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As per a stress survey done by the American Psychological Association in 2020, the stress levels in Americans have increased. While 78% of people blame the pandemic for such an increase, there are many people who still blame external factors for increased stress levels. These include factors like economic downturn, mass shootings, health care, and others.
Stress may be an emotional response to the stressors in our life. However, it has the potential to impact both our physical as well as mental health.
Accordingly, tiredness, high blood, digestive issues, chest pain, headaches, muscle tension, stress rashes, etc are some of the physical symptoms of stress.
About one in five people develop white bumps or itchy red skin, patches, or puffy welts, commonly known as hives. The medical name for hives is Urticaria.
Although in most cases urticaria is idiopathic, there are still a number of factors that are cited as hives causes. One of the many factors responsible for causing hives or urticaria includes stress.
That’s why it is also called a stress rash. Although ‘rash’ is a commonly used term by people to describe everything red and itchy, dermatologists do not adopt such a practice. In fact, they even distinguish between stress hives and stress rash when describing the issue.
So, let’s understand what is a stress rash or stress hives, what causes hives, hives treatment, and the best antihistamine for hives.
Also Read: 18 Best Massage Oils for stress relief 2021
What is a Stress Rash?
A stress rash is nothing but the small red bumps or welts that individuals develop on their skin that are pruritic or itchy. Some people may observe that when they are stressed out, they develop red, irritated welts on their skin in response to stressors. In fact, for people who already have skin issues like acne, eczema, or psoriasis, the issue becomes even worse.
In acute situations, these small, red welts look like a group of mosquito bites and are called stress hives or urticaria.
What are Stress hives or Urticaria?
Urticaria or stress hives are marked by intense, scratchy welts that are the result of allergic reactions to both internal and external triggers. Thus, apart from being red, puffy, and itchy, stress hives may at the beginning look like separate welts.
But, these typically do not have any fixed shape and may come together as large patches, especially when they are scratched.
The word ‘urtīca’ is a Latin word that means ‘nettle’. Nettle is any plant from the genus Urtica that has tooth-like leaves that have hair all over.
These tooth-like leaves give out a biting fluid that affects your skin, when in contact.
Accordingly, stress impacts various skin types in different ways.
Thus, both stress rash and stress hives belong to the same category of skin issues. In addition to this, urticaria or hives is commonly taken to be an allergy rash, but it is not an allergy. This can occur across age groups and is self-recovering in two out of three people who suffer such a condition.
Further, there are a number of factors that can result in a stress rash or hives. Therefore, medical professionals consider the clinical track record of an individual to understand the underlying cause of urticaria, despite this being idiopathic in many cases.
What do Hives Look Like?
The next thing that comes to mind is how do hives look like? Or what does a stress rash look like? Hives on body:
- are characterized by raised, pink, welts on skin that are itchy. These vary in size and range from a few millimeters to centimeters and may merge.
- typically get worse by scratching.
- are diminishing in nature. That is, the older bumps vanish and the new ones originate every 24 hours, leaving no marks behind
- may stay for up to 24 hours and originate again periodically on various areas of the body, and that too for an unlimited period of time.
- It may affect various areas of your body. The common sites include the tongue, genitalia, areas around the mouth and eyes, and extremities. Likewise, you may develop a rash on neck, rash on face, rash on back, rash on hands, rash on chest, rash on stomach, rash on legs, rash on arms, and a rash all over body.
- These occur in the skin where an immunologic reaction takes place due to the release of histamine. This causes red, itchy bumps in the skin.
- In the cases where hives occur deep into the skin, these result in even more swelling and are called Angioedema.
What Causes Hives?
There are a number of factors or causes of hives. Therefore, medical professionals consider the clinical track record of an individual to understand the underlying cause of urticaria, despite this being idiopathic in many cases.
Hives are the result of histamine release which is a natural component occurring in mammalians.
What is Histamine?
Histamine is a chemical neurotransmitter produced by the body while it experiences an allergic reaction. These allergies typically result in irritation on the skin, throat, lungs, and nose.
Further, histamines are biologically active substances that develop in a number of living organisms. These are distributed unevenly throughout the spectrum of animals and are also found in a variety of plants, bacteria, and insect venom.
However, when it comes to humans, histamine is found in almost all the tissues of the body. Further, it is stored majorly in the mast cells of the granules of the tissue. In addition to this, histamine is found in the blood cells known as the basophils.
Now, there are many things that trigger histamine release in individuals which results in hives.
Common Triggers of Urticaria
1. Immunoglobulin E Mediated Reactions
Many people become sensitive to a number of allergens and generate Specific Immunoglobulin E Mediated (SIgE) against them. IgE is a type of antibody that is produced in response to an allergen and that further binds to the IgE receptors of the mast cells. This is followed by the cross-linking of the bound IgE antibodies by the re-exposure to the allergen that produces mast cells mediators like histamine.
