Chronic Hives (Urticaria)
Hives or urticaria can be defined as a red rash with itching, swelling and elevation of the skin. Hives can be accompanied by more severe swelling which can occur underneath the skin, especially in the soft tissues around the eyes, lips, hands and feet. This form of swelling is referred to as angioedema. Hives and angioedema may occur alone or together. Both may occur suddenly in the form of a reaction to a drug such as penicillin, an infection such as hepatitis, or after a sting by an insect. Certain foods such as eggs, peanuts, tomatoes, walnuts and fish can cause allergic reactions which can be manifested by the appearance of hives and angioedema.
The vast majority of patients who come to the allergist’s office with hives have suffered with them almost on a daily basis for six weeks or more. Often in these cases, no underlying cause such as food, infection or drug reaction can be identified. This form of long lasting or chronic hives usually is well controlled with antihistamines. Large studies performed on patients with chronic hives have rarely found an association with underlying serious diseases. More recent studies indicate that up to 40% of chronic hive cases might be autoimmune in nature. This means that your immune system might be making antibodies in response to receptors found on the surface of allergic cells in your skin, called mast cells. To determine if you have this antibody, your doctor may want to skin test you to your own serum. Most patients with this condition can be reassured that this problem will not continue forever as they will usually improve within a period of five years.
On your initial visit, the allergist will take a careful history and perform a physical examination. This is done to exclude any forms of underlying illness. He will also perform certain laboratory tests which are used primarily as screening tools to rule out any underlying disorders. Treatment is usually begun with antihistamines. Atarax (hydroxyzine) or Benadryl are some effective antihistamines used for the initial treatment of hives. If one antihistamine does not seem to work, another may substituted at some time during the course of treatment. In some situations in which certain foods are suspected of causing hives, your doctor may ask you to keep a food diary in order to identify the unsuspected foods that may be contributing to the problem.
Some patients may experience the onset of their hives after scratching (dermatographism) or following exposure to extreme cold or sunlight, during exercise, or following direct pressure on the skin (for example, from a tight belt or bra strap). In these particular situations, it may be wise to avoid those physical factors that are known to provoke hives.
In most cases, with the appropriate medication and avoidance measures, hives and angioedema can be controlled to the satisfaction of both the patient and the physician.
- Fine LM1, Bernstein JA. Urticaria Guidelines: Consensus and Controversies in the European and American Guidelines. Curr Allergy Asthma Rep. 2015 Jun;15(6):30.
- Amin P, Levin L, Holmes SJ1, Picard J, Bernstein JA. Investigation of patient-specific characteristics associated with treatment outcomes for chronic urticaria. J Allergy Clin Immunol Pract. 2015 May-Jun;3(3):400-7.
- Bernstein JA, Lang DM, Khan DA, et al. The diagnosis and management of acute and chronic urticaria: 2014 update. J Allergy Clin Immunol. 2014 May;133(5):1270-7.