Home Diseases Hives (Urticaria): Causes & Treatment

Hives (Urticaria): Causes & Treatment

by Josephine Andrews
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Hives ( urticaria ) is a common skin disease and occurs in both adults and children. Typical symptoms are reddened skin and very itchy wheals. Sometimes the skin and mucous membranes also swell. Hives are acute or chronic and have very different triggers. Read more about the causes, symptoms, diagnosis, treatment and prognosis of hives here!

ICD codes for this disease:

ICD codes are internationally valid codes for medical diagnoses. They can be found, for example, in doctor’s letters or on certificates of incapacity for work.

L50

quick overview

  • Causes and risk factors: Excessive histamine release, cause not always known, various triggers possible, e.g. B. allergies and intolerances, infections, physical or chemical stimuli, UV light
  • Therapy: Mostly anti-histamines, in more serious cases cortisone, possibly leukotriene antagonists, immune suppressants, drugs against the infections that cause them, supportive measures such as cooling, ointments, etc.
  • Symptoms: wheals and itching on the skin and/or mucous membranes, tissue swelling on localized parts of the body or on the entire body, in severe cases also shortness of breath
  • Course of the disease and prognosis: Depending on the form, often improved by medication and avoidance of the triggers
  • Examinations and diagnosis: anamnesis, laboratory tests, allergy tests, diagnostic diet

What is hives?

Hives (urticaria) are what doctors call a skin rash (exanthema) with itchy wheals and sometimes also skin/mucous membrane swelling. Various stimuli cause these skin reactions in urticaria.

The part of the body where the skin phenomenon occurs varies from patient to patient. Hives often show up on the face, hands, neck, or crooks of the arms. But there are also patients in whom hives develop on their feet.

Areas where clothing is too tight and chafing often show urticaria symptoms. Generalized urticaria affects the whole body.

Depending on the severity and duration of the symptoms, hives significantly reduce the quality of life of those affected. The skin changes are sometimes very psychologically stressful and in some cases also affect everyday life.

Is hives contagious?

At the sight of the conspicuous, reddened areas of skin, many people wonder whether hives are contagious. The clear answer to that is: no. In the case of urticaria, infection is not possible. The skin disease is harmless to other people and is not transmitted by contact.

Is hives an allergy?

Hives are usually an allergy-like reaction of the body to certain stimuli. Doctors therefore also speak of a so-called pseudo-allergy. Above all, pseudo-allergic reactions to medication or food play a role in the development of hives.

A “true” allergic reaction is rarely the cause of urticaria.

What is the cause of hives?

Where does hives come from? This question worries many of those affected, but it is not easy to answer. The development of hives is very complex:

The typical itchy rash develops when certain immune cells (mast cells) are irritated and then release pro-inflammatory messenger substances. The tissue hormone histamine is primarily responsible for the symptoms of hives (hives, itching, reddening of the skin, swelling).

But what causes this irritation of the mast cells? Sometimes it is an allergic reaction to certain foods, pollen or something similar. In many other cases, the mast cells are activated in other ways. This means: Not every hives is caused by allergies.

Different forms of hives

There are different subtypes of hives. They do not always occur individually: some patients have two or more of these forms of the disease at the same time.

The different forms of hives can be divided into three large groups:

  • Spontaneous hives: wheals and/or swelling (angioedema) develop suddenly and without any recognizable external trigger. Depending on the duration of the symptoms, a distinction is made between spontaneous acute and spontaneous chronic hives . About 80 percent of all hives patients have spontaneous urticaria, two-thirds of them the acute variant.
  • Physical hives: This includes all forms of hives that are triggered by physical stimuli (such as pressure, wind, contact with cold, etc.). They only account for about ten percent of all cases of hives.
  • Other forms of hives: Causes here are, for example, physical exertion, contact with water or sweating. Such special forms of hives are found in less than ten percent of all patients.

In many people with urticaria, no cause can be identified. Doctors then speak of idiopathic urticaria or – in the case of longer-lasting symptoms – of chronic idiopathic urticaria.

The various forms of urticaria are described in more detail below.

Spontaneous acute hives

The hives symptoms last less than six weeks and come on quite suddenly and without any external stimuli obvious to the doctor or patient.

