Hives

HIVES, medically called urticaria, are red itchy swellings of the skin. Characteristically, hives last for a few hours and then fade away. New ones may develop as old ones resolve. The causes of hives are numerous; foods, drugs, infection, insect bites, pressure, heat or cold, and sunlight. Undiagnosed internal medical conditions may also manifest as hives. It is estimated that almost 20% of the population will experience hives during their lifetime. The duration of involvement varies from days to weeks or possibly years.

Although the cause of hives may differ from person to person, the mechanism is identical. "Mast" cells present throughout the body release a chemical called histamine into the skin or blood stream. Usually, an individual experiences itching, however, burning or stinging can also occur. The skin becomes red and swells. In extreme cases an individual may experience hoarseness, breathing difficulties, vomiting, diarrhea, abdominal pain, headaches, or flushing.

Causes
Foods: Foods that should be avoided with recurrent attacks include: nuts, chocolate, fish, tomatoes, eggs, fresh berries, food additives, preservatives, and products containing azo dyes.

Medications: Any prescription or over-the-counter medication may cause hives. Examples include antibiotics, sedatives, tranquilizers, diuretics, anti-acids, vitamins, eye and eardrops, laxatives, aspirin, quinine, thiamine, and pain medications such as narcotics.

Infections: Any illness, such as a viral cold or flu, can cause hives. There is an association with sinusitis, upper respiratory infections, urinary tract infections, parasitic infections, and hepatitis.

Allergies: It is accepted that hives are an allergic or hypersensitivity response. Numerous environmental influences such as pollens, mold spores, animal dander, or other inhaled allergens may be a cause of hives.
Food Additives or Preservatives: Research is ongoing in this area. Many patients show benefit from elimination of food additives and preservatives. Examples include tartrazine, benzoic acid derivatives, antioxidant preservatives such as butyl hydroxytoluene (BHT) and butyl hydroxyanisole (BHA), natural salicylates, and yeast.

Penetrants / Contactants: Hives may result from direct skin contact or penetration of a skin irritant. Substances such as foods, textiles, animal dander, saliva, bug bites, marine plants, medicaments, chemicals, cosmetics, and airborne allergens can all penetrate the skin to cause hives.

Internal Disease: When a person has constant or recurrent hives, other underlying medical conditions should be considered. Examples include lupus erythematosus, arthritis, autoimmune process, endocrine abnormalities such as hypo- and hyperthyroidism, menstruation, pregnancy, and possibly cancer (rare).

Cold Urticaria: This type of urticaria (hive) can present in two phases. Some individuals exhibit an immediate response when exposed to something cold such as an ice cube. Other individuals experience the urticaria on re-warming after exposure to something cold. This type of urticaria usually lasts one to two hours. If the mouth is involved, care should be taken to avoid cold drinks as this could make the condition worse.
Heat Urticaria: This is usually localized. The rash occurs within five minutes of exposure and can last one to two hours.

Cholinergic Urticaria: Almost 7% of chronic urticaria is associated with this phenomenon. The body releases a chemical called acetylcholine, which stimulates this type of hive. Acetylcholine can be released by heat, exercise, hot baths, stress, or emotional situations.
Solar Urticaria: This type of urticaria is a response to sun exposure. It occurs within minutes and may last one to two hours after an initial exposure.

Aquagenic Urticaria: This is extremely rare and is associated with water exposure at any temperature.

Dermatographism: This type of urticaria afflicts almost 5% of the population. The skin appears normal until pressure or outside stimuli is encountered. If the skin is stretched, stroked, or traumatized, a hive readily appears at the site of stimulation. This type of urticaria can be especially problematic with tight fitting clothing or during physical activity.

Angioedema: This term designates urticaria that involves the deeper portions of the skin. This type of hive is usually seen as a swelling with little or no itching. Swelling of the lips, tongue, or eyelids may occur without itching. Other causes of urticaria previously mentioned may also precipitate this type of reaction. A hereditary component may be involved since the condition may be seen in related family members.

Recommendations:
When afflicted with urticaria (hives), understand that this is a hypersensitivity response to an outside influence. Some regard this as an allergy. Most of the time, however, it is very difficult to pinpoint the exact cause of the urticaria. Ideally, an attempt should be made to establish a relationship between the development of symptoms and exposure to possible triggering agents. For example, the development of hives after petting a cat. Exposures could then be eliminated or minimized in the future.

The standard of treatment initially involves oral antihistamines, topical anti-itch lotions, and moisturizers that soothe the skin. Frequently, individuals affected with hives have associated eczema and must be treated for both conditions at the same time. (See eczema)

Examine any changes in diet or lifestyle. Avoid aspirin, nonsteroidal anti-inflammatory medications (Ibuprofen), alcohol, over-exertion, heat, and emotional stress. Many times, systematic diet elimination is very helpful. Azo dyes, benzoates, yeast, and salicylates are a good place to start.

If the hives are severe, or if you are experiencing shortness of breath, vomiting, diarrhea, abdominal pain, headache, or flushing, seek the help of a physician immediately. You may need more intensive treatment that involves prescription medications.

Remember, even the worst cases generally resolve with time!