Urticaria appears as wheal-like bumps on the skin which are usually pink or red in colour, and have an oval or round shape. The wheals usually occur in clusters across the skin, and are commonly seen on the face and extremities, i.e. the arms, legs, hands, and feet. Welts usually appear soon after exposure to the trigger, and usually disappear within 24 hours. Though, chronic cases of this condition may see the sufferer enduring symptoms for months or even years on end.

Often experienced alongside Urticaria, Angioedema manifests as deep swelling within the skin. Unlike Urticaria, Angioedema is not usually itchy and tends to occur on the lips and tongue. Spontaneous Urticaria is the most common form of Urticaria, whereby the sufferer tends to develop symptoms of both Urticaria and Angioedema, with no identifiable cause.

Dr Khoza will examine the skin, especially if there is a rash. She will ask you if there are any cases of hayfever or asthma in the family. Along with that, she may perform a patch test; this helps to identify possible food triggers. As mentioned, foods don’t cause eczema, but sensitivities to certain foods may cause the flare-ups to be more severe. Dr Khoza will place tiny amounts of potential allergens on the skin. After 24/48/72 hours she will check the result to see if there is any reaction.

Dermographism: 

Generally lasting for less than an hour, this type of Urticaria gets triggered by friction. The itchy wheal symptoms may worsen with heat exposure. 

Cold Urticaria:

This severe type of Urticaria gets triggered by exposure to cold temperatures in air, wind and water. Symptoms can put the sufferer at risk of fainting. 

Solar Urticaria:

A very rare form of the condition, Solar Urticaria occurs when the sufferer endures direct sunlight exposure.

Aquagenic Urticaria:

Aquagenic Urticaria is an extremely rare type of Urticaria. It’s characterised by the development of small wheals on the upper half of the body after coming into contact with water.

Delayed Pressure Urticaria

This painful type of Urticaria develops as a result of pressure on the skin. For example, when the sufferer wears a tight garment of clothing. Symptoms can persist for longer than a day.

Cholinergic Urticaria

Cholinergic Urticaria occurs with sweating and symptoms develop within minutes. For example, when the sufferer is under severe emotional stress, in a hot climate, eating spicy food, or exercising. 

Contact urticaria

This type of Urticaria develops when the sufferer comes into physical contact with any of the following: certain chemicals, foods (eggs, nuts, citrus fruits), plants, animals, animal products, rubber (latex), cats, and dogs.

Apart from the known triggers of specific types of Urticaria, there are also many other possible causes in less obvious cases. Possible causes include, but are not limited to:

• Medications, such as antibiotics and non-steroidal anti-inflammatory drugs
• Infections, such as influenza, the common cold, glandular fever, and hepatitis B
• Bacterial infections, for example, urinary tract infections and strep throat
• Extreme environmental temperatures or rapid changes in temperature
• High body temperature
• Dust mites
• Alcohol
• Insects, such as cockroaches, and parasites
• Pollen
• Plants, such as nettles, poison ivy, and poison oak
• Chronic illness, for example, thyroid disease and lupus

The first port of call for treating hives is taking antihistamines. These can be either over-the-counter or prescription. Common antihistamine medications for treating Urticaria include: 

• Loratadine (Claritin)
• Fexofenadine (Allegra)
• Cetirizine (Zyrtec)
• Desloratadine (Clarinex)

If the case presented is more severe and the Urticaria is not responding to antihistamines, a doctor may prescribe the following:

• Antibiotics to reduce redness and swelling, and prevent infection from scratching.
• Steroids to reduce inflammation.
• Omalizumab or Xolair injections to block immunoglobin E production (antibody released during an allergic reaction).