Sakes Alive! I’ve got Hives!

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

What is going on with my skin??

Hives, also known as urticaria, is an inflammation of the skin. Most types of hives occur when the immune system releases histamines. Histamines cause small blood vessels to leak, leading to a swelling of the skin that’s raised, 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 histamines trigger 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 for more than twenty-four hours before resolving and often appearing somewhere else. They leave no residual marks on the skin after resolving. Angioedema may appear as swelling around the eyes, 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 for more than twenty-four hours are indications of other underlying conditions.

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

How did I get this??

There are many causes of urticaria. Allergies are the most well-known trigger for hives; this includes reactions to foods, medications, insect stings, airborne allergens, or contact allergens. Physical urticaria is another class of urticaria, which is triggered by stimuli like pressure, vibration, cold, heat, exercise, or sun exposure. Urticaria 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 can be identified. Approximately 30% of these patients are found to have an antibody that can attach to cells holding histamines and cause these cells to release histamines 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 upsets, 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 are the best ways 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 the 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 then 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/or urine tests.

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

Written by Dana Dalbak, PA-C