Hives
That itchy feeling
Hives are an allergic skin reaction characterized by round, pink or red, raised welts usually 1/4 to 1/2 inch (1 to 5 cm) across, although they can be larger. Often, wheals (bumps) "join" together to form larger swollen areas, and in roughly half of the cases, they may involve structures beneath the skin.
They frequently itch or cause a burning sensation, and can appear anywhere on your body including your scalp, lips, palms, and the soles of your feet. Hives generally resolve on their own, are harmless, and leave no trace.
In severe cases accompanied by wheezing, shortness of breath, swelling of the lips, or fainting, you should seek immediate attention at an emergency room as these symptoms may signal a life-threatening allergic reaction.
Synonyms
- Urticaria
- Giant urticaria
Detailed Description
The primary symptom of hives (also known as urticaria) are itchy, whitish or reddish raised bumps called wheals or welts. Wheals can quickly join together and form larger plaques of various shapes. Wheals can appear, disappear, and reappear in minutes or hours, a phenomenon unique to hives.
Most cases of hives disappear within hours or days without any treatment. Antihistamines may relieve the itching and reduce swelling. Calamine lotion can also help. In severe cases, prednisone, a corticosteroid, may be prescribed.
Chronic hives are those that persist for six weeks or more. If the cause is not obvious (such as an allergic reaction to a particular food), you should stop taking all nonessential drugs until your hives subside. Chronic hives may be relieved by antihistamines or calamine lotion. In serious cases prednisone may be given for as short a time as possible. Even when left untreated, chronic hives can disappear spontaneously.
"Deep hives," or angioedema, is a form of hives involving deeper skin tissue and generally lasting longer than urticaria. People with angioedema often have swelling around their eyes, lips, hands, and feet. Angioedema of the face may involve the soft tissue of your airway and cause life-threatening obstruction to breathing.
Swelling of the larynx and the inability to breathe is a sign of a rare, but life-threatening complication. Itching, wheezing, a runny nose, paleness, cold sweats, low blood pressure, and abdominal pain may occur. Another dangerous symptom is swollen lips. If you have these symptoms, seek immediate treatment at a hospital as coma, cardiac arrest, and respiratory arrest can occur.
How Common Is Hives?
It has been estimated that 15% to 20% or nearly one out of five Americans are afflicted with hives at some point in their lives. Hives frequently appear in children as a reaction to medication, certain foods, or insect bites. While hives occur more frequently in women ages 40 and 64, the condition can affect people of all ages. Chronic hives can occur in anyone; however, it most commonly appears in women between ages 40 and 64.
Goals of Treatment
Hives are usually self-limiting and often disappear quite rapidly.
In general, the itching and rash associated with hives may be relieved by calamine lotion or other anti-itch lotions. In addition, your doctor may prescribe antihistamines or topical or oral corticosteroids to relieve your discomfort.
The goals in the treatment of hives are to reduce the itching and burning sensation as well as to identify and eliminate the cause of the allergic reaction. An elimination diet can help identify food triggers. In some cases, an allergist can help pinpoint the substance causing hives.
Treatment Overview
Once diagnosed, your doctor will likely recommend a course of treatment you can follow at home. Emergency room care may be necessary for those reactions that may be life-threatening, such as swelling of the lips and throat or difficulty breathing.
Several types of physicians may be involved in treating your condition, including family physicians, internists, dermatologists, allergists, or pediatricians.
Drug Therapy
Drugs most commonly prescribed
- First generation antihistamines such as diphenhydramine (Benadryl) and hydroxyzine (Atarax)
- Calamine lotion
Second choices
- Second generation antihistamines such as loratadine (Claritin) and cetirizine (Zyrtec)
- Oral corticosteroids
- Topical corticosteroids
- Stronger H2 antihistamines (cimetidine, ranitidine) may be added in stubborn cases
Possible Complications
A possible complication of this disorder includes life-threatening anaphylaxis, wherein breathing stops and the circulatory system collapses.
In rare cases, hives may be the first sign of a viral infection like hepatitis, rubella, mononucleosis, or a more serious illness such as lymphoma, lupus cutaneous vasculitis, or hyperthyroidism.
Activity and Diet Recommendations
Heat or sweat may increase discomfort and cause additional outbreaks. Patients with cold urticaria (hives brought on by exposure to cold) should be careful when swimming in cold water or when spending extensive time in snowy environments.
Relaxation therapy may provide relief to people with hives.
An elimination diet may effectively identify the cause of your hives. The foods most commonly associated with hives are chocolate, shellfish, nuts, peanut butter, tomatoes, strawberries, melon, pork, cheese, garlic, onion, and spices. These should be avoided. Alcohol, coffee, and caffeine may also cause outbreaks.
Naturally, if you suspect your outbreak occurred as a reaction to a specific food, you should eliminate that food from your diet.
Considerations for Women
Pregnancy
Check with your doctor before taking any medications during pregnancy or lactation.
Supplements
Vitamin C has antihistamine-like action. Try 2,000 mg to 3,000 mg per day.
Herbs
Stinging nettle (urtica dioica) often helps treat hay-fever-type allergies. Some herbalists also recommend it for hives.
Relaxation
Hives may be stress-related. Incorporate a stress-management regimen like meditation, visualization, self-hypnosis, yoga, or tai chi into your life.
Preventing Hives
- Look for possible food intolerances. Hives often erupt shortly after people have eaten offending foods. Keep a food diary to help pinpoint problem foods that may be related to your attacks.