A specific hives trigger can often not be found here. In many other cases, the following triggers can be identified:

  • Acute infection , for example of the respiratory tract or the digestive tract
  • Incompatibilities (intolerances) : Sometimes, for example, certain additives in food or certain medications (such as acetylsalicylic acid = ASA or heart/high blood pressure medication of the ACE inhibitor type) trigger pseudo-allergic reactions that manifest as hives.
  • Allergies : Certain foods are sometimes triggers. Hives after vaccination are also possible: The hives then appear a few hours to about two days after the vaccination. Drug allergies sometimes manifest themselves as hives.

Acute urticaria becomes dangerous when the mucous membrane of the respiratory tract (pharynx, larynx , etc.) swells severely (angioedema). Then it is difficult or impossible for the air to get through. Those affected experience shortness of breath and there is a potential risk of suffocation!

In the event of sudden shortness of breath, always call the emergency services immediately (No. 112)!

Spontaneous chronic hives

When spontaneous hives last longer than six weeks , it is called “spontaneous chronic urticaria” (or “chronic urticaria”). The urticaria symptoms are either permanent or occur repeatedly after more or less long symptom-free phases.

Possible triggers of chronic hives include:

  • Chronic infections: For example, with the stomach germ Helicobacter pylori or with streptococci. Chronic urticaria based on a chronic infection is also called infected urticaria.
  • Autoimmune reaction: This is referred to as autoreactive hives or autoreactive urticaria. The symptoms here are caused by a malfunction in the immune system.
  • Intolerances (intolerances): For example, to certain food additives or medicines.

Other causes such as an allergy are less common behind chronic urticaria.

Physical hives

Physical stimuli (such as pressure or cold liquid) sometimes trigger a nettle rash. In the event of direct skin contact, an itchy rash forms at the site of the irritation and possibly also on another part of the body. Sometimes blood pressure also drops or the heart beats faster.

Depending on which physical stimulus triggers the symptoms, there are different types of physical hives:

  • Urticaria factitia (urticarial dermographism): It is triggered by shear forces acting on the skin. Such shear forces arise, for example, when scratching, rubbing and chafing the skin.
  • Delayed pressure urticaria: Persistent pressure triggers the nettle rash at a later point in time – the wheals only form three to twelve hours later. Those affected therefore often do not recognize the direct connection with the pressure effect.
  • Cold urticaria (cold contact urticaria): The trigger is contact with cold objects, cold air, cold wind or cold liquids. For example, in winter, hives develop on uncovered parts of the body due to the cold.
  • Heat urticaria (heat contact urticaria): The symptoms (such as wheals) of this form of hives are caused by heat with which the skin comes into local contact (e.g. when blow-drying or a hot foot bath).
  • Light urticaria: This is hives caused by the sun or UV light in the solarium .
  • Vibratory urticaria: Vibrations, such as those that occur when working with a jackhammer, are also possible triggers of hives.

The so-called familial cold urticaria is a rare, genetic disease that does not belong to the classic hives (despite the similar name)!

Special forms of hives

Cholinergic urticaria: Cholinergic urticaria (or cholinergic urticaria) results from an increase in the core temperature of the body. This happens, for example, when you eat spicy food or take a hot bath. Physical exertion also increases the temperature inside the body. Stress is also one of the triggers.

In all cases, the skin of those affected reacts by forming wheals the size of a pinhead, which disappear again within an hour. More general symptoms are also possible, such as dizziness, nausea or headaches.

Exercise- induced urticaria: It is triggered by physical exertion – possibly in combination with food intake. Compared to cholinergic urticaria, the wheals here are larger than a pinhead and the general symptoms (including shock) occur more frequently.

Contact urticaria: In contact urticaria, the nettle rash is caused by contact with so-called urticariogenic substances. Sometimes these are substances to which the person is allergic, such as certain foods or latex.

Contact urticaria sometimes occurs independently of an allergy when irritants are touched. Possible triggers are the scent of Peru balsam (in cosmetics, medicines, cleaning agents, among other things), the preservative benzoic acid (in foods, among other things) and certain plants such as stinging nettles.

Aquagenic urticaria: Urticaria very rarely develops through contact with water – regardless of the temperature. This aquagenic urticaria is often stressful for those affected: hives appear after showering, swimming or a heavy downpour and the skin reacts to water contact with itchy wheals.

However, aquagenic urticaria is not an allergy to water!

Physical hives and the special forms of the disease are also referred to as “inducible urticaria”. The skin reactions here are triggered by contact with specific stimuli.

