Hives are itchy, red welts or small bumps that last from 15 minutes to several hours. They usually appear suddenly and leave no trace when they disappear. Hives are treated by Dr. DeEtta Gray at Pinnacle Dermatology in Bellveue, Washington.
Crops of welts may appear several times a day. They may come and go for days or weeks, sometimes longer. They are harmless except when they cause throat swelling, which is rare but requires immediate treatment. Angioedema is a hive-like swelling of the lips, eyes, or other tissue. Angioedema may take 24 hours or more to go away.
What causes them?
They are usually the result of an allergic reaction. This causes release of histamine from cells in the skin. Histamine causes the blood vessels to dilate and leak fluid into the surrounding tissue causing the skin to swell. This irritates nerve endings resulting in itching. In severe reactions, feelings of nausea, vomiting, and dizziness may be present.
How do I determine their cause?
Many things can cause Hives. Medications such as penicillin, aspirin, or codeine can cause them in allergic people. Certain foods like shellfish, strawberries, chocolate, and blue cheese commonly trigger Hives. Infections such as infectious mononucleosis, urinary tract infections, colds, infected teeth or sinuses can also cause them. Only very rarely have Hives been the result of an internal disease such as an overactive thyroid. Occasionally physical agents such as pressure, heat, sunlight, exercise, or cold may cause them.
Since medications are the most common cause, please list all the medicines you’ve been taking, including headache tablets, allergy pills, and medicines for stomach discomfort, laxatives, tranquilizers, cough medicines, pain killers, and herbal medicines. List any unusual foods you ate in the last 2 days before they first appeared. Have you had any recent illnesses? It is important to search for a cause of them if you are having other symptoms such as fever or joint pains, or if you have had Hives more or less daily for more than 6 weeks.
Outbreaks are best treated by removing the inducer. All drugs not critically important to health, including aspirin and vitamins, should be stopped, even if you have taken them safely for years. Contact Dr. Gray before discontinuing use of medications for heart conditions, epilepsy, and the like. Foods are more difficult to incriminate. Usually they will appear within 8 hours of eating something and will then disappear and not reappear unless the same food is eaten again. A daily diary of foods and activities may be helpful to pinpoint the reactor.
Often the cause can’t be found. Fortunately, our physician can usually treat Hives successfully. Medicines can be prescribed to control the rash and itching. Antihistamines will counteract the histamine your body is releasing. It will not cure the underlying condition which is inducing the Hives. Some antihistamines can make you tired. If you feel sleepy, it is important not to drive or operate heavy machinery. Don’t drink alcohol when taking sedating antihistamines. Newer antihistamines do not cause drowsiness, and may be prescribed alone or in addition to sedating ones. Antihistamines are most effective when taken on a regular schedule to prevent new Hives from forming. When your hives have cleared up, continue to take the medicines for 2 more days. Once you’ve been free of Hives for 2 days, gradually take less and less of your medicines over the next 7 – 8 days. If the Hives come back while you’re tapering off the medicines, resume the original amount until the Hives disappear. It’s a good idea to take the medicines for about 10 days after they have cleared up while your body eliminates their cause.
Injections of epinephrine (adrenaline) may be used for treatment of severe Hives. Sometimes they are taken by mouth and used in combination with antihistamines. Cortisone pills and injections are also used to treat Hives, but these measures have potential side effects as well, and are often reserved for severe breakouts.
Things you can do to obtain relief from the itching:
- Avoid hot baths, heavy physical exertion, and becoming overheated, especially near bedtime. For this same reason, you should not use an electric blanket or extremely
heavy cover. If you stay relatively cool, the Hives will often be less uncomfortable.
- Avoid wearing tightly fitted clothes or clothes made from rough fabrics such as wool or coarse knits; as these may often worsen the itching of Hives. Clothes worn next to the skin should be soft and smooth.
- Pat dry after bathing or showering. Vigorous rubbing of the skin, such as toweling off after a bath should be avoided.
- Keep skin moisturized, as dryness of the skin often worsens Hives. It is almost always helpful to moisturize the skin frequently, since this decreases the amount of friction between your skin and your clothing.
- Avoid aspirin and all combination medicines which contain it. These drugs almost always make Hives worse. It is not always obvious which medications contain aspirin. You should carefully read the labels for all non-prescription medications you use.
- Eliminate use of alcoholic beverages since like aspirin, alcohol is a histamine releasing chemical and often worsens Hives.
- Apply ice packs to control itching in specific areas. Quite often vigorous scratching will cause the skin to welt and itch even more. Application of cold will often relieve
the itching so that vigorous scratching will not be necessary.
- Apply an anti-itch lotion which will help to reduce the itching you experience, as often as you need it.
- Use the antihistamine-type medications prescribed to you with great regularity during the treatment period to produce maximum control of Hives. It is usually not sufficient to take these medications only when the Hives are present. Rather, they should be taken continuously according to the direction on the prescription, in order to maintain a constant high blood and tissue level. Also, you should know that most antihistamines can cause some drowsiness as a side-effect and you should be very careful if you drive or are involved in other activities which demand a high level of attention.