This release of histamine by such contact of allergen and the SIgE either via mucous membranes or directly on the skin can cause urticaria.
Likewise, urticaria may be caused by the production of SIgE against food protein antigens, insect venoms, animal saliva, penicillin, biological detergents, and latex proteins.
2. Non-IgE Mediated Urticaria Caused by Food
Studies reveal that natural chemicals in foods and food additives may also result in urticaria. These may include preservatives, colorings, anti-oxidants, or artificial sweeteners.
This specifically occurs in patients who experience acute allergic symptoms after consuming aspirin or NSAIDs (non-steroidal anti-inflammatory drugs).
Likewise, foods like shellfish, egg-white, and strawberries are suggested to stimulate the release of histamine directly in some patients.
Accordingly, histamine gets released and urticaria occurs in some patients who consume these foods.
Also, foods that contain higher histamine content may also result in food-related urticaria.
3. Physical Urticaria
Certain physical factors may also lead to urticaria in certain individuals. These include factors like heat, cold, pressure, sweating, exercising, water, sunlight, and vibrations.
The welts formed by physical urticaria last for a short period of time, typically less than an hour in contrast to those developed by the delayed pressure urticaria.
Further, researchers have suggested international standards in order to diagnose physical urticarias.
For instance, cold urticaria may develop in patients with cold-dependent antibodies. Although, most of the cold urticaria cases are idiopathic.
4. Urticaria Associated with Medical Conditions
Individuals with urticaria have chances of developing other medical conditions. For instance, Systemic Lupus Erythematosus (SLE) is suggested to be linked to chronic urticaria.
SLE is an autoimmune disease in which your body’s immune system wrongly attacks the healthy tissues. Accordingly, it may impact your kidney, brain, joints, as well as other organs. Further, this disease is more common in women than in men.
Likewise, people having urticaria are also more prone to have thyroid, especially those having ‘autoimmune urticaria’.
5. Urticaria linked to Infection
Much like medical conditions, a number of infections may also result in urticaria. These may include infections like hepatitis, sinusitis, dental infections, etc.
Similarly, parasitic infections typically result in urticaria across the world. Further, infection-related urticaria is seen more common in children as an outcome of viral respiratory infection as compared to adults.
6. Urticaria linked to Hormones
Women having urticaria at times observe that the itchy allergic reaction varies in severity with regards to their menstrual cycle.
Further, there exists autoimmune progesterone urticaria, an unusual form of urticaria that is cyclical in nature. This occurs 7 to 10 days before mensuration.
However, during pregnancy, urticaria improves. But, some pregnant women may experience PUPP (Pruritic Urticarial Papules and Plaques of Pregnancy). Women who enter their third trimester, develop urticarial papules and plaques on thighs and abdomen and see the same spreading and impacting limbs and trunk.
This is more common in first pregnancies and in Vitro fertilization. Further, women are treated with antihistamines, topical and oral steroids, or softeners in moisturizers called emollients which soften the dry skin.
7. Urticaria linked to Stress
As mentioned earlier, stress also is one of the triggers for urticaria and may make hives from stress worse. Stressors like financial pressure, poor relationships, work-related stress, etc may even lead to chronic urticaria.
8. Urticaria linked to Drugs
There are a wide variety of drugs that may result in urticaria. For instance, drugs like NSAIDs and aspirin are taken to be a common cause of urticaria.
Likewise, drugs made from opium including codeine lead to direct histamine release from mast cells causing urticaria. In fact, many over-the-counter analgesics have NSAIDs, aspirin, and codeine and must be taken by people with urticaria after consulting medical professionals for these may worsen the same.
9. Autoimmune Urticaria
As per studies, 30%-40% of chronic idiopathic urticaria is autoimmune. Although urticaria remains idiopathic in patients with Chronic Urticaria, many patients having non-physical Chronic Urticaria are said to have autoimmune urticaria.
It involves histamine-releasing autoantibodies which lead to mast cell degranulation. Further, patients having autoimmune urticaria in most cases have associated angioedema.
Classification of Urticaria
There is a wide range of clinical occurrences of various subtypes of urticaria. In fact, a patient may have two or more subtypes of urticaria at the same time. Urticaria may be classified based on duration, frequency, and underlying causes.
We have already discussed the classification of urticaria based on its causes in the above section. Now, let’s have a look at urticaria classification based on duration and frequency.