What to do with hives

The urticaria therapy consists of various components – adapted to the individual case. The type of urticaria and the severity of the symptoms play a role. However, the goal of urticaria therapy is always to alleviate the symptoms and, if possible, to eliminate the cause.

Avoid or eliminate hives triggers

The best remedy for hives is to avoid or eliminate the trigger whenever possible . Of course, this is only possible if it can be clearly identified. Some examples:

  • Avoid known trigger foods
  • Discontinue the triggering medication after consultation with the doctor or replace it with a tolerable medication
  • In the case of pressure urticaria, for example, only use backpacks and bags with wide straps.
  • Appropriate treatment of chronic infections, such as those with the gastric germ Helicobacter pylori or chronic respiratory infections

It is more difficult when physical stimuli such as heat or friction cause the hives. Here the stimulus threshold is often very low. People with urticaria factitia sometimes develop hives symptoms just by wearing clothes that are not completely loose.

In addition, it is hardly possible to completely avoid some physical stimuli such as cold wind or UV rays.

If chronic urticaria is based on chronic (or recurring) tonsillitis, the doctor often recommends surgical removal of the tonsils. Afterwards, the nettle rash usually improves.

Hives: medication

In the case of mild hives, ointments or creams with cooling menthol are beneficial. If necessary, the treating doctor will also prescribe a cream with a local anesthetic effect (e.g. with polidocanol) for hives.

But what to do if such creams or ointments against hives symptoms do not help sufficiently? Then there are other drugs.

Some hives medications are available over the counter. For example, you do not need a doctor’s prescription for a cooling menthol ointment or for cetirizine preparations (anti-histamine). Always seek advice from a doctor or pharmacist before self-medication.

Anti-Histaminics

Antihistamines are among the most important drugs in the treatment of hives. They effectively relieve allergic and allergy-like symptoms in many patients. Anti-histamines inhibit the effects of histamine. This messenger substance is mainly responsible for the hives symptoms.

As a rule, doctors use so-called H1 anti-histamines of newer generations as hives drugs. They do not have a dampening (sedating) effect on the brain , so they do not make you tired and sleepy. Possible H1 antihistamines for hives include:

  • Loratadine,
  • Desloratadine
  • and cetirizine.

These antihistamines are usually taken in pill form. In the case of severe acute hives symptoms, however, it is sometimes necessary to administer them as an infusion .

So-called H2 antihistamines also inhibit the histamine effect, but in a different way than H1 antihistamines. However, they are only used in the treatment of hives in special cases, such as chronic urticaria that is difficult to treat.

In some patients, the approved dose of antihistamines does not relieve the symptoms of hives. The doctor treating you may then prescribe a higher dosage – even if this is not officially approved for urticaria therapy.

Glucocorticoids (“Cortisone”)

In severe cases, urticaria sometimes also needs to be treated with a cortisone (such as prednisolone ). This is sometimes the case when the hives do not respond (sufficiently) to anti-histamines.

The active substance is administered either as a tablet or, in acute cases, as an infusion. Sometimes the doctor also prescribes an ointment containing cortisone, for example in the case of urticaria that is triggered by pressure (pressure urticaria).

In general, cortisone should only be used for a short time and in low doses. This lowers the risk of side effects.

leukotriene antagonists

These drugs have anti-inflammatory and anti-allergic effects. For example, if you cannot get chronic hives under control with antihistamines (even in higher doses), the doctor may prescribe an active ingredient from the group of leukotriene antagonists.

These active ingredients are also an option for certain types of urticaria (such as cold urticaria) if other treatments are not effective enough.

Ciclosporin A

This is an active ingredient that suppresses the immune system (immune suppressant). It is effective, but is not part of the standard treatment for hives. Cyclosporin A comes into consideration in severe urticaria that cannot be successfully treated with antihistamines (even in higher doses).

The combination of immune suppressant and antihistamine can often get rid of the symptoms of hives. Experience has shown that the symptoms then disappear within four to six weeks.

The doctor carefully monitors this combination treatment in order to identify any side effects at an early stage.

Other medications

Sometimes hives can be very difficult to treat. For example, chronic hives and cold urticaria sometimes prove to be very persistent. It may then be necessary to administer other active ingredients in addition or as an alternative.

Some examples:

Some patients with chronic hives that are difficult to treat benefit from treatment with omalizumab . This is an artificially produced antibody that blocks the release of inflammatory messengers from the mast cells.

