What are hives?
Hives are itchy, bumps or patches on the skin. They often develop on the limbs and trunk but can occur anywhere on the body, and may appear for no apparent reason. For most people hives only last a few weeks, but if they continue beyond 6 weeks the condition is diagnosed as chronic hives or chronic urticaria. Urticaria or hives is a rash with the following characteristics: red to pink in color, varied shape from small bumps to blotchiness, to streaking, itchiness, and appear and disappear at irregular time intervals. Hives can also be accompanied by swelling at different locations (lips, hands, tongue) of the body. This is also called angioedema.
Hives can occur as an allergic reaction to a variety of things such as foods, insect stings, or medications. Often the patient realizes an association (if caused by an allergic reaction) because the break out is usually within one hour of ingestion or allergen exposure. Chronic hives or urticaria on the other hand, is a much more challenging problem for both the patient and the doctor. Patients with this come in miserable, frustrated, and worried, often having seen several specialists and neither the patient nor the physician can determine the cause of the hives.
In most patients with chronic hives, no allergy trigger is found. Despite the mystery, it remains worthwhile to see a physician to rule out any potential underlying conditions that can be associated with hives such as thyroid disease, liver disease, skin disease, infections, sinusitis, or an actual allergy. To assist with a diagnosis and treatment, the allergist may choose to perform necessary tests such as allergy testing, blood testing, and skin biopsy. But the fact remains, in about 35% of chronic hives cases, the hives are “idiopathic” or of unknown cause. In about half of patients with chronic idiopathic hives, the explanation is that the body’s immune system is attacking the normal tissue of the body and causing inflammation. This is also known as an “autoimmune” phenomenon.
How are they treated?
The main treatment offered for hives is antihistamines. Most Allergists prefer to try the new non-sedating antihistamines first. If this doesn’t eliminate the hives, some allergists will either increase the dose, or add another sedating type of antihistamine at night. Sedation may be a factor, but it is important that high doses are attempted. Most patients will become less affected by sedation after they have taken the medication regularly for a while. The lack of effectiveness of antihistamines is usually due to stopping it too early or not attempting a strong enough dose.
If antihistamines fail, some physicians may try a short course of cortisone pills to clear the hives completely. Then the hives may stay clear with the much safer antihistamines. There are also other medications that allergists will consider trying if the hives are not responding to high doses of antihistamines such as anti-acid pills, antibiotics, asthma medications, anti-inflammatory medications, and several others. Often these medications help for unknown reasons.
Whatever amount or type of medication, experts say that patients with chronic hives should remain on that particular regimen, taking the medications every day, whether or not they have the hives on any given day. The idea is to prevent the hives from breaking out. An exception would be the cortisone medications, which should ideally be used for short periods or every other day for control of the urticaria.
The good news for patients with hives is that more than 50% of cases of hives will be spontaneously resolved in about 6 months. Other patients resolve with more time, so that by a few years, most patients are free of hives.