CHRONIC HIVES – SYMPTOMS, CAUSES, AND TREATMENT
Hives (urticaria) are red, itchy welts that are the result of a skin reaction. The welts differ in size and appear and fade several times as the reaction runs its course.
The condition is considered chronic hives if the welts appear for more than six weeks and recur usually over months or years. Often, the cause of chronic hives is unclear.
Chronic hives could be very uncomfortable and interfere with sleep and daily activities. For many people, antihistamines and anti-itch medications offer relief.
SYMPTOMS
Signs and symptoms of chronic hives are:
- Batches of red or skin-colored welts (wheals), which could appear anywhere on the body
- Welts that differ in size, change shape and appear and fade several times as the reaction runs its course
- Itching, which might be severe
- Painful swelling (angioedema) of the lips, eyelids, and inside of the throat
- A tendency for signs and symptoms to flare-up with triggers like heat, exercise, and stress
- A tendency for signs and symptoms to continue for more than six weeks and to recur frequently and unpredictably, sometimes for months or years
Short-term (acute) hives appear unexpectedly and clear up within a few weeks.
WHEN SHOULD YOU SEE A DOCTOR?
See your doctor if you have severe hives or hives that persist to appear for several days.
Seek emergency medical care
Chronic hives do not put you at any unexpected risk of a severe allergic reaction (anaphylaxis). If you do experience hives as part of a severe allergic reaction, seek emergency care. Signs and symptoms of anaphylaxis include dizziness, difficulty breathing, and swelling of your lips, eyelids, and tongue.
CAUSES
The welts that come with hives arise when specific cells release histamine and other chemicals into your bloodstream.
Doctors usually cannot identify the reason for chronic hives or why acute hives sometimes turn into long-term problems. The skin reaction might be triggered by:
- Pain medications
- Insects or parasites
- Infection
- Scratching
- Heat or cold
- Stress
- Sunlight
- Exercise
- Alcohol or food
- Pressure on the skin, similar to a tight waistband
In some cases, chronic hives might be associated with an underlying disease, such as thyroid disease or, rarely, cancer.
COMPLICATIONS
Chronic hives do not put you at any sudden risk of a severe allergic reaction (anaphylaxis). But if you do experience hives as part of a severe allergic reaction, seek emergency care. Signs and symptoms of anaphylaxis include dizziness, difficulty breathing, and swelling of your lips, eyelids, and tongue.
DIAGNOSIS
Your doctor will do a physical examination and ask you a number of questions to try to understand what may be causing your signs and symptoms. He or she might also ask you to keep a diary to keep track of:
- Your activities
- Any medicines, herbal remedies, or supplements you take
- What you eat and drink
- Where hives appear and how much time it takes a welt to fade
- Whether your hives come with painful swelling
If your physical examination and medical history suggest your hives are caused by an underlying problem, your doctor might have you undergo testing, such as blood tests or skin tests.
TREATMENT
Your doctor will probably recommend you treat your symptoms with home remedies, such as over-the-counter antihistamines. If self-care steps do not help, talk with your doctor about finding the prescription medication or combination of drugs that works best for you. Usually, an effective treatment could be found.
Antihistamines
Taking nondrowsy antihistamine pills every day helps block the symptom-producing release of histamine. They have few side effects. Examples include:
- Loratadine (Claritin)
- Fexofenadine (Allegra)
- Cetirizine (Zyrtec)
- Desloratadine (Clarinex)
If the non-drowsy antihistamines do not help you, your doctor might increase the dose or have you try the type that tends to make people drowsy and is taken at bedtime. Examples are hydroxyzine pamoate (Vistaril) and doxepin (Zonalon).
Check with your doctor prior to taking any of these medications if you are pregnant or breastfeeding, have a chronic medical condition or are taking other medications.
Other medications
If antihistamines alone do not relieve your symptoms, other drugs might help. For example:
- Histamine (H-2) blockers – These medications are also known as H-2 receptor antagonists, are injected or taken orally. Instances are cimetidine (Tagamet HB) and famotidine (Pepcid).
- Anti-inflammation medications – Oral corticosteroids, such as prednisone, could help lessen swelling, redness, and itching. These are usually for short-term control of severe hives or angioedema because they could cause severe side effects if taken for a long time.
- Antidepressants – The tricyclic antidepressant doxepin (Zonalon), used in cream form, could help relieve itching. This drug might cause dizziness and drowsiness.
- Asthma drugs with antihistamines – Medications that interfere with the action of leukotriene modifiers might be helpful when used with antihistamines. Instances are montelukast (Singulair) and zafirlukast (Accolate).
- Man-made (monoclonal) antibodies – The drug omalizumab (Xolair) is very effective against a kind of difficult-to-treat chronic hives. It is an injectable medicine that is generally given once a month.
- Immune-suppressing drugs – Options are cyclosporine (Gengraf, Neoral, others) and tacrolimus (Astagraft XL, Prograf, Protopic).
If you or anyone you know is suffering from chronic hives, our expert providers at Specialty Care Clinics will take care of your health and help you recover.
Call us on (469) 545-9983 to book an appointment with our specialists.