HIVES (Urticaria)

WHAT ARE HIVES?

Hives are red, itchy, swollen areas of the skin. They may appear suddenly or gradually and may go away in several hours or can last for 24 hours or more. Often appearing in clusters, some may be clearing while new clusters appear elsewhere.. Hives often occur along with swelling called angioedema. Hives are very common and surveys have shown that about 20% of the population has hives at one time or another. They generally last less than one year but may rarely last decades in some individuals.

WHAT CAUSES HIVES?

Hives are frequently assumed to be caused by an allergy to some item but may, in fact, have one of many other known causes. The most common allergic causes include insect stings (bees, ants, wasps, for example), foods (shellfish, nuts, tomatoes, and fresh fruits such as berries), and medications (penicillin, sulfa, aspirin, and many others), and latex exposure commonly in people who work in medical settings who use latex gloves. Cosmetics, deodorants, detergents, and medications that are placed directly on the skin rarely cause hives but may be associated with other types of skin rashes that appear similar to poison ivy. A common form of hives is dermographism, which occurs in about 5% of the population. This form of hives starts where the skin is gently stroked or scraped. The hive appears at the area of the stroking. A similar type this is called pressure urticaria in which the hives may appear at points of pressure against the skin such as tight clothing, prolonged sitting (thighs) or prolonged standing (feet). The hives may then spread over other areas making the starting point unclear. Cholinergic urticaria (hives) is the term we use for hives that develop after activities, which increase the bodys temperature. Activities that can cause this include exercise, hot baths, fever, or at times, emotional stress. This accounts for about 5% of all hives. Cold-induced urticaria (hives) occurs after being exposed to cold temperatures usually in contact with the skin such as cold air or water. In this type drinking cold drinks may cause swelling of the lips or mouth.

Solar urticaria is caused by exposure to sunlight or sunlamps and may occur within minutes. It is believed that it is caused by ultraviolet light. Exercise-induced urticaria is another type usually caused by strenuous exercise and may progress to more serious types called exercise-induced anaphylaxis in some individuals. Chronic idiopathic urticaria is the most common form of hives. This simply means that the hives are recurrent and are without an obvious cause. In fact, conditions that seem to be causing it one day might not be present the next episode. This form is generally a nuisance and is rarely associated with other serious medical problems, the exact reason for it is not known. This type usually goes away on its own but may come and go for as long as a year.

ANGIOEDEMA
WHAT IS ANGIOEDEMA?
Angioedema means swelling and frequently happens along with hives. It is as if the hives were deeper in the skin. It often involves the face, hands, and feet. If it occurs in the throat or windpipe it becomes an emergency since normal breathing and swallowing may be blocked. Fortunately, this is rare since angioedema usually involves only the lips and eyes and goes away even without treatment in a few days. Hives and angioedema may occur together or separately anywhere on the body. Angioedema may in some cases be related to minor trauma to the skin such as with a sharp surface on a tooth in which case a minor dental procedure may alleviate the problem, In other cases, certain families of blood pressure medications, called ACE inhibitors sometimes cause edema of the face, necessitating substitution of a different medication from another family of medications. Hereditary angioedema is a rare inherited familial disease that can be fatal in rare cases. It differs form other types of swelling since it is more serious. Swelling may involve the airway or larynx (voice box) in addition to the face and extremities, it may even occur internally in the stomach thus appearing as appendicitis. There is a deficiency of a particular protein in the blood that leads to the swelling in this form of angioedema. It is treated with special hormone injections that replace the missing one. A blood test can diagnose this form of angioedema.

HOW CAN HIVES BE TREATED?

A simple test on the skin can usually determine if the hives are caused by an allergy to a food. It may even in some instances determine if a medication is causing the hives although not all medication allergies are diagnosable this way. Aspirin, for example, causes a different type of allergy and a traditional allergy test will not demonstrate it. When a provoking factor can be determined, avoiding the food of drug is recommended. Antihistamines are the main type of treatment for hives. Newer ones such as Clarinex and Allegra are FDA-listed as non-sedating. Other older antihistamines such as diphenhydramine and hydroxyzine also work well but may cause drowsiness. It is recommended that you use these medications only at the advice of your doctor. In more severe cases, corticosteroids(prednisone, methylprednisolone) may be used for short periods of time but extended use of these medications may be dangerous. Additional information can be found on our office Facebook page and on our office Twitter page. Medical references for further reading: Horan Richard F. Allergic Skin Disorders and Mastocytosis. Journal of the American Medical Association. November 25, 1992. Pages 2858-2868 Ofran NA. Physical Urticarias. Annals of Allergy. September, 1993. Pages 205-212 Revised 10/4/2012