Hives

WHAT ARE HIVES?

Fig. 1 Hive eruption on the arm

Hives or (urticaria) refers to a skin condition which results in acute or chronic itching and swelling. The eruption lasts for a few hours, before fading, eventually leaving no trace. Hives can continue to form, as old ones disappear, in sequential fashion. Skin lesions, themselves, can vary in size, shape and degree of itching. Hives are produced by numerous stimuli, which cause the release of a body chemical called histamine. This chemical is found in cells in the skin referred to as mast cells, which are present in both the skin and lung tissues. Medications, foods or environmental influences can cause hives to form. In addition, stress, changes in body temperature, pressure, heat, cold, vibration or simple exertion can cause hives to develop. It is important, when presenting yourself to our office, that you relate all possible factors to our ADAS providers such as recent food intake, medication changes, or changes in your health. This can often help us determine the particular source of your skin eruption.

ARE THERE ANY ASSOCIATED INTERNAL PROBLEMS WHICH CAN OCCUR WITH HIVES?

In rare instances, trouble with breathing or swallowing can occur with a hive reaction. These are considered serious because life threatening respiratory and blood pressure changes can occur. If you experience dizziness, difficulty with swallowing or breathing, as in after an insect bite or a certain food ingestion, it is important to let our office know immediately or to present yourself to the Emergency Room, promptly. In some instances, allergy evaluations are appropriate. An Epi-pen™ may also be prescribed and should be carried by you at all times. This will help you in such an emergency, when there is no other available person or persons to assist you.

Fig 2.

Epinephrine Injectable - to be used in case of an emergency, e.g., difficulty with breathing or swallowing

HOW ARE HIVES CLASSIFIED?

Hives can be classified into multiple groupings. They have been described as either physical, infectious, chronic, drug related, stress or emotional related, heat or cold related, or food related. Acute urticaria usually refers to hive development which occurs over a period of time, lasting no more than six weeks. In such instances, causes are easily identifiable and readily eliminated. The most common cause of hive formation is food ingestion, drug ingestion or infections. Insect bites, bee stings, wasp stings, ant bites, fire ant bites or other internal diseases can also induce hives to form. Sometimes, hives can be perplexing because no causes are found, and the eruption proves to be no more than a temporary nuisance.

SOURCES OF HIVE ERUPTIONS:

1. Food. The most common sources of food that cause hives to form are peanuts, chocolate, fish, tomatoes, soy bean, berries and milk. Fresh foods cause hives to occur more often than cooked foods. Hives also can appear after ingestion of fish, shellfish, lobster, milk or dairy products, or citrus product ingestion. A careful history is essential, to help with food avoidance problems.

2. Drug ingestion. There are may types of oral medications that have a tendency to induce hives to form. These include agents such as penicillin or sulfa, Dilantin®, for seizures, codeine, morphine, and even aspirin. Hives can also be triggered by certain blood pressure medications, antacids, ear and eye drops, laxatives and vaginal douches. When experiencing hives, it is important to relate the various medications that you are on, to assist our staff in helping you find the cause of your hive eruptions.

3. Infections. There are many types of infections which can cause hives to occur. Viral infections, such as mononucleosis, bacterial infections, such as strep throat, are common causes. Hepatitis and fungal infections can also be sources of hive formation. If you have encountered a recent infection or been exposed to somebody with infection, let our office know this, so that we can review your history in a thorough manner.

WHAT ARE SOME OF THE OTHER CAUSES OF HIVES?

As mentioned earlier, changes in pressure, vibration, temperature, emotion, or heat or cold changes can induce hives to form. Sunlight can also induce hives to form in a condition called solar urticaria. Typically, this will occur immediately when going outside, into the sun, and resolves upon returning to a shaded area. Antihistamines can be prescribed in such an instance.

Fig 3. Example of Solar Urticaria

HOW CAN WE DETERMINE THE NATURE OF YOUR HIVE ERUPTIONS?

At ADAS, we can perform a blood RAST tests to determine what type of allergen is causing your hives. In some instances, ADAS providers will refer you to an allergist, who can perform prick testing, to test for some specific causes of hives.

WHAT ARE THE COMMON TREATMENTS FOR HIVES?

The best treatment for hives is to avoid those aggravating factors which have been identified. Though not an easy task, careful attention to both history and physical can often save a lot of time and energy in assessing the cause of your skin rash. Antihistamines or corticosteroids, either orally or topically, are the mainstay of therapy for these disorders. On occasion, immunosuppressive agents or light therapy may be needed. ADAS providers may also perform blood work on you, to exclude such things as diabetes, thyroid disease, or other internal conditions. As mentioned earlier, if you suffer trouble with breathing, blood pressure problems or throat swelling, from your hive development on a routine basis, an Epi-pen™ will be prescribed to help you if assistance is not readily available, and you should have all emergency numbers available, at your fingertips, to contact in such a situation.

For more information on hives or to set up a consultation, click here or call 904-285-7546. Thank you and we look forward to helping you.

For more information on hives or to set up a consultation, click here or call 904-285-7546. Thank you and we look forward to helping you.