Hives Urticaria Chicago

What are hives?

Hives

also known medically as urticaria are red itchy bumps

Hives characteristics:

• Raised off of the skin
• Variable size from small bumps to silver dollar size or larger
• Scratching of the skin can cause worsening of the hives (referred to as dermatographism, which literally means- writing on the skin)
• Migratory – hives move from one place on the body to another over the course of the day
• Can occur on any part of the body
• Very itchy hives

Key point: Many different types of rashes are often confused with hives. One factor that distinguishes hives from other types of rashes is that hives are migratory- meaning they move from one part of the body to another over a period of hours (an individual hive rarely stays in the same location for more than several hours at a time).

What causes hives?

Hives occur when mast cells (inflammatory cells of the skin) are triggered to release a chemical called histamine. Histamine affects the blood flow in the skin, causing the red itchy bumps. Anti-histamines are taken to block the effect of histamine in the body.

What are other symptoms that can occur with the hives?

The most common symptom in addition to the hives is angioedema (see below), which can occur with hives approximately half of the time. Most people experiencing hives or angioedema will not experience more life-threatening allergic symptoms. When hives do occur as part of a more severe allergic reaction (referred to as anaphylaxis), other symptoms can include:

• Shortness-of-breath
• Wheezing
• Tongue or throat swelling
• Light-headedness, feeling faint, loss of consciousness
• Abdominal pain, diarrhea, nausea, or vomiting

If hives occur with any of these symptoms, call 911 immediately. If they have occurred in the past, follow up with an allergist immediately to discuss important ways to treat severe allergic reactions in the future.

My doctor told me that idiopathic hives (urticaria) are the most common type of hives. What does idiopathic mean?

Idiopathic

literally means-arising spontaneously, or without a known cause.

Many patients with hives will not be able to identify any allergic (external) triggers for their hives. This confuses many patients because there are many different allergic triggers that can also cause hives (see list below). So while allergic triggers are possible, many people with hives do not have an allergic trigger. This point is illustrated by the frustration most patients experience from not being able to identify a consistent trigger for their symptoms. Most patients discover that making such changes as their soaps, detergents, personal care products, etc does not eliminate their symptoms.

Are idiopathic hives the same thing as autoimmune hives?

Many patients with idiopathic hives are actually experiencing an “autoimmune” reaction. These patients make proteins that bind to mast, causing histamine release. We do not yet know why patients develop these proteins. Although autoimmune hives can be associated with thyroid problems, it is only rarely associated with other more serious autoimmune disorders.

How long do hives last?

Assuming the hives are idiopathic and no allergic cause is identified, hives lasting less than 6 weeks are considered acute and are more likely to resolve quickly. Hives lasting longer than 6 weeks are called chronic and are more likely to continue for a longer period. Essentially, the longer you have had your hives, the longer that they are likely to continue. Chronic hives can last for many months or even years. Some patients will have recurrent episodes over the years with long symptom-free periods in between. Unfortunately, we do not know what turns this process on and off. Ultimately, however, the hives will stop in most cases.

So besides idiopathic or autoimmune urticaria, what are other possible causes?

Chronic hives are much less likely to have an allergic trigger. Even with acute hives, we are often not able to identify any allergic triggers. However, it is still essential to consult your doctor to make sure that you are not at risk for a more severe allergic reaction.

Possible allergic triggers include:

• Foods: When a food allergy is responsible for causing hives, the allergic reaction typically occurs immediately after eating the food but may occur up to two hours later. A food allergy will rarely cause hives (or other allergic symptoms) more than several hours after eating the food. Also, allergic symptoms will usually occur every time that the food is eaten. Of course, there are always some exceptions and it is important to discuss your symptoms with a physician.

• Medications: although any medication can cause an allergic reaction, some are more likely to do so than others. Because medication allergies can be potentially severe- it is extremely important to discuss your symptoms with a physician knowledgeable about medication allergies. Information here is intended only for informational purposes.

Medications more likely to cause an allergic reaction are:

• Insect stings (such as bees, wasps, hornets, yellow jackets, or fire ants)
• Latex allergy
• Heat or cold-induced
• Exercise-induced
• Viral infections (may be responsible for the some cases of acute hives in children)
• Pressure-induced (areas of more intense pressure such as the feet, belt/waist area, or bra strap)
• Sun-induced

So let me get this straight. Are you saying that despite all of the things that may cause hives, many people with hives do not have any type of allergy?

Yes, but a person with hives should always follow up with their doctor to make sure there are no allergic causes. I know it is confusing. But ask yourself, is there anything that seems to consistently trigger your hives? For most people, the answer is “no.” Routine viral infections may be a common cause of acute hives (lasting less than six weeks), however there is no routine way of testing for this. Because an allergy causing hives should cause symptoms with each exposure (there are some exceptions to this rule), an allergist should be able to identify possible allergic triggers in most cases. If no allergy is found, the hives are likely to be idiopathic.

Why do I sometimes experience swelling of my lips or eyes with the hives?

This type of swelling is called angioedema and occurs when histamine is released in deeper areas of the skin. The lips and eyelids are most commonly involved although other areas of the body such as hands and feet can also swell. Swelling can last several days if not treated. The swelling can occur with or without the hives. Swelling only rarely involves the throat or tongue. If you have experienced possible throat or tongue swelling in the past, you should notify your doctor immediately.

What else can cause angioedema?

There are two types of angioedema that can occur without hives:

1. Hereditary angioedema
2. Ace inhibitor-induced angioedema: ace inhibitors are a popular class of blood pressure medications that can cause angioedema without hives. The following medications all contain an ace inhibitor. If you experience angioedema and are taking one of these medications, notify your doctor immediately. The angioedema can be potentially life threatening.