According to studies, it can also be used successfully in some other forms of urticaria, such as cholinergic urticaria, cold urticaria or light urticaria.

Other drugs that may be tried for difficult-to-treat chronic hives include dapsone and hydroxychloroquine . Dapsone has an antibiotic and anti-inflammatory effect. Hydroxychloroquine is mainly used to fight malaria, but is also used for certain skin diseases.

For persistent cold urticaria, some patients are given antibiotics (such as penicillin ) as a trial.

Hives: Other treatments

In addition to medication, other treatments can sometimes be considered for severe hives, depending on the form of the disease, if the standard therapy with H1 antihistamines is not effective enough.

This includes, for example, the habituation therapy (“hardening”): It offers, for example, in the case of difficult-to-treat light urticaria. The skin is repeatedly and specifically exposed to the sun’s rays. This is to cause the body to gradually tolerate the light.

Stubborn cold urticaria can sometimes be treated in this way, for example by taking regular cold showers.

A habituation therapy must be carefully considered and accompanied by a doctor. It can be distressing for the patient.

In the case of urticaria factitia that is difficult to treat, targeted irradiation with UV-B light ( UV-B therapy ) is helpful in some cases.

Hives: home remedies

What to do against hives? Some home remedies are said to help with acute flare-ups of urticaria and support the effects of medication. Examples:

  • Cold against itching: The itching can be relieved with cool compresses or cool curd compresses – but only if it is not cold urticaria!
  • Baking soda: According to guides, baking soda (e.g. in bath water) should relieve itching.
  • Medicinal plants: Hamamelis (witch hazel) has an anti-inflammatory effect, relieves itching and constricts the vessels. Ointments or creams based on this medicinal plant may be suitable for relieving the symptoms of hives. Marigold also has similar effects.
  • Vinegar compress: A vinegar compress (e.g. with apple cider vinegar) is said to help as a tried and tested remedy against itching in hives. In order not to irritate the skin further, it is only advisable to use it diluted with water.

Home remedies have their limits. If the symptoms persist over a longer period of time, do not get better or even get worse, you should always consult a doctor.

Hives: Homeopathy

Some people swear by alternative treatments for hives – such as homeopathy. This should be helpful in the lengthy treatment of chronic urticaria. There is no scientific evidence for this.

For example, homeopaths use the following globules for hives:

  • Urtica urens ( Brennnessel )
  • Acidum formicicum (formic acid)
  • Sulfur (Purified Sulfur)

The conventional medical treatment of hives is usually supplemented with homeopathy.

The concept of homeopathy and its effectiveness are controversial in science and not clearly proven by studies.

What are the symptoms of hives?

Even if the triggers are very diverse – you can usually recognize hives by the following symptoms:

  • flushed skin
  • Raised skin blisters (hives) that are very itchy
  • Extensive skin/mucous membrane swelling (angioedema)

Some patients only have the itchy wheals. Rarely, there is only angioedema, i.e. the hives run their course without itching. Some sufferers also develop both urticaria symptoms.

The main messenger responsible for the hives symptoms is histamine . It widens the small blood vessels in the skin, causing it to turn red . At the same time, the vessels become more permeable. As a result, more liquid enters the tissue – wheals form .

These are superficial elevations of the skin of variable size, which are almost always surrounded by redness. They are fleeting: they disappear on their own within 24 hours. At the same time, however, new wheals may form elsewhere.

Sometimes the wheals are limited to one area, in other cases they cover the whole body. They are accompanied by severe itching . It can sometimes be alleviated by scouring and rubbing, but not so much by scratching. Therefore, even with the strongest itching, the skin is rarely scratched.

In some cases, pronounced swelling of the skin or mucous membranes suddenly develops in urticaria, for example on the face. This so-called angioedema is sometimes accompanied by an unpleasant feeling of tension and itching. They resolve more slowly than wheals (within 72 hours).

Swelling of the mucous membranes of the respiratory tract (e.g. in the throat or larynx) are potentially more dangerous: the air then gets through only with difficulty or not at all – shortness of breath and the risk of suffocation set in!

In the event of sudden shortness of breath, call the emergency services immediately (No. 112)!

Where do the hives symptoms appear?

