may also be triggered by drugs, especially penicillin, by biologicals containing proteins, and by inhalants (e.g., pollens, insecticides, dust, feathers). Less frequently, physical agents, such as cold, heat, insect bites, and mechanical injury, as well as parasitic and other infectious diseases, may be triggers. Emotional and mental stresses are believed to be major and contributing causes of chronic urticaria.

The mechanism by which psychogenic factors give rise to chronic urticaria is not clear, but the overall sequence of biological events that triggers acute urticaria has been clarified. The mast cells lining the blood vessels contain histamine, which is released following contact of the mast cells with the irritating substance. Histamine in turn increases the permeability of the capillaries, so that plasma escapes into the spaces between the cells of the skin, giving rise to swellings that constitute the wheals and plaques. The itching is also thought to be caused by histamine.

Hives appear to show a familial incidence and are more common in persons with a history of allergic reactions. Treatment involves identification and subsequent avoidance of the allergen; administration of epinephrine and antihistamines may help to control the acute skin symptoms.