Have you—perhaps when you were a child—ever gotten into stinging nettles? Then you surely still remember the itching and burning and the feeling of having to scratch. Usually, itching is the most unpleasant and agonizing symptom of urticaria. Affected patients can be “driven up the wall” and often do not sleep. Incidentally, the itching (in contrast to the itching associated with atopic eczema/neurodermatitis, for example) provokes rubbing and not scratching, that is, skin scratched raw by fingernails is seldom seen. Almost always, the affected skin is perceived as over-heated and after resolution of an episode as dry. Occasionally patients also report a burning of the skin; rarely, outright pain in the affected skin areas is reported. In patients with urticaria the wheals often occur all over the body, and not just once, but often several times a day and every day for months, years, and even decades.

During an urticaria attack, headaches or joint pain may occur. In such cases, it should first be established whether the hives, itching, or swelling are a consequence of the treatment of pain and have been triggered, for example, by the use of acetylsalicylic acid (ASA, e.g. in aspirin) or other chemically related drugs. We know that many medications can cause hives. Patients suffering from hives should take less problematic painkillers such as paracetamol instead of acetylsalicylic acid. In about one tenth of urticaria patients nausea, indigestion, or other breathing difficulties occur. In extreme cases, so-called anaphylactic shock may also occur in connection with cases of urticaria. However, pain may also be an indication of an inflammation, and it is known that chronic inflammation, i.e., inflammation that persists over a long period, can cause urticaria to persist.

Quality of life

It is not surprising that urticaria can have a negative effect on the quality of life of those affected. The effects of urticaria go far beyond the physical symptoms and can also have serious consequences with regard to the well-being and quality of life of those affected. The frequent failure of efforts to identify an underlying cause of urticaria, the unpredictable symptoms, and the significant burden represented by the disease very often lead to frustration among those affected.

The discomfort caused by urticaria can lead to sleep disturbances and lethargy. Itching and sleep disorders can have a negative impact on the careers. Many patients feel limited in everyday life. The disease also often leads to a restriction of social contacts and, subsequently, to isolation and loneliness. Not uncommonly, anxiety and depression occur. Sometimes, those affected are therefore plagued by thoughts of suicide. Urticaria is also a great burden on a partnership, and family life is strongly influenced.