Allergic Urticaria: Causes, Symptoms, and Treatment Options

Hives are very itchy?

Two days ago, I suddenly experienced intense itching all over my body while sleeping.
The next day, I saw a doctor who diagnosed me with allergic urticaria.
I suspect it might be due to eating Russian chocolate (the only unusual food I had that day), but I'm not certain.
However, I don't have any noticeable rashes, especially severe itching in my limbs.
During my first visit, I received an injection and took medication for a day, but the itching persisted.
I also took Vistaril 25 mg at night, but it didn't help me sleep due to the unbearable itching.
Today, I visited another doctor who didn't say much and gave me two more injections, but I'm still itching and unable to sleep.

Two days ago, in the afternoon before the onset, I felt tingling in my thighs and soreness in my lower back (thinking it might be a kidney stone issue).
After going to bed that night, the itching became unbearable, but why do I not have any obvious rashes (just something resembling goosebumps)? Scratching causes red welts.
What type of urticaria is this (it is very itchy, with muscle soreness and some pain)? How long will the itching last? Do I need to go to a major hospital for blood tests?

Irene, 30~39 year old female. Ask Date: 2016/02/20

Dr. Wu Yuxin reply Dermatology

If symptoms persist for more than a month, they may not necessarily be related to allergies, and it is recommended to undergo a blood test.

Reply Date: 2016/02/20

More Info

Allergic urticaria, commonly known as hives, is a condition characterized by the sudden appearance of itchy welts on the skin. These welts can vary in size and may appear anywhere on the body. Understanding the causes, symptoms, and treatment options for allergic urticaria is essential for managing this uncomfortable condition effectively.

Causes of Allergic Urticaria
Allergic urticaria can be triggered by various factors, including:
1. Food Allergies: Common allergens include nuts, shellfish, eggs, and dairy products. In your case, the Russian chocolate you consumed could potentially contain allergens that triggered your reaction.

2. Medications: Certain medications, including antibiotics, non-steroidal anti-inflammatory drugs (NSAIDs), and some pain relievers, can cause allergic reactions.

3. Environmental Factors: Pollen, pet dander, dust mites, and mold can also trigger allergic reactions in sensitive individuals.

4. Physical Triggers: Factors such as pressure, temperature changes, sunlight exposure, or even exercise can lead to physical urticaria.

5. Infections: Viral or bacterial infections can sometimes provoke hives.

Symptoms of Allergic Urticaria
The primary symptom of allergic urticaria is intense itching, which can be accompanied by:
- Raised, red welts or hives on the skin.

- Swelling in areas such as the face, lips, or throat (angioedema).

- A burning or stinging sensation.

- In some cases, systemic symptoms like fatigue or malaise may occur, as you described with muscle soreness and a feeling of general discomfort.

Interestingly, hives can appear without the classic raised welts, manifesting instead as a rash that resembles goosebumps, which may explain why you did not observe prominent hives.

Treatment Options
1. Antihistamines: Over-the-counter antihistamines like cetirizine (Zyrtec) or diphenhydramine (Benadryl) are commonly used to alleviate itching and reduce the severity of hives. Vistaril (hydroxyzine) is another antihistamine that can help with itching and promote sleep, but it may cause sedation.

2. Corticosteroids: In cases of severe urticaria, doctors may prescribe corticosteroids to reduce inflammation and control symptoms.

3. Avoidance of Triggers: Identifying and avoiding known allergens is crucial. Keeping a food diary or noting any new products you use can help pinpoint triggers.

4. Emergency Treatment: If you experience symptoms of anaphylaxis (such as difficulty breathing, swelling of the throat, or a rapid drop in blood pressure), seek emergency medical attention immediately.

Duration and Prognosis
The duration of allergic urticaria can vary. Acute urticaria typically lasts less than six weeks, while chronic urticaria can persist for months or even years. In your case, since the itching has been persistent despite treatment, it may be beneficial to consult a specialist, such as an allergist, who can perform specific tests, including blood tests or skin prick tests, to identify potential allergens.

Conclusion
In summary, allergic urticaria can be a distressing condition characterized by intense itching and welts on the skin. Identifying triggers, using appropriate antihistamines, and possibly corticosteroids are key components of treatment. If symptoms persist or worsen, further evaluation by a healthcare professional is recommended to explore underlying causes and tailor a treatment plan. It’s essential to communicate openly with your healthcare provider about your symptoms and any concerns you may have regarding your treatment and overall health.

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