1. Spontaneous Urticaria
Spontaneous urticaria includes the following two types of urticaria:
a) Acute Urticaria
Acute urticaria episodes last for less than six weeks and have a higher probability of having identifiable triggers. Further, patients with acute urticaria experience spontaneous wheals that appear most of the days between six weeks.
In addition to this, acute urticaria may be idiopathic or caused due to an infection, certain types of foods, medications, venom, latex, or contact with the relevant allergen.
b) Chronic Urticaria
Chronic urticaria, on the other hand, includes urticaria episodes that last for more than six weeks. Further, this type of urticaria is less likely to have an identifiable trigger.
Chronic Urticaria has unknown causes in close to 70% of the cases. However, the longer the duration of Chronic urticaria, the lower are the chances of identifying the underlying cause of this type of urticaria.
Further, chronic urticaria may be further categorized as chronic idiopathic urticaria, chronic autoimmune urticaria, physical urticaria, and others.
Physical urticaria, however, may be triggered due to a number of factors. These may include exercise, cold, sunlight, water, delayed pressure, sweating, and vibration.
c) Special Types of Urticaria
The special types of urticaria include the following:
- adrenergic urticaria
- cholinergic urticaria
- contact urticaria
- aquagenic urticaria
- urticaria pigmentosa
- urticarial vasculitis
- familial cold urticaria
Stress Rash Pictures
The following pictures of hives showcase hives rash occurring as face rash, neck rash, chest rash, rash on hands, rash on back, and body rash.
Breaking out in hives is itchy and painful and so the next thing that comes to mind is how to treat hives. But before jumping to treatment for hives, let’s have a look at some of its symptoms.
The symptoms of hives can become evident between a few minutes to hours after one gets exposed to one of its triggers. The typical symptom includes an itchy skin rash.
The skin rash includes red bumps or weals that look like raised red lines on the skin. These red bumps or welts occur in hives or groups and come together to form large swellings. Also, the older bumps disappear and give way to new welts.
Further, hives or urticaria appear across the body, with major areas being throat, face, chest, stomach, legs, back, and arms.
How to Treat Hives?
The following treatment for hives is typically given to patients suffering from these itchy skin rashes.
1. Common Course of Action
The first thing that medical professionals typically do is to educate patients about urticaria and how it is not the outcome of any skin allergy.
In addition to this, they may give confidence to the patients that mostly all urticaria cases do not lead to any major medical condition that may cause hives or rash. Further, patients may also be comforted that there are treatments available for urticaria and that long-term treatment is effective.
Likewise, medical professionals should try to identify and eliminate any evident triggers by getting into the patient’s history. For instance, they may exclude certain foods from the patient’s diet, physical triggers like heat, sunlight, water, cold, etc may prevent treatment with NSAIDs, aspirin, and codeine, or treat any primary infection or clinical thyroid disease.
Further, certain lotions may provide relief to the patients from itching. These include 1% menthol in aqueous cream or cooling skin lotions such as calamine lotion.
2. Treatment Using Drugs
A number of drugs are used for hives treatment. These are as follows:
Antihistamines are the first-line treatment for hives which includes a standard dose of a second-generation H1 antihistamine. The second-generation H1 antihistamine enter the blood-brain barrier only to some extent. That is why these are Antihistamines are a category of agents that prevent histamine release from histamine-1 receptors and are majorly used for the treatment of hives, allergies, colds, as well as flu symptoms.
Further, antihistamines can be classified into two categories. These include first-generation and second-generation antihistamines.
Classification of Antihistamines
The first-generation antihistamines were rolled out over seventy years ago and are still used widely across the world. These antihistamines influence the histamine receptors in the spinal cord, brain, as well as the remaining body, called the periphery.
These antihistamines also influence serotonin, muscarinic, and alpha-adrenergic receptors. The muscarinic and alpha-adrenergic receptors are the receptors of the autonomic nervous system. These are responsible for controlling the various sympathetic and parasympathetic effects of the body.
Accordingly, the first-generation antihistamines result in side-effects like dry mouth, sedation, low blood pressure, and an increased heart beat.
The second generation antihistamines, on the other hand, came out in the 1980s. These are much less narcotic as compared to the first-generation.
Further, the second-generation antihistamines attack the histamine – 1 receptors and do not enter the brain. Therefore, they cause less side-effects or are less probable to combine with drugs.
That’s why many of the second-generation antihistamines do not result in drowsiness.
The Autonomic Nervous System and Its Receptors
Our autonomic nervous system is divided into the sympathetic and parasympathetic nervous systems. The sympathetic nervous system is also known as the ‘fight or flight’ response. Accordingly, it is responsible for all the physiological changes in the body when any stimuli like seeing a predator, shock, or stress act upon it.
These changes may include an increased heart rate, dilating pupils, the opening of airways, constricting blood vessels, increased force of heart contraction, etc.
