Dallas Allergy

What You Need to Know About “HIVES”

·”Hives” are caused by histamine released in the upper layers of the skin.

·Histamine can be released from mast cells and basophils found in everyone’s skin.

·Patients with hives release too much histamine when it is not needed.

·Hives can happen
Only when exposed to an identifiable trigger, i.e., drug, food, etc.
Almost Daily without an identifiable trigger– labeled chronic hives
Episodically without an identifiable cause; also labeled chronic hives

·In patients with chronic or persistent hives, a trigger rarely is found. A complete history is taken to look for identifiable triggers.

·The history may reveal several triggers that may aggravate the hiving of chronic hivers, i.e., Aspirin, scratching, pressure (under belts or straps), or exertion.

·Essentially, chronic or persistent “hivers” have “twitchy” mast cells!!!

·Blood tests or any other tests are expensive and rarely helpful

·Fortunately, chronic hives go away (resolve spontaneously) with or without treatment:
50% of patients resolve in 3-12 months
20% of patients resolve in 12-36 months
20% of patients resolve in 36-60 months
1.5% of patients can hive for up to 25 years!!
60% of chronic hivers have recurrences of chronic hives

·Management is directed toward keeping you comfortable with or without some hives. This can be achieved with appropriate antihistamine therapy and occasionally with other medications. Prednisone (steroids) should be avoided unless they are absolutely needed!

Adapted from Beltrani, V. Urticaria: Reassessed. Allergy and Asthma Proc. 25:143-149, 2004