- Look for possible drug intolerances. Hives may develop in reaction to certain drugs and disappear when you discontinue the medication. If you suffer from chronic hives, you may want to avoid aspirin and other nonsteroidal anti-inflammatory drugs (such as ibuprofen and naproxen), since these medications can initiate allergic skin reactions including hives.
- Avoid food colorings. The connection between food additives and hives is not certain, but some experts suggest you avoid the food and drug coloring tartrazine, the food dye FD&C yellow No. 5, as well as the food preservatives BHA & BHT, sulfates, and benzoates.
Self-Care Measures
If you have hives, the following self-care steps may help ease your symptoms:
- Avoid tight clothing. Irritating fabrics and harsh detergents can worsen hives.
- Try antihistamines. They may help reduce itching. Remember that those available over-the-counter are more sedating than prescription antihistamines.
- Apply anti-itch lotions. Commonly available brands are Sarna and Aveeno.
- Take a bath. Soothing oatmeal baths can also help relieve itching. Use Aveeno powder (one to two cups per bath), or process a few handfuls of plain oatmeal in a coffee grinder until finely ground. Avoid overly hot water.
Websites & Organizations
American Academy of Allergy, Asthma & Immunology
611 East Wells St.
Milwaukee, WI 53202
Phone: 414-272-6071
American Academy of Dermatology
930 N. Meachum Road
P.O. Box 4014
Schaumburg, IL 60168-4014
Asthma & Allergy Foundation of America
1717 Massachusetts Ave., Suite 305
Washington, DC 20036
Phone: 800-7-ASTHMA (800-727-8462)
Contact Dermatitis and Contact Urticaria
Dr. Green's House Calls
Health World
National Health Information Center
P.O. Box 1133
Washington, DC 20013-1133
Phone: 301-565-4167 or 301-984-4256
Fax: 800-336-4797
Email: nhicinfo@health.org
The SkinSite
The Society for Investigative Dermatology Suite 340
820 West Superior Avenue
Cleveland, OH 44113-1800
Phone: 216-579-9300
Fax: 216-579-9333
Email: SID@SIDNET.org
Women's Dermatologic Society
930 North Meacham Road
Schaumberg, IL 60173
Phone: 847-330-9830
FAX: 847-330-1090
Email: kward@aad.org
Sources for This Article
Books
Balch, James F. and Balch, Phyllis A. Prescription for Nutritional Healing. Garden City Park, NY: Avery Publishing, 1997.
Bennett, J. Claude and Plum, Fred. Cecil Textbook of Medicine, eds. Philadelphia: W. B. Saunders, 1996.
Fauci, Anthony J., et. al. Harrison's Principles of Internal Medicine, eds. New York: McGraw-Hill, 1998.
Hurst, J. Willis. Medicine for the Practicing Physician eds. Stamford, CT: Appleton & Lange, 1996.
Murray, Michael T. Encyclopedia of Natural Medicine. Prima, 1998.
Noble, John. Primary Care Medicine ed. St. Louis: Mosby, 1996.
Physicians' Desk Reference. Montvale, NJ: Medical Economics Co., 1998.
Rakel, Robert E. Conn's Current Therapy eds. Philadelphia: W.B. Saunders, 1998.
Taylor, Robert B. Family Medicine: Principles and Practice. New York: Springer-Verlag, 1998.
Tierney, L.M., McPhee, S.J., and Papadakis, M.A. Current Medical Diagnosis and Treatment eds. Stamford, CT: Appleton & Lange, 1998.
Articles
Black, AK. "The Pathogenesis of Urticaria." Keio J Med. 46(1):37-9. Mar 1997.
Castillo, R, Delgado, J, Quiralte, J, Blanco, C, Carrillo, T. "Food Hypersensitivity Among Adult Patients: Epidemiological and Clinical Aspects." Allergol Immunopathol. 24(3):93-7. May-Jun 1996.
Chung, HS, Lee, KH, Ro, JY. "Heat Contact Urticaria--A Case Report." Yonsei Med J. 37(3):230-5. Jun 1996.
Gonzalez, E, Gonzalez, S. "Drug photosensitivity, Idiopathic Photodermatoses, and Sunscreens." J Am Acad Dermatol. 35(6):871-85; quiz 886-7. Dec 1996.
Kanerva, L, Toikkanen, J, Jolanki, R, Estlander, T. "Statistical Data on Ocupational Contact Urticaria." Contact Dermatitis. 35(4):229-33. Oct 1996.
Park, HS, Nahm, D. "Localized Periorbital Edema as a Clinical Manifestation of Sulfite Sensitivity." J Korean Med Sci. 11(4):356-7. Aug 1996.
Pollack, CV Jr, Romano, TJ. "Outpatient Management of Acute Urticaria: The Role of Prednisone." Ann Emerg Med. 26(5):547-51. Nov 1995.
Sveum, RJ. "Urticaria. The Diagnostic Challenge of Hives." Postgrad Med. 100(2):77-8, 81-4. Aug 1996.
Tharp, MD. "Chronic Urticaria: Pathophysiology and Treatment Approaches." J Allergy Clin Immunol. 98(6 Pt 3):S325-30. Dec 1996.
Zuberbier, T, Chantraine-Hess, S, Hartmann, K, Czarnetzki, BM. "Pseudoallergen-Free Diet in the Treatment of Chronic Urticaria. A Prospective Study." Acta Derm Venereol. 75(6):484-7. Nov 1995.