Accuretic Aceon Acupril Altace Benzapril Capoten Capozide Captopril Enalapril Fosinopril Lexxel Lisinopril Lotensin HTC Lotrel Mavik

Moexipril Monopril Perindopril Prinivil Prinizide Quinapril Ramipril Tarka Trandolapril Uniretic Univasc Vaseretic HTC Vasotec Zestoretic Zestril

Most medications are assigned two different names.

• Generic name: when a medication is first discovered, it is given a chemical name that describes certain biochemical properties of the medication. This is referred to as the generic (official) name. It is usually too long and cumbersome for general use. (i.e. ibuprofen is the generic name of a type of anti-inflammatory pain medication).
• Trade (branded or proprietary) name: drug manufacturers create a name for their version of the medication that they produce. This trade name of the medication is the exclusive property of the company. The trade name is typically followed by the symbol ®. (i.e. Advil® is the trade name given to ibuprofen by one drug manufacturer. Motrin® is the trade name of ibuprofen given by a different drug manufacturer).

Can stress cause hives?

Although hives can be stressful, stress does not appear to cause hives for most people (Think of all of the stressful times in your life that were not associated with hives!!).

Can hives or angioedema be life threatening?

Fortunately, most people with idiopathic or autoimmune hives and/or angioedema do not develop swelling of the tongue, throat, or other life-threatening symptoms. However, if tongue swelling, throat swelling, or any difficulty breathing (respiratory distress) does occur, an Epipen® can be lifesaving and should be available at all times. An Epipen® contains the medication Epinephrine (adrenalin) in an injectible form and is used to reverse severe allergic reactions. It is very important to discuss your symptoms with your physician, particularly if you have had possible swelling of the throat, tongue, or other potentially life-threatening symptoms.

Hives treatment / swelling (Angioedema) treatment options in Chicago

There are a number of different hives treatment options that can be discussed with your doctor. Anti-histamines are the most commonly prescribed medications for treating hives.

A number of different hives treatment medications are used to treat hives. (Trade names are capitalized and followed by ®, while the generic names are in lower case without the symbol ®).

Hives treatment with Anti-histamine medications

Hives treatment with Anti-histamine medications is the most common form of hives treatment and helps block the histamine release that causes the itching and swelling.

Hives treatment with over-the-counter anti-histamines

• Zyrtec® (ceterizine) is a very effective anti-histamine and is available without a prescription. A minority of patients can experience sedation.
• Claritin® (loratidine) is non-sedating and available over-the-counter but less effective than Zyrtec®.
• Benadryl® (diphenhydramine) is effective for hives treatment but sedation is a problem for many people. It has a shorter duration of action (4-6 hours) than Zyrtec® or Claritin®.

Hives treatment with prescription anti-histamines:

• Xyzal® (levocetirizine) is felt by many allergists to be the most effective anti-histamine for hives treatment. It is the new version of Zyrtec® and appears to have less sedation
• Allegra® (fexofenadine) is one of the least sedating anti-histamines.
• Clarinex® (desloratidine) is the new version of Claritin® and is non-sedating
• Atarax® (hydroxyzine) has a shorter duration of action than most other anti-histamines and is also sedating.

Hives treatment with H-2 blockers

Although normally used to treat acid reflux (GERD), H-2 blockers can also be helpful for some patients with hives when used in combination with anti-histamines.

Over-the-counter hives treatment H-2 blockers:

• Pepcid® (famotidine)
• Zantac® (ranitidine)

Hives treatment with leukotriene modifiers

These medications are usually used for asthma and allergic rhinitis but can sometimes be helpful for hives treatment. I usually try this medication when anti-histamines and H2 blockers have not been effective. No over-the-counter leukotriene modifiers are available.

Hives treatment with prescription leukotriene modifiers

• Singulair® (montelukast)
• Accolate® (zafirlukast)
• Zyflo® (zileuton) is not used commonly because of the need to follow liver tests while taking the medication.

Hives treatment with oral corticosteroids

Although the most effective medication for hives treatment, oral corticosteroids should be reserved for more severe hives that have not responded to other medications. Side effects with short-term use are not common but long-term use should be avoided when possible. It is important to discuss dosing instructions carefully with your doctor and to take the medication as prescribed. Steroid injections should not be routinely used to treat chronic hives.

• Prednisone
• Medrol dose-pak ® (methyl-prednisolone)
• Orapred®¹, Pediapred®², Prelone®² (prednisolone)

¹Available in liquid form or as an orally disintegrating tablet (ODT)

²Available only in liquid form

Hives treatment with Ketotifen

A medication that can block histamine release that is only available in Europe and Canada. It can be effective when other medications have not worked.

Hives treatment with Doxepin

Available by prescription, doxepin was originally developed as an anti-depressant, but it is a potent anti-histamine and is sometimes used to treat more severe hives. Sedation and weight gain have limited its use.

Hives treatment with other medications

Other medications such as Plaquenil® (hydroxycloroquine), dapsone, and cyclosporine are occasionally used to treat severe chronic hives.

Hives treatment and testing

• For idiopathic hives lasting less than 6 weeks, no testing is usually required. However, there are times when testing should be considered as determined by your doctor. Hives that are painful or that leave pigment changes of the skin may be a sign of a more serious underlying disorder.
• If a specific allergic trigger for the hives is suspected, allergy testing can be helpful
• Routine blood work is most often normal but can be checked in patients with chronic hives.
• Rarely, a skin biopsy (piece of skin is taken and sent to a lab for interpretation) is necessary for more severe hives that do not respond to medications

Hives treatment in Chicago

Clarity Allergy Center provides comprehensive hives testing, diagnosis and treatment in the Chicago area.