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In the Know- All About...Hives

March 21, 2017        

By Mendy Hecht, Hamaspik Gazette

“Hives?  Aren’t those what bees live in?”  But this irritating skin reaction is anything but funny to those who get it.

Hives that fade away after a relatively short time are usually not a serious concern.  But hives that last over six weeks, or which recur over months or years, have a medical category of their own: urticaria (ur-tih-KAR-e-uh), or chronic hives.  Here’s what you need to know.

Definition

Hives are white, pink or red welts (bumps or raised marks) on the skin. 

Hives can appear within minutes of exposure to their cause (read on), or in a delayed reaction of an hour or two (or even more) later.

Hives can appear anywhere on the body, including the face, lips, tongue, throat, or ears, or on the hands, feet, arms, legs, torso, back or elsewhere.

Hives range in size from as small as a pen tip to as large as a dinner plate.  They may connect to form even larger welts.

A hive often goes away in 24 hours or less, but since new hives may appear as old ones fade, hives can sometimes last for a few days or longer.

There are a few kinds of hives:

  • Acute, the most common kind, runs from a few hours to less than six weeks.

  • Chronic hives, or urticaria, are hives that last over six weeks.

  • Physical, or hives caused by direct physical stimulation of the skin, like cold, heat, sun exposure, vibration, pressure, sweating, and exercise.  These hives usually hit right where the skin was stimulated, rarely appearing elsewhere.  Most such hives pop up within one hour after exposure.

  • Dermatographism, a sub-type of physical hives, in which hives form after firmly stroking or scratching the skin.  These hives can also occur with other kinds of hives.

  • A related diagnosis is angioedema, in which swelling occurs beneath the skin, not on the surface.  Angioedema usually strikes around the eyes and lips, and sometimes the hands, feet and elsewhere.

 Symptoms


The most common signs and symptoms of hives are:

  • Slightly raised, white, pink or red bumps or welts on the skin

  • Itchiness, which may be severe

  • Welts that occur alone or in batches, or connect over a large area—usually the face, torso, arms or legs

  • Welts that fade or go away within 24 hours at one spot but may appear at another spot

  • Welts that change size and shape over the course of the reaction

  • Occasional stinging or pain

 Complications

People with chronic hives often have a trigger, or the substance that causes the hives.  Every time they are exposed to that trigger, they get hives. 

But in cases of chronic hives, complications can also occur, like muscle soreness, vomiting, stomach upset, or difficulty breathing.  Difficulty breathing is typically caused by swelling of the tongue or throat—and if that occurs, call an ambulance immediately.

Hives can also be a symptom of anaphylaxis, a severe and life-threatening allergic reaction in which the airway narrows and blood pressure drops.  Anaphylaxis is a medical emergency that needs immediate treatment.

Causes

Hives are usually a reaction by the skin to something to which the body is allergic.  But they can have other causes.

Allergies

Allergies that trigger hives are wide-ranging. They range from insect stings and bites to consuming anything dairy-based, and from common food items like peanuts or wheat to even specific medications.  (Allergies, of course, are a full subject in their own right.)

Other foods known to trigger allergies are fruits (especially citrus fruits), eggs and shellfish.

Other items known to trigger allergies are alcohol, berries, chocolate, food additives, latex, pollen, tomatoes, or even an allergy shot.

In more detail, allergic hives are caused when certain blood-vessel cells react to the trigger by releasing histamine and other chemicals into the bloodstream.  The histamine and other chemicals cause plasma to leak out of small blood vessels in the skin.  The leaks of plasma into the skin then cause the hives.

 Other medical conditions

In some cases, hives may be caused by other medical conditions like hepatitis, lupus, a type of vasculitis, or certain colds or other infections caused by specific bacteria or fungi.  Hives can also be caused by thyroid disease or even cancer.

Other causes

  • Exposure to sun (solar urticaria), heat, cold, or water

  • Exercise

  • Stress

  • Pressure on the skin, such as from sitting too long or a tight waistban

  • Contact with chemicals

  • Scratching the skin


Factors that increase risk of developing chronic hives include being female, as women are affected twice as often as men, and being a young adult.