In principle, redness, itching, wheals and swelling occur anywhere on the body. Commonly affected areas are the arm, crook of arm and elbow, back and legs and feet. Sometimes the symptoms of hives also affect the neck, abdomen or torso or the hand, especially the back of the hand and fingers.

Wheals from hives are also possible on the scalp, ears and eyes .

Skin/mucous membrane swelling (angioedema) often develops in urticaria on the lids of the eyes and/or lips, but sometimes also in other places, such as in the intimate area. Less commonly, the mucous membrane of the tongue and larynx swell.

Hives: when to see a doctor?

If you get itchy bumps on your skin, keep a close eye on the rash. If the symptoms last longer than 24 hours, it is advisable to see a doctor.

The right contact person when such a rash occurs for the first time is the general practitioner. He classifies the complaints and, if necessary, refers you to a dermatologist. If you already know you have hives, contact your dermatologist directly for skin changes.

A doctor’s visit is particularly advisable if hives are accompanied by fever. Here, an acute infection may be the cause of the urticaria.

A doctor’s visit is also recommended if the symptoms are very pronounced or if the skin and mucous membranes swell severely. Severe swelling in the mouth, nose and throat impairs breathing: if shortness of breath develops, it is a medical emergency – call the emergency doctor (112)!

How long does hives last?

There is no general answer to how long hives last. It is usually acute hives. Here the symptoms usually disappear again within a short time – possibly supported by cooling ointments, anti-histamines or other aids.

In a small proportion of those affected, spontaneous hives last longer: the wheals and itching persist for more than six weeks. Then it is chronic hives . The trigger can often be identified.

Then there is the possibility of treating it (e.g. a chronic infection) or avoiding it to a large extent (e.g. certain medications or food additives).

If the cause of chronic urticaria cannot be determined, all that remains is to alleviate the symptoms – and to remain optimistic that eventually all chronic hives will heal on their own. In some cases, however, this takes years or even decades.

Cooling ointments, anti-histamines and other options usually also help with inducible urticaria such as physical urticaria against the annoying symptoms. Above all, however, it is important to avoid the trigger if possible, for example avoiding cold or pressure on the skin.

Unable to work due to hives?

If it is a spontaneous urticaria, it is possible that you go to work as usual with hives. The symptoms usually disappear completely within a few days. The skin disease is not contagious, so there is no danger to other people.

However, the symptoms of hives sometimes affect everyday life. The severe itching in particular leads to insomnia in some of those affected in the evening and at night, which often reduces performance.

Therefore, it is possible for the doctor to issue a sick note during a flare-up of hives. If you are severely affected by the hives symptoms, it is therefore advisable to speak to your doctor.

hives in pregnancy

During pregnancy, it is possible for hives to occur due to hormonal fluctuations. Urticaria disappears in most women after childbirth when the hormone balance returns to normal.

How pre-existing hives develop during pregnancy is variable. Chronic urticaria improves in many pregnant women. But the pregnancy hormones sometimes also increase the symptoms, especially the stressful swellings.

There is no danger to the unborn child. The skin rash of the expectant mother has no effect on the course of the pregnancy. Also, hives are not hereditary.

Treatment of hives in pregnancy and lactation

Not all medications are suitable for treating hives during pregnancy. Doctors generally advise pregnant women against systemic therapy (i.e. tablets or infusions). This mainly affects the beginning of pregnancy.

If you are pregnant, it is important to always discuss the medication for urticaria with your doctor and adjust it if necessary.

The same applies during breastfeeding as during pregnancy: it is important to only take medication after consulting a doctor. Many drugs get to the baby through breast milk. The hives rash itself does not usually pose a problem with breastfeeding.

hives in children

Hives occur in all age groups. However, children and young people are particularly affected.

You can learn more about the causes, symptoms, and treatment of childhood urticaria in the article Hives in Children and Babies .

How is hives diagnosed?

The reddish, itchy wheals are a typical clinical picture that quickly suggests the diagnosis of hives. It is often more difficult for the doctor to find out the exact cause of the urticaria.

anamnese

The simplest, but most important means for this purpose is the thorough patient questioning : During the conversation, the doctor collects the medical history of the patient (anamnesis). To do this, he has the symptoms described in detail, asks about any previous or underlying illnesses and possible triggers of the hives.

