Urticaria can affect anyone irrespective of age, gender, and race. It is estimated that between 15 percent and 23 percent of the adults will experience at least one bout of urticaria in their lifetime. 

Allergic

Allergy is a common cause of urticaria. It is caused when the immune system responds abnormally to an otherwise harmless substance and floods the body with an inflammatory chemical known as histamine.

While the release of histamine can often trigger allergic rhinitis and other respiratory or gastric symptoms, there are others times when it will cause capillaries to swell excessively and release interstitial fluid into surrounding tissues. When this happens, the localized swelling of the dermis will lead to a well-defined rash we recognize as a hive.

There are two allergies frequently associated with urticaria:

Food allergies, most commonly nuts, shellfish, milk, eggs, wheat, and soy Drug allergies, including those triggered by certain antibiotics (like cefaclor), anticonvulsants, antifungals (like clotrimazole), ibuprofen, or sulfonamides,

Less commonly, hives may be caused by such common allergens as pollen, pet dander, insect bites, and latex. Even less commonly, scombroid food poisoning may be the cause. This occurs when an individual consumes fish that has begun to spoil. The high concentration of histamine in the decaying flesh triggers a food “pseudoallergy” with symptoms such as diarrhea, cramps, dizziness, and widespread hives.

Most of these allergy-induced hives will resolve on their own when the allergy trigger (allergen) is removed.

Physical

Physical urticaria is a subset of hives in which the skin rash is provoked by specific environmental or physical stimuli such as cold, heat, pressure, vibration, friction, and sunlight.

While this can trigger the same inflammatory response seen with allergic hives, the appearance of the hives is often quite different. In some cases, they will only develop in areas of skin exposed to the environmental stimuli. In others, a widespread eruption can lead to a rapid drop in blood pressure and symptoms such as headaches, flushing, blurry vision, and fainting.

Because physical urticaria is believed to be related to autoimmunity (rather than induced by an external trigger), the condition is most often chronic and can last for years.

Among some the familiar (and less familiar) types of physical urticaria:

Aquagenic urticaria is a rare form of hives caused by contact with water. Cold urticaria is an uncommon form caused by exposure to cold. Cholinergic urticaria, also known as heat rash, is caused by excessive sweating and elevated skin temperatures. Dermographism urticaria is caused by friction or the firm stroking of skin. Pressure urticaria is caused when excessive pressure is exerted on the skin (such as when you carry a heavy bag on your shoulder). Solar urticaria is caused by exposure to ultraviolet (UV) light. Vibratory urticaria is caused by any form of vibration (including mowing the lawn or clapping).

Stress

In addition to physical stimuli, stress is commonly associated with the development or worsening of chronic hives. Again, the exact cause is unknown, but it is believed that the release of stress hormones such as cortisol may have a knock-on effect in which the underlying cause of hive is activated.

One such example is cholinergic urticaria in which stress-related perspiration may instigate the development of heat rash.

Exercise

In food-dependent exercise induced urticaria, a person will have symptoms only when both eating a particular food (e.g. wheat) and then exercising shortly after; in this disorder neither exercise alone nor specific food ingestion alone will trigger the symptoms. In some cases, this can lead to a potentially life-threatening exercise-induced anaphylaxis.

Infections and Diseases

There are certain infections and diseases for which urticaria is common.

This is especially true for young children in whom 80 percent of hives are caused by a viral infection. The activation of the immune response may be triggered by something as simple as a cold. The hives tend to develop within a week of infection and usually resolve in a week or two without treatment.

Other illnesses are commonly associated with hives, many of which are autoimmune and others of which are related to an infection or malignancy. They include:

Chronic kidney disease (CKD) Dermatitis herpetiformis, an autoimmune disorder of the skin related to celiac disease Hashimoto’s thyroiditis, an autoimmune disease associated with low thyroid function Helicobacter pylori, a common bacterial infection of the stomach Hepatitis B, a viral infection of the liver Hepatitis C, a chronic viral infection of the liver Lupus, a systemic (whole-body) autoimmune disorder Lymphoma, a type of blood cancer Parasitic gastrointestinal infections, like Giardia lamblia and Anisakis simplex Polycythemia vera, a slow-growing cancer of the bone marrow Rheumatoid arthritis, an autoimmune form of arthritis Sjögren’s syndrome, an autoimmune disorder affecting moisture-producing glands Type 1 diabetes Vasculitis, the inflammation of blood vessels that has both autoimmune and non-autoimmune causes

Hives associated with these diseases can be chronic or acute.

Autoimmune urticaria, a common cause of unprovoked hivesDermatographic urticaria, caused by the scratching the skinCholinergic urticaria, caused by exercise, stress, or sweatingCold-induced urticaria, caused by exposure to extreme coldPressure urticaria, caused by pressure placed on the skinSolar urticaria, caused by exposure to ultraviolet (UV) radiationVibratory urticaria, caused by exposure to extreme vibration