What Are Hives?
Urticaria, also known as hives, is an outbreak of swollen, pale red bumps or plaques (wheals) on the skin that appear suddenly — either as a result of the body’s adverse reaction to certain allergens, or for unknown reasons.
Hives usually cause itching, but may also burn or sting. They can appear anywhere on the body, including the face, lips, tongue, throat, or ears. Hives vary in size (from a pencil eraser to a dinner plate), and may join together to form larger areas known as plaques. They can last for hours, or up to one day before fading.
Angioedema is a form of hives, but the swelling occurs beneath the skin instead of on the surface. Angioedema is characterized by deep swelling around the eyes and lips and sometimes of the genitals, hands, and feet. It generally lasts longer than hives, but the swelling usually goes away in less than 24 hours.
Rarely, angioedema of the throat, tongue, or lungs can block the airways, causing difficulty breathing. This may become life threatening.
New Treatment for Hives
We now have a new option for patients with chronic urticaria. If they have had symptoms for more than 3to 6 months we can give them Xolair injections after an evaluation. Xolair seems to be very effective in controlling the symptoms better than antihistamines but is not a cure.
Statistics are still the same. You only find a cause for urticaria in about 10 % of the patients. But going over the history with them and a few targeted test will improve the attitude of the patient. Be on the lookout for patients who might have mastocytosis or Erlers Danlos. A diagnosis of mastocytosis is confirmed by a bone marrow or skin biopsy. A subset of patients have Erlers Danlos Syndrome, have flushing, hives, and anaphylaxis. However, many of these patients respond to therapy for mast cell activation disorder (including H1 and H2 blockers).
When to See an Allergist
Your Allergist may or may not be able to determine what causes your hives but we are experts in looking for causes. Only about 7 % of patients with hives, itching or swelling get a specific diagnosis. But we certainly can make you comfortable while we wait for the hives to disappear.Along the way we will check for allergy and other causes of hives.