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Getting Help with Hives
By: Barbara Muller, MD
Some people break out in hives whenever they share a room with a cat. Others find themselves covered in these itchy red bumps when they're feeling stressed. While stress-induced hives usually resolve on their own, other types of hives require treatment that can range from antihistamines to oral steroids. Most of the time hives are short term, but some people suffer from chronic hives that can last for years, leading to problems such as sleep loss and depression.
Hives are part of an allergic reaction that occurs when a chemical called histamine is released by cells in the body called mast cells. The release of histamine can be triggered in response to a variety of stimuli, including certain foods, medication or even heat or cold. In some cases, chronic hives may be a sign of an underlying disease condition. In others, it can very difficult for an allergist-immunologist to figure out the cause of hives.
Below, Barbara Muller, MD, a professor of clinical medicine in the allergy-immunology Division of the Department of Internal Medicine at University of Iowa Hospitals and Clinics, Iowa City, discusses common causes of hives and treatment approaches for short-term and chronic hives.
What are hives?Hives are raised, itchy wheal-and-flare reactions on the skin medically referred to as "urticaria." The lesions look and itch similar to mosquito bites. They can be very small, a few millimeters in size, or become quite large, several centimeters in size, especially with scratching. They often coalesce to involve an entire portion of an extremity or extend to the abdomen or trunk. The itching associated with hives is bothersome and can be intense. If severe, the hive outbreak can include symptoms such as fatigue, chills or joint aches.
Individuals who develop hives may also suffer from a condition called "angioedema" where swelling occurs in the deeper part of the skin. Swelling can be severe and lead to deformity of a portion of the face, lips, around the eyes or genitalia. If swelling occurs in the throat, breathing may be affected and medical attention must be sought immediately.
How long do hives last?Hives can develop suddenly and last a few hours or days, or continue for weeks or months at a time. Hives lasting less than six weeks are referred to as acute. Outbreaks can also be long-term, or chronic, lasting longer than six weeks. Hives can reoccur often over years.
What causes hives?Acute cases of hives that come on suddenly and are short-term are generally caused by ingesting a food or medication you are allergic to, or by contact with or exposure to an allergen in your environment.
Basic food allergy is a common trigger of hives. Tree nuts including brazil nuts, walnuts, cashews and almonds or legumes such as peanuts are common causes of allergic reactions. Seafood, particularly shrimp, lobster, crawfish, and mollusks are also commonly reported. Eggs, milk, soy, cheese, wheat, strawberries and tomatoes are all known to cause hives in susceptible individuals.
Preservatives or additives in foods can also cause hives. Rarely, people can be allergic to tartrazine, yellow dye number 5, or other coloring additives found in many processed foods such as candies, puddings, etc. Keeping a diary noting the foods ingested prior to the development of hives can help you figure out which foods you may be allergic to.
Allergic reactions to medications are a commonly reported cause of hives. Penicillin, cephalosporins (semisynthetic penicillins), aspirins, non-steroidal anti-inflammatory drugs, opiates, and muscle relaxants may produce acute reactions in susceptible individuals. If you begin a new medication and develop hives or red blotches on the skin, you should report the reaction to your prescribing physician immediately, before taking another dose.
Various ingredients used in the manufacturing of cosmetics and fragrances can also trigger hives. People who are allergic to bee or wasp venom may develop hives or more serious reactions if stung. It is important to seek medical attention promptly if you suspect you are having an allergic reaction.
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