On the other hand, the parasympathetic nervous system opposes the sympathetic responses by enabling the body to relax. Accordingly, when your body is not triggered or is not under any kind of stress or pressure, it requires rest and needs to regain energy.
Therefore, parasympathetic reactions or responses include lowering the heart rate, narrowing of pupils, triggering the digestive system, and lowering blood pressure.
Further, to activate or deactivate the sympathetic and parasympathetic responses, the autonomic nervous system makes use of receptors.
These receptors can be triggered or turned on either by a neurotransmitter or blocked when a chemical gets into these receptors. Accordingly, a neurotransmitter that activates or triggers a receptor is referred to as an agonist. Likewise, a neurotransmitter that blocks a receptor is called the antagonist.
Thus, epinephrine is a neurotransmitter that triggers a receptor or is an agonist. While propranolol is an antagonist that blocks the Beta 2 receptor.
Some of the commonly talked about Sympathetic Receptors are the adrenergic receptors. The adrenergic receptors further include Alpha, Beta 1, and Beta 2 receptors.
Likewise, the two types of parasympathetic or cholinergic or parasympathetic receptors include muscarinic and nicotinic receptors.
There may be cases where patients suffer acute urticaria, which is either linked to systemic symptoms or angioedema. In such instances, medical professionals may recommend oral steroids for the short term. The time period and dosage of oral asteroids depends on the patient’s clinical response to such treatment as well as his body weight.
In cases where patients experience chronic urticaria, oral steroids for a longer time span is typically avoided as long as possible. Just in case the long-term steroid treatment becomes unavoidable, medical professionals suggest a medication or a treatment that prevents the disease from occuring.
Such a treatment is called prophylactic treatment which is given during the early stages of urticaria.
Furthermore, the patients may require oral steroids for urticarial vasculitis or acute delayed pressure urticaria.
- Leukotriene Receptor Antagonists (LTRA)
There may be instances where giving a high dose of H1 antihistamine treatment may not treat severe urticaria. In such cases, a second line treatment to H2 antihistamines such as LTRA may be given to such patients.
LTRA are medicines that are prescribed to treat asthma and allergies. These medicines function by blocking the activity of leukotrienes. Leukotrienes are nothing but the inflammatory chemicals that are released when your body comes in contact with stimuli that trigger allergies. Further, they are responsible for causing allergies and tightening of the airways.
Accordingly, LTRAs like montelukast and zafirlukast are given which block the activity of leukotrienes which are responsible for inflammation and nasal congestion that is linked to allergies.
However, one must note that urticaria does not always recover from LTRA treatment. In fact, in a few cases, it may even result in aggravating the rashes and making them worse.
In such cases, the LTRA treatment must be stopped.
3. Changes in Diet
Medical professionals may even give a low salicylate diet to patients with a history of severe urticaria. Such dietary interference is done even with patients experiencing angioedema or bronchospasm specifically after consuming NSAIDs, aspirin, and in cases where the patients also reciprocate to LTRA (Leukotriene receptor antagonists) treatment.
Further, medical professionals may even make the patients understand that it may be easy for them to take a regular dose of antihistamine. In other words, the diet should not become more worrisome than the urticarial symptoms themselves. That is, it may be easy for them to take a continuous antihistamine dose as compared to a strict diet that excludes foods rich in salicylate.
Salicylates are nothing but the group of chemicals that are obtained from salicylic acid. Further, these occur naturally in specific foods and are produced synthetically to be used in specific items like food preservatives, aspirin, and toothpaste.
So, whether it be natural or synthetic salicylates, both can cause allergic reactions in many people.
Salicylates are produced by plants naturally to protect themselves against injurious elements like disease, fungus, certain insects, etc.
Likewise, synthetic salicylates are used as preservatives in foods. Therefore, they are commonly found in medications like aspirin. Furthermore, aspirin has more salicylate content than foods. And for this reason, medications like these having higher salicylate content cause more reactions due to patients being intolerant to salicylates.
Best Antihistamine for Hives
Mostly, medical professionals suggest over-the-counter antihistamines for treating urticaria. As mentioned above, the antihistamine medicines block the release of histamine from the mast cells in the skin.
Some of the best antihistamine for hives include:
- Cetirizine sold under brand name Zyrtec
- Fexofenadine sold under brand name Allegra
- Loratadine sold under the brand name Claritin
- Desloratadine sold under the brand name Clarinex
Although many cases of hives are idiopathic, it is always better to consult a medical professional and then take medication accordingly. Hives causes may vary and therefore it becomes necessary for you to consult a doctor so that he can see your clinical history and suggest treatment for hives accordingly.
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