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In general, if an allergic reaction causes hives or swelling, it is usually ingested (food, oral drug) or injected (drugs, stings).

If an allergen can penetrate the skin locally, hives will develop at the site of exposure.

For example, contact urticaria may occur following exposure to latex gloves if sufficient latex penetrates through the skin.

Acute urticaria can result from "non-specific" stimulation of mast cells, when there is degranulation of mast cells in the absence of a defined allergen.

The causes and mechanisms of hive formation are different in each instance, as are the prognosis and approaches to treatment.

Acute urticaria can be divided into two general types, depending on the rate at which hive formation occurs and the length of time it is evident.

Characteristically, hives should blanch with pressure; they generally resolve within 24 hours, leaving no residual change to the skin.

This type is encountered with food or drug reactions, delayed pressure urticaria, chronic spontaneous urticaria, and urticarial vasculitis (click for picture).

Chronic spontaneous urticaria (click for picture) is characterized by a non-necrotizing perivascular mononuclear-cell infiltrate (CD4 positive T lymphocytes and monocytes) with variable accumulation of eosinophils, neutrophils, and mast cells (click for picture).

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