Hives: Causes and Treatments by Howard Murad, M.D.

 
Hives or Urticaria as they are known by their medical name, will affect up to 20% of the population at least once in their lifetime. They are one of the most annoying and common skin conditions, usually caused by reactions to environmental influences such as heat, alcohol, foods or even fabrics. An allergic reaction to medications, emotional upsets and even exercise can also trigger hives. These skin eruptions are commonly identified by itchy, burning or stinging lesions on the skin or mucous membranes. Generally lasting from one to six hours, hives may be as small as a pencil eraser or as large as a dinner plate; on occasion, hives join together with the surrounding flat skin. The trunk and the extremities are the usual sites. Swelling of the palms and soles may occur. Areas that involve loose tissue, such as the eyes or genitalia may lead to massive swelling and disfigurement. While this condition is not usually dangerous, the airways could be involved, becoming swollen and closed off.


CAUSES
Urticaria is usually divided into acute, chronic or single episode stages. Acute urticaria has been present for less than six weeks while chronic conditions last for six weeks or longer. Single episode urticaria is caused by infections such as chicken pox, viral infections, mononucleosis and serum hepatitis. Reactions to medications can also cause a single episode. With many outbreaks of hives, the cause is highly difficult to pinpoint.
Individuals with recurrent episodes of hives should examine their diets for the foods that most commonly cause repeated attacks such as; peanuts, eggs, beans, chocolate, strawberries, tomatoes, spices, citrus fruits, corn, shellfish and pork. Fresh foods cause hives more frequently than cooked foods. Certain food additives and preservatives, such as monosodium glutamate (MSG) readily trigger repeated attacks of hives.
Aspirin, penicillin, sulfa drugs, tetracycline and codeine are the most common hive inducing drugs, though any drug, even those which have been taken over long periods of time without previous problems may be the culprit. Hives can also develop due to physical stress, sunlight, cold and physical pressure.
Approximately 15% of people in the United States are atopic, meaning they have an inherited predisposition to become allergic to things such as ragweed, grass, pollen, molds, animal hair and dust. These allergies are most commonly manifested in asthma, hay fever, migraine headaches, eczema and hives. Chronic sufferers who suspect allergic reactions to be their cause of hives can determine the cause by submitting to a scratch test.
Chronic conditions may also be caused by a low-grade infection, such as a fungal infection of the feet, yeast infections, bladder or kidney infections, a tooth abscess or a blocked sinus. Abnormal thyroid activity is the cause of chronic hives in one out of 400 people; a simple blood test can determine whether thyroid is the culprit.
TREATMENT OPTIONS
If the cause is unknown, the therapy becomes fairly simple - avoid the offending agent. Almost all patients however, need some form of treatment. Antihistamines are effective in relieving symptoms. Taken orally, they begin to relieve an already formed hive in about ten minutes. In recurring hives, the best method for relief is to take antihistamines on a regular schedule to prevent hives from forming.
Some antihistamines must be taken four times a day, while other long-acting formulas require only two daily doses. There are nine classes of antihistamines, with several in each class; therefore it may be necessary to try several to determine the best one for you.
Topical corticosteroids may be effective while corticosteroids taken by mouth and injection remain popular treatments for severe hives, though they are only taken for short periods of time. In certain cases where there is acute severe edema, called angioedema, which may be life threatening, an injection of epinephrine may be necessary.
Anyone who suffers from chronic hives should know the history of his or her case so that the cause can be more easily discovered. It is important to investigate every possible cause. With the help of a physician, certain laboratory testes may be helpful. For the most part, the real detective work is up to the patient to ascertain what conditions precede or surround an outbreak of hives.
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