Urticaria is characterised by the development of itchy weals or hives. Each weal tends to last a few hours only but may last up to 24-48 hours. It affects approximately 10% of the population at some stage in their lives. Urticaria may be acute and resolve after a couple of weeks or may become chronic and last many years.
In most cases there is no obvious trigger but some people may notice a worsening of their symptoms in association with:
temperature – hot or cold
drugs - especially codeine and aspirin-like drugs
pressure for example from a tight waist band or watch
Urticaria is a result of increased histamine release from cells called mast cells in the skin. This is the same chemical released following an insect bite or nettle sting. It causes redness and swelling. Occasionally individuals also experience swelling of their lips and/or swelling around the eyes. For this reason people often think that they must be allergic to something but usually no allergic trigger is identified.
The mainstay of treatment is antihistamines which include over-the-counter preparations such as cetirizine or loratadine, or you may be prescribed fexofenadine. Some people may require very high doses, much higher than those usually recommended. Sometimes more than one form of antihistamine may be used. They may be taken safely long-term, if required. Monteleukast, a treatment usually used in patients with asthma, may be added when symptoms persist. Occasionally for short term relief of symptoms in acute urticaria a steroid tablet may be prescribed.
A newer tablet called omalizumab is now used when these treatments do not work.