Hives and angioedema are skin reactions typically treated with antihistamines, although both conditions may heal without medication. Hives, or urticaria, are annoying skin welts that can be small or up to several inches across. Angioedema is similar to hives but affects deeper layers of the skin, frequently around the lips, cheeks, or eyes. The swelling of both conditions usually resolves without scarring or otherwise marking the skin.

Angioedema and hives may arise simultaneously or show up separately. The welts common to hives are notoriously itchy, appear somewhat oval, or as worm-like shapes, and are either flesh color, or red. Angioedema welts tend to be red, thick, firm, and large; affected areas might be warm or painful.

Hives and angioedema can be caused by:

  • Foods and Medications. People with sensitivities to certain foods such as fish, shellfish, peanuts, tree nuts, milk, and eggs may develop hives or angioedema when exposed those foods. Nearly all medications can trigger skin reactions, but common offenders are aspirin, ibuprofen, penicillin, naproxen (Aleve), and blood pressure drugs.
  • Environmental Triggers and Common Allergens. Some people’s skin may be sensitive to everyday environmental factors including cold, heat, water, sunlight, exercise, emotional stress, or pressure against the skin. Other individuals have skin reactions to common allergens such as animal dander, pollen, insect bites, or latex.
  • Other Medical Conditions. Angioedema or hives can occur after blood transfusions, or as symptoms of bacterial or viral infections (e.g., HIV, hepatitis), certain cancers (lymphoma, for one), or immune system diseases such as lupus.
  • Our Genes. Hereditary angioedema is a rare genetic condition owed to abnormalities in specific blood proteins involved with immune system regulation.

Having a family history of angioedema, hereditary angioedema, or hives increases a person’s risk of developing these conditions. Other risk factors are having prior outbreaks of hives or angioedema, experiencing other types of allergic reactions, and developing a medical condition associated with hives and angioedema such as lupus or lymphoma.

To diagnose these conditions, doctors will gather a medical history, examine any skin welts or swelling, and might recommend an allergy skin test. A blood test to measure levels of specific blood proteins may be ordered to check for suspected hereditary angioedema.

Treatment and Remedies

Mild cases of angioedema or hives may resolve on their own, but many people visit their doctor for relief from itching or other discomforts. Severe cases of either condition, where the throat or tongue swell and breathing become difficult, require immediate emergency care. Individuals who experience frequent severe attacks may carry injections of epinephrine with them to treat a sudden onset of symptoms.

For those suffering mild angioedema and hives, medical professionals offer these six tips:

  1. Avoid known triggers (e.g., foods, meds, pollen, latex).
  2. Use OTC antihistamines such as Claritin, Benadryl, or Zyrtec.
  3. Soak in cool bath water mixed with baking soda, uncooked or colloidal (finely ground) oatmeal.
  4. Apply cool, wet compresses, and/or cover affected areas with a dressing to prevent scratching.
  5. Wear loose, smooth-textured clothing.
  6. If unsure what is causing the skin reaction, keep a diary of the foods you are eating, and what you were doing prior to an outbreak.

Typical medications for hives and angioedema are antihistamines that reduce swelling and itching, corticosteroids to relieve redness, itching, and swelling in more severe cases, and possibly autoimmune drugs to quiet jumpy immune systems. For hereditary angioedema, there are several medications that can help with blood protein levels to reduce symptoms.

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