Frequently asked questions by the doctor are:

  • What symptoms do you have and how long have they existed?
  • Is there a connection between the symptoms and your job, your hobbies, any travel or leisure activities or (in women) the menstrual cycle?
  • Are there cases of hives or atopic diseases (neurodermatitis, hay fever, allergic asthma, etc.) in your family?
  • Have you had or do you have an allergy or intolerance (to food, medication, etc.)?
  • Do you have infections, psychosomatic or psychiatric illnesses?
  • Do you have any suspicions as to what could be causing the symptoms (certain foods, alcohol, smoking, cosmetic products, cold, physical exertion, stress, etc.)?
  • What medications do you use (occasionally or regularly)?

diary

In the case of persistent or frequently recurring hives, it is advisable to keep a diary in which you document the occurrence and the extent of your symptoms. Also write down what you ate and drank and what medication you used.

Also document other possible influencing factors on the disease, such as stress. The records will help you and the doctor find the cause of the hives.

Further investigations in certain cases

In the case of spontaneous acute hives, the anamnesis is often sufficient for the diagnosis. However, if there is a suspicion that the urticaria is an allergic reaction, further investigations are indicated. The same applies to chronic hives and other forms of urticaria.

Further examinations are also used to rule out other diseases with similar symptoms. Examples:

Labor-Tests

In the case of chronic nettle rash, laboratory tests help to detect any infections or other diseases as a trigger. For this purpose, the doctor determines the inflammatory parameters in the blood (such as CRP and the number of leukocytes ).

Another option is to test the patient’s blood for antibodies against infectious agents , for example against the “stomach germ” Helicobacter pylori. If one actually finds antibodies against this bacterium, the analysis of a stool sample confirms the infection.

A Helicobacter pylori infection can also be diagnosed by examining a tissue sample from the stomach. The doctor takes the sample as part of a gastroscopy (gastroscopy).

So-called auto-antibodies (antibodies that act against the body’s own tissue) are sometimes considered to be the trigger of a chronic nettle rash. A special skin test ( ASST = autologous serum skin test) is usually helpful in diagnosing such autoreactive hives.

ENT or dental examination

If someone is suffering from a chronic infection or inflammation in the area of ​​the upper respiratory tract or teeth , a visit to an ENT doctor or dentist is advisable. The suspicion can either be confirmed or eliminated.

special diet

Sometimes a food intolerance is the cause of chronic hives. The doctor then changes the diet for three weeks in such a way that the trigger or triggers of the pseudo-allergic reaction can be identified. For this purpose, everything that many people are sensitive to is avoided as much as possible.

But which foods often trigger hives and should therefore be avoided as a test? The following ingredients in foods are often critical:

  • flavorings
  • preservatives
  • dyes
  • antioxidants

Such substances are particularly found in industrially processed foods. It therefore makes sense to remove them from the menu for the duration of the “diet”. If the patient’s symptoms improve as a result, the probable cause of the hives has been found.

Provokations-Test

A targeted provocation test is usually used to confirm a suspected food intolerance: suspicious foods may be eaten in large quantities to see how the skin reacts to them.

Such provocation tests can also be used to identify physical stimuli as triggers for hives. A part of the body is specifically exposed to a stimulus, for example cold or hot water, a wet body-warm compress (if aquagenic urticaria is suspected), light, pressure or friction.

If the skin then reddens, forms wheals and begins to itch, a corresponding inducible urticaria is present.

Allergy Tests

Allergies are rarely the cause of chronic hives. But if there is a suspicion, allergy tests bring clarity. The provocation test is also sometimes useful. But there are other forms of allergy testing. You can read more about this here .

Tissue sample of the skin

Taking and analyzing a small sample of skin is sometimes necessary when the chronic rash may not be due to “conventional” hives, but to what is known as cutaneous mastocytosis . These diseases are caused by an excess of mast cells in the body.

If this excess is limited to the skin, a so-called cutaneous mastocytosis is present. It is also called urticaria pigmentosa. It used to be considered a sub-form of “conventional” hives, but not anymore.

A tissue sample may also be useful if a patient is diagnosed with an inflammatory or autoimmune disease. The sample is then examined for evidence of vascular inflammation (vasculitis).

If this is the case, the doctor diagnoses urticarial vasculitis . This is a chronic inflammation of the skin vessels that is accompanied by a skin rash that resembles hives.

Like cutaneous mastocytosis (urticaria pigmentosa), urticaria vasculitis is no longer considered a subtype of urticaria, but an independent clinical picture.

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