If you're like most of my patients, you've likely experienced an outbreak of hives at least once in your life. They are fairly common responses to something you came in contact with that you were either slightly, or badly, allergic to in food, medicine, or something in your environment like dust, pollen, weeds, and insect bite. They can affect anyone, young or old, and show no preference for race or gender. They can even be brought on by stress or excess perspiration!

They appear as raised red welts that resemble a mosquito bite, and can itch or burn. They usually show up in clusters of 2 or more and are a result of the body releasing histamine - a chemical agent your body produces when it comes in contact with something foreign and/or just doesn't like. Let me share some important information about hives as they may be an important warning signal to you!

Types of Hives

There are several types of hives that you should be aware of in case of an outbreak. They include:

•Acute urticaria - these are the hives that most people get most frequently. They are raised, little red bumps on the skin that itch. They are usually very short-lived in their outbreak, and may be due to some food (chocolate, eggs, nuts, fish, fresh berries, raw produce, milk) or drugs (ibuprofen, high blood pressure medication, pain killers like codeine), an insect bite, or some illness (like the flu).
•Chronic urticaria - this type of hives is longer lasting and can be accompanied by diarrhea, shortness of breath, and sore muscles. The exact cause of this type of hives is often unknown and can be a symptom of an underlying illness.
•Physical urticaria - these hives appear about 1 hour after physical stimulation to the skin from cold, heat, vibration or pressure, or rubbing against the area.
•Dermatographism - these hives form after some deliberate touching or scratching of the skin.

Treatments for Hives/Angioedema

When I have patients come in with an outbreak of hives, treatment with an antihistamine is the first order. Hives are usually harmless but indicate that the body is sensitive, and/or allergic, to something contacted. Some allergies on first presentation are mild with maybe just hives/itching as a symptom. If this initial presentation is ignored and left undiagnosed, you may come in contact with this agent again and have a much more severe second-time reaction, or even anaphylaxis, a severe, allergic reaction.

For example, a patient of mine had to undergo an x-ray of her kidneys in which they had to inject contrast dye. A few moments after receiving the contrast injection she started to develop hives on her face and arms. The radiologist stopped the test immediately and referred her to a dermatologist who tested her for contrast dye allergy. It was found that, indeed, she did have a severe allergy to the iodine in contrast dye that she was not aware that she had. In this way, hives are the body's warning signals that you may have anywhere from just an ordinary allergy to a life-threatening one!

Another patient broke out in hives on his face whenever he cleaned his house! Again, after allergy testing, it was shown that he had a mild/moderate reaction to dust mites (which many people do). Very important is to determine, if possible, the cause of the hives at the time they breakout, especially if you break out in a pattern. A detailed question and answer session between you and your doctor may be necessary to tease out the cause of your hives.

The best treatment for avoiding an outbreak of hives is to avoid contact with the source of the reaction in the future. However, like my patient with the dust mite allergy, it's not always possible to avoid the allergen, especially in public. So, usually an as-needed treatment with antihistamines is likely what your doctor will advise.

Depending on the severity of your allergy, antihistamine products can range from over-the-counter antihistamines such as the old, favorite standard, Benadryl (diphenhydramine), to other prescription antihistamines. You may be able to take these just at the time the hives occur or may have to be on a low, chronic dose, to ensure that the hives outbreak is suppressed. My patient with the dust mite allergy carries an over-the-counter pack of Benadryl on him to take when needed.

While waiting for the hives to clear, you can apply cool compresses, or even ice wrapped inside a washcloth, to the affected areas. This will help take out the sting and itch as well as shrink the hives to give you some relief.

Serious Warning Signs of Hives

As mentioned above, hives outbreak can be a warning of a severe allergic reaction especially if accompanied by these symptoms:

•Swelling of the lips, tongue or face
•Tightness, or "closing sensation", of the throat
•Shortness of breath, difficulty breathing
•Dizziness

If you experience any of these symptoms along with the hives, contact your doctor, 911, or get to the closest emergency room immediately, as these can be signs of anaphylaxis, a serious, life-threatening allergic reaction.

Otherwise, most hives are just temporary nuisances that can be treated with an over-the-counter antihistamine and will clear within a short period of time. If you break out with hives often, do contact your doctor to set up allergy testing with a dermatologist to determine the cause of your hives reactions.

Jay Brachfeld, M.D.