Urticaria in older adults

Overview

Urticaria, commonly known as hives, is a skin reaction that causes raised, red, and itchy welts (bumps) to appear on the skin. These welts can vary in size and shape and often come and go quickly. In older adults, urticaria can be triggered by medications, infections, or other age-related factors.

Urticaria is a common condition in older adults, though it is slightly less common than in younger age groups. It often results from medications, infections, or other health issues more common in later life.

Urticaria can affect anyone, but older adults may be more prone to certain triggers such as medications, underlying health conditions (like thyroid disorders), or physical factors like pressure or temperature changes.

Symptoms

Common symptoms

• Raised, red or skin-colored welts (hives) that can appear anywhere on the body
• Intense itching, which may worsen at night
• Welts that change shape, move around, and disappear within 24 hours only to appear elsewhere
• Swelling (angioedema) around the eyes, lips, hands, feet, or genitals

Symptoms in children

• Hives in children look similar to those in adults but may be more often triggered by infections or foods
• Children may also have more generalized skin reactions and can be very irritable due to itching

Symptoms in older adults

• Older adults may experience larger welts that last slightly longer
• Itching can be more severe and disrupt sleep
• Swelling (angioedema) may be more common, especially around the face and throat
• Triggers often include medications (like certain pain relievers or blood pressure drugs) rather than foods

Causes

Main causes

• Allergic reactions to foods (e.g., nuts, shellfish, eggs)
• Medications, especially antibiotics, pain relievers, and blood pressure drugs
• Infections (viral, bacterial, or fungal)
• Physical triggers: pressure on the skin, cold, heat, sunlight, or vibration
• Stress or emotional upset
• Insect bites or stings
• Underlying health conditions like thyroid disease, autoimmune disorders, or chronic infections

Risk factors

• Being over 60 years old
• Taking multiple medications (polypharmacy)
• Having a history of allergies, asthma, or eczema
• Having an autoimmune condition (e.g., lupus, rheumatoid arthritis, thyroiditis)
• Recent infection or illness
• Chronic stress or anxiety

When to see a doctor

See a doctor urgently if:

• If you have trouble breathing, swallowing, or feel your throat is closing
• If you have severe swelling of the face, lips, or tongue
• If you feel dizzy or faint
• If you have a rapid weak pulse or chest tightness

Book a routine appointment if:

• If hives last longer than 6 weeks (chronic urticaria)
• If hives are very uncomfortable and affect your daily life or sleep
• If you suspect a medication is causing your hives
• If you have other symptoms like joint pain, fever, or fatigue along with hives

Diagnosis

Your doctor will ask about your symptoms, when they started, and what might have triggered them. They will examine your skin and check for any swelling. They may ask about your medical history, including medications, recent illnesses, and any allergies. In most cases, the diagnosis is made based on this information alone.

Tests that may be done

• Allergy testing (skin prick test or blood test) if an allergic trigger is suspected
• Blood tests to check for underlying conditions (e.g., thyroid function, autoimmune markers)
• Skin biopsy in rare cases to rule out other skin conditions

What to expect at your appointment

Your doctor will work with you to find the cause and suggest a treatment plan. If needed, they may refer you to a skin specialist (dermatologist) or an allergy specialist. You may be asked to keep a diary of your symptoms and possible triggers.

Treatment

Treatment for urticaria focuses on relieving symptoms, avoiding triggers, and managing any underlying conditions. Many cases improve with simple self-care and over-the-counter treatments. For chronic or severe cases, prescription medications may be needed.

Self-care at home

• Apply a cool compress or take a cool bath to soothe itching
• Wear loose, comfortable clothing made from natural fibers like cotton
• Avoid scratching – keep nails short and use a moisturizer to reduce irritation
• Identify and avoid triggers, such as certain foods, medications, or stress
• Keep a diary to track when hives appear and what might be causing them

Medical treatments

Doctors may suggest antihistamines, which help reduce itching and swelling. These can be taken as pills, liquids, or creams. For more stubborn cases, other medications that calm the immune system may be used. Always speak with your healthcare provider before starting any new treatment, especially if you take other medications.

When is surgery considered?

Surgery is not a treatment for urticaria.

Living with this condition

Living with urticaria can be frustrating, but most people manage well with simple adjustments. Avoid known triggers, keep your skin cool and moisturized, and have an action plan in case hives appear. If you take medications for other conditions, check with your doctor if any could be causing your hives.

Lifestyle tips

• Try to reduce stress through relaxation techniques like deep breathing, meditation, or gentle exercise
• Avoid hot baths or showers – use lukewarm water instead
• Stay cool in warm weather and avoid excessive sweating
• If cold triggers your hives, dress warmly and limit time outdoors in cold weather

Diet and exercise

There is no special diet for urticaria unless you identify a specific food trigger. A balanced, healthy diet supports your overall immune system. Gentle exercise like walking or swimming can be beneficial, but avoid activities that cause heavy sweating or pressure on the skin if these trigger your hives.

Mental health and emotional wellbeing

Chronic itching and skin changes can affect your mood and sleep, leading to anxiety or frustration. It is important to talk to your doctor if urticaria is affecting your mental health. They can offer support or refer you to a counselor if needed.

Prevention

You cannot always prevent urticaria, but you can reduce your risk by avoiding known triggers. If you have a medication that causes hives, your doctor may prescribe an alternative. Maintaining a healthy lifestyle and managing stress can also help.

Vaccines

There are no vaccines to prevent urticaria. However, staying up to date on recommended vaccines (like flu and pneumonia) can help prevent infections that might trigger hives.

Screening programmes

No routine screening is needed for urticaria. If you have chronic hives, your doctor may check for underlying conditions like thyroid disease or autoimmune disorders.

Complications

If left untreated

• Chronic urticaria can cause persistent itching, sleep loss, and reduced quality of life
• Severe swelling (angioedema) of the throat can lead to breathing difficulties (though this is rare)
• Scratching can damage the skin, leading to infections or scars

Long-term outlook

Most cases of urticaria in older adults improve with treatment and trigger avoidance. Even chronic urticaria can often be managed effectively, allowing you to live a full and active life. With the right support, most people find their symptoms become much less bothersome over time.

Find support

International organisations

• International Society of Dermatology
• World Allergy Organization

Local organisations

• NHS (UK) - Urticaria information · UK
• American Academy of Dermatology · USA

Helplines

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