Sakes Alive! I’ve got Hives!

by Dana Dalbak, PA-C, Midwest Allergy Sinus Asthma

About 20% of individuals will experience hives at some point.  For some, a few transient, itchy spots are a nuisance.  For others, persistent lesions with severe, body-wide itching that prevents sleep becomes extremely miserable.  These patients are often so bothered by the unrelenting itch and their efforts to subdue it, that they describe the discomfort as “controlling my life”.

What is going on with my skin??

Hives, also known as uticeria, is an inflammation of the skin.  Most types of hives occur when the immune system releases histamine.  Histamine causes small blood vessels to leak, leading to a raised swelling of the skin, known as a wheal or a welt.  Wheals can vary in size and may be round or irregular in shape.  The skin around the wheal is pink due to the inflammation, and the histamine triggers itching.  Swelling may also occur in the deeper layers of the skin; this is called angioedema.

Hives can appear anywhere on the body, and move from place to place.  A hive typically will not remain in the same location longer than 24 hours before resolving, often to appear somewhere else.  They leave no residual marks on the skin after resolving.  Angioedema may appear as swelling around the eyes, or swelling of the lips, hands, or feet.

Hives usually worsen with scratching, and always blanch (turn from pink to white) with pressure.  Wheals that don’t blanch, leave a residual mark, or stay in one spot more than 24 hours are indications of other underlying conditions.

Hives can occur at any age, but are most common in young adults.  Acute hives last anywhere from minutes to a few weeks before disappearing.  Chronic hives will last more months or longer.

How did I get this??

There are many causes of uticeria.  Allergy is the most well-known trigger for hives, and includes reactions to foods, medications, insect stings, airborne allergens, or contact allergens.  Physical urticaria is another class of urticaria, which is triggered by stimulus such as pressure, vibration, cold, heat, exercise, or sun exposure.  Uticeria can also be a manifestation of a separate disease process, such as infection, autoimmune disease, thyroid disease, or cancer.

For some patients with chronic urticaria, no specific trigger is identified.  Approximately 30% of these patients are found to have an antibody that can attach to cells holding histamine and cause these cells to release histamine when they otherwise would not.  This condition can be confirmed by a skin test in an allergist’s office.

Hives can also occur as one symptom of a more serious allergic reaction called anaphylaxis.  If hives occur along with breathing difficulty, stomach upset, lightheadedness, or swelling of the tongue or throat, quick emergency treatment is necessary.

How do I get rid of this??

When a specific trigger is identified, avoidance of the offending trigger, or treatment of the underlying medical condition, is the best way to stop outbreaks of hives.  For patients suffering chronic urticaria without a trigger, medications are effective.  An allergist may use a combination of two or three antihistamines to resolve the hives.

Breakthrough flares of urticaria may be treated with temporary use of an oral steroid or prednisone.  Hives that are stubbornly persistent can be treated with immune-modulating medications.  After a patient has been free of symptoms for a few months, medications are tapered.  An allergist can guide this therapy for the patient.

An allergist is a physician with additional training in the area of allergy, asthma, and immunology.  When evaluating a patient with urticaria, an allergist will take a detailed medical history and examine the patient for possible causes.  In some cases, appropriate testing may include skin tests, blood tests, and urine tests.

An allergist helps patients with hives by identifying specific triggers, ruling out underlying conditions, and prescribing treatment to relieve the hives.  A refusal to see an allergist is not necessary unless required by insurance.  relief from hives is quite possible with the right therapy regimen tailored to the patient!

Midwest Allergy Sinus Asthma specializes in the treatment of immune-related disorders.  In addition to immunodeficiency, focus is given to the treatment of asthma, allergic rhinitis, hives, food, hypersensitivity, insect sting allergy, and anaphylaxis.  The center has also been a leader in clinical research for over 20 years.  If you suffer from allergies, asthma, COPD, or psoriasis you may qualify to participate in a clinical trial.  You may contact them at (309) 452-0995 or www.asthma2.com.  Their office is located at 2010 Jacobssen Dr. in Normal.