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Hives

By Debra Jaliman, MDJanuary 18, 2012
From the WebMD Archives

Hives are red, splotchy, and very itchy weals that suddenly appear on the skin. Also known as urticaria, hives are actually an allergic reaction that usually shows up on the skin, but can also appear on mucous membranes, such as the inside of the mouth, and even in the internal airway.

Hives are not to be taken lightly, because what starts out as an annoying, itchy skin condition can morph unexpectedly into a life-threatening episode. If your lips and tongue start to tingle or to swell, go to the ER immediately. And if you have hives and difficulty breathing, call 911 instantly – because the hives are occurring internally and your airway can swell and close in a matter of minutes. If you don’t get an immediate injection of epinephrine, you may die. So don’t hesitate!

What sets off the allergic reaction that leads to hives? Here is a list of the more common triggers:

  • shellfish
  • nuts
  • eggs
  • berries
  • chocolate
  • food additives
  • aspartame
  • aspirin, ibuprofen, and naproxen
  • medications such codeine, sulfa drugs, penicillin and other antibiotics
  • insect bites and stings
  • cat dander
  • pollen
  • exercise – the hives are triggered by the rise in body heat.
  • weather and water temperature – some people react with hives to hot or cold weather, or to hot or cold water.
  • tight clothing – the friction and pressure points can set off the reaction. Many women get hives from their bra straps and the elastic waistbands of their panties.
  • viral infections, especially upper respiratory infections
  • stress

Most of the time, hives can be treated with cold compresses, over-the-counter cortisone creams and antihistamines such as Benadryl, Allegra and Claritin. Obviously, avoiding specific triggers is critical. Food sensitivities are often to blame but can be hard to pinpoint; I always suggest that patients with hives try a simple diet and keeping a food journal for a couple of months. People prone to hives should stay away from wool and try to wear loose-fitting, 100% cotton clothes.

Hives can be peculiar in appearance. “Look, doctor, I can write my name on my arm and it stays for hours,” one patient told me. He could indeed, for he had a form of hives called dermographia (also known as dermatographism), which literally means “skin writing.”

Chronic hives, which means hives that last longer than six weeks, require a medical check-up, often including a chest x-ray and a complete blood panel. Hives can be symptoms of serious underlying conditions, such as hepatitis, lupus, or thyroid disease. Don’t be surprised if your doctor also orders a fecal test: hives can also be the result of intestinal parasites. Stationary hives – a hive that stays in the same spot for more than 24 hours – can even mean vasculitis, inflammation of the blood vessels.

Bottom line: Hives that don’t go away with drugstore products should be seen by a doctor.

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