Diagnosis

Since there are no specific tests for hives, testing will depend on the patient’s medical history and a thorough exam by a primary care doctor, allergist or dermatologist.

To find out what is causing hives, the doctor, dermatologist or allergist will review the patient’s health history, ask a series of questions (often in questionnaire form), and do a physical exam.  The patient may also need any of the following tests:

  • Allergy tests (on the skin or blood)

  • Blood tests (to rule out other illnesses or infections)

  • Skin biopsy, in which a tiny layer of affected skin is painlessly removed for examination under microscope

 The doctor or specialist may also ask the patient to keep a diary to keep track of daily activities, foods and drinks consumed, all medications or supplements taken, where/when hives appear, and how long it takes them to fade.

Unfortunately, because there are so many things to which a person can be allergic, doctors often can’t find their cause.  As a matter of fact, it’s often impossible to find the exact cause—especially in the case of chronic hives.

 Treatment

See a doctor if you have severe hives, hives that don’t respond to treatment, or hives that continue to appear for several days.

Seek emergency care if you feel dizzy, have severe chest tightness or trouble breathing, or feel your tongue or throat swelling.

In in the minority of cases where hives are not allergy-related, treatment of the underlying medical cause should eliminate or at least reduce the symptom of hives.

Antihistamines

For mild to moderate cases of hives, the most common treatments are over-the-counter (OTC) or prescription drugs called antihistamines.  These help relieve the itching and inflammation of hives.  Antihistamines are also prescribed to treat chronic hives.  Daily dosages help prevent hives from forming.

There are many antihistamines on the market.  Some make people drowsy, while some are specifically “non-drowsy” formulations. 

Some common new (and mostly non-drowsy) antihistamines include Alavert, Allegra, Clarinex, Claritin, Xyzal and Zyrtec.  Other older (and mostly drowsiness-causing) antihistamines include Benadryl, Chlor-Trimeton and Vistaril.

Epinephrine

For some emergency cases of hives or angioedema, patients may need an injection of epinephrine.  This is usually administered by an EMT or ER staff member, or an ordinary responder using the popular Epi-Pen devices usually on hand in every school or public place.

Medications

If antihistamines alone don’t relieve symptoms, other drugs that doctors may prescribe include:

  • Corticosteroids (in oral or cream form; usually short-term, as long-term has side effects).

  • Dapsone, an antibiotic that can also relieve redness and swelling.

  • Xolair is an injected drug that can help patients with long-term chronic hives.

  • Histamine (H-2) blockers, also called H-2 receptor antagonists, may be injected or taken orally. Examples include Axid, Pepcid, Tagamet and Zantac.  They do have side effects, though.

  • Asthma drugs that also contain antihistamines, like Accolate and Singulair.  Side effects may include behavior and mood changes.

  • Cyclosporine (brand names Gengraf, Neoral and others) affects the immune system and provides relief from chronic hives.  Possible side effects include headache, nausea and increased risk of infection and reduced kidney function.

  • Tacrolimus, medicine’s leading immunosuppressant, reduces the immune system response that causes hives.  It may cause a range of side effects, from minor to serious.

 Whatever you’re prescribed, ask about possible side effects.

Temporary relief remedies

While you’re waiting for hives and swelling to disappear, here are some tips:

  • Avoid irritating affected areas

  • Apply cool compresses or wet cloths to affected areas

  • Cool showers, fans, or soothing lotions may also help

  • Try to work and sleep in a cool room

  • Wear loose-fitting lightweight clothes

 Prognosis

For most people, hives are not serious, despite being very uncomfortable and interfering with sleep and daily activities.  Children may outgrow the allergies that cause their hives.

But with most cases of hives, chronic or otherwise, being symptoms of allergic reactions, treatment consists of counteracting the allergen itself if an outbreak is underway.

And once that’s over, the informed patient is best served by engaging in patient personal research of his or her own—to isolate the allergen(s) triggering the hives and then eliminating them from his or her life.