Urticaria (hives) is a common skin condition where the affected person develops red to skin coloured bumps in the skin with or without itching. It may be acute (less than 6 weeks) or chronic (more than 6 weeks). We take a look at a number of popularly held beliefs about allergy. But are these just myths or are they true?

Myths about hives

MYTH 1. Hives are contagious.

Hives are not contagious. There can be many causes of urticaria. To know more about the causes and triggers of urticaria, read All About Urticaria.

Upto 30 percent of chronic hives are caused by an autoimmune reaction, which means your body’s immune system activates to fight an infection that isn’t there. Many people with chronic urticaria never find an answer as to why the hives appear.
Dr. Siddhartha Saikia

MYTH 2: All hives are due to allergies.

Hives are not all due to allergies.
Although hives are often caused by allergens, there are other non-allergic causes of hives. Occasionally, hives may be the presenting feature of another systemic disorder like thyroid disease, and should prompt an individual to seek evaluation by a doctor. Sometimes, there is no specific cause of hives which is called idiopathic. Many cases of chronic urticaria may develop spontaneously without any particular trigger.

Acute Urticaria can be a known reaction to allergens, for example, if you eat peanuts and then break out with hives. But chronic urticaria is different. They usually appear without any evidence of an allergy. Despite this, many people suggest avoiding high-allergen foods, such as sour food or peanuts.
Dr. Siddhartha Saikia

MYTH 3. Patients with urticaria should be given an extensive list of foods that must be avoided.

Patients do not always have to avoid “trigger foods”. Often, doctors suggest avoiding egg, milk, brinjal, spinach, prawn, and fish as these are the “triggers” for urticaria. Strict avoidance has little or no effect on the frequency of urticarial eruptions in chronic urticaria. However, there are some foods that release more histamine and clinical advice often entails educating patients to avoid eating most of the foods that are high in histamine during acute urticarial eruptions until the “episode” settles down.

In selected patients with supportive histories, presence of IgE to specific foods or sensitivity (non-IgE mediated reactions) to certain dyes or colouring agents in food (pseudo allergies) could have a relevance to their chronic urticaria symptoms.

MYTH 4. Patients with urticaria should undergo testing to exclude specific allergies.

Allergy testing is not usually required for urticaria. Whilst the concurrent presence of house dust mite (D. pteronyssinus, D. farinae, and Blomia sp.) allergy or other aeroallergen sensitivities can be found in some patients, these tests should be reserved for patients who complain of allergic rhinitis symptoms rather than urticaria.

Usually, house dust mite reactivity in chronic idiopathic urticaria is linked with respiratory allergy. Avoidance of these allergens will, therefore, have little effect on urticaria, except in a few cases where there is a strong consistent history of contact urticaria on exposure to dust, but antihistamine and nasal spray treatment will have an effect on the rhinitis and will encourage the patient to continue on antihistamines that will control the urticaria. In some highly atopic individuals, allergens such as grass pollens, moulds, animal dander, house dust mites, and latex might aggravate chronic urticaria but this is usually not the primary cause for the urticaria.

MYTH 5. Patients should not receive high doses of antihistamine medications and definitely not in pregnancy.

Not true. Almost all specialists dealing with chronic urticaria patients recognize that standard or recommended doses of antihistamines are usually ineffective in treating this condition. Consensus guidelines recommend that higher doses, even up to four-fold higher, are safe and have been verified in studies. First-generation antihistamines should preferably be avoided in infants and children as well as adults especially those dealing with heavy machinery or ]skilled tasks such as driving.

The EAACI/GA²LEN/EDF/WAO consensus guidelines mention that loratidine is safe in pregnancy but supratherapeutic doses should be carefully considered.

MYTH 6. Skin specialists will prescribe steroids.

Not true unless it is severe. It is true that sometimes steroids are required to control the disease in acute and severe flare-ups. But long term steroid usage is not helpful in chronic urticaria especially because of the side effects. Usually, skin specialists give a medicine known as “anti-histamine” which is not a steroid and it is safe to take even for extended periods without any major side effects. The newer antihistamines are non-sedative and do not cause drowsiness.

MYTH 7 There isn’t any treatment for chronic urticaria.

While there is no cure for chronic urticaria, there are many treatments, such as taking non-drowsy antihistamines, that can help relieve the itching and reduce the number of flares. Treatments are aimed at controlling symptoms. To know more about the management of urticaria, check out Urticaria Treatment.

MYTH 8. I will need to take medicines for a lifetime.

You may not need lifetime medicines. Chronic Urticaria (lasting for more than 6 weeks) can have an unpredictable course. Some may recover in a few months and for some, it may take many years. Sometimes, it can be frustrating to think that one needs to take medicines to control the hives for their entire lifetime. Unlike chronic medical conditions like diabetes or high blood pressure which requires lifetime medication, urticaria may not require that. Many people do recover spontaneously and modern medicines are very safe and can be taken without any major side effects.

MYTH 9. Chronic urticaria doesn’t affect quality of life.

CU can affect the quality of life and can be stressful for patients. When you live with chronic hives, you live with uncertainty. You don’t know when or how severe your next flare will be. Some people avoid social gatherings because they fear breaking out in hives. If your chronic hives are caused by an autoimmune reaction, you battle fatigue on a regular basis and might feel too tired to even get out of bed.

MYTH 10. There is nothing to worry about. Urticaria does not have any complications.

It is rare but urticaria may have severe complications requiring emergency care. While it’s true that usually the symptoms of urticaria are not severe or life-threatening and one shouldn’t worry too much about urticaria as stress can cause flare-ups; urticaria may sometimes be accompanied with angioedema which is a deeper form of swelling which usually occurs on the face, neck or extremities. If you are having angioedema and it is causing difficulty in breathing, contact your emergency doctor immediately. Another rare complication is anaphylaxis which may occur with urticaria sometimes and it is a medical emergency requiring immediate treatment.

Conclusions

Chronic urticaria is a relatively common condition in India and most cases have no specific allergic trigger and remain idiopathic (no specific cause).
Autoimmune causes have been found to be associated with up to 30-40% cases.
It is important to look for physical triggers such as pressure urticaria in chronic cases.
Avoidance of foods without appropriate testing for food allergy should not be routinely recommended.
Long-acting nonsedating antihistamines at even higher than standard doses if necessary are safe and effective.
Quality of life is affected adversely in many patients with chronic urticaria.
Psychological stressors can play an important role in this disease and require special attention.