Hives (i.e., urticaria) are a fairly common occurrence which is usually very annoying to the individual who suffers from them. They are often called “welts” by the general public and “wheals” by allergists. Hives are itchy, red blotches on the skin that are usually raised. Some affected individuals may experience a burning sensation while others notice a stinging sensation. Hives, in some instances, may be flat and not raised. The size of an individual hive may range from very small to rather large. They can also coalesce with other hives to create giant “plaques” of hives. Hives can be various shapes and are usually not symmetrical. They often look like mosquito bites but without the actual bite. They can occur anywhere externally on the body (e.g., face, neck, extremities, back, abdomen) or be located internally (e.g., throat, intestines). When they are internal, symptoms such as swelling of the throat, abdominal pain, or diarrhea may ensue. When hives occur on the lips, tongue, eyes, or ears, it is not uncommon for the individual to notice only swelling of these body parts. This swelling is termed angioedema. Angioedema is essentially a hive that is in the deeper tissue layers. As a result, the lesion appears as a swelling, opposed to a hive. Either way, both are bothersome to the person who is afflicted with either or both of them.
Hives are basically grouped into two main categories, although there are actually more than two. The first category is referred to as acute urticaria. Acute urticaria is a condition where the hives occur for 6 weeks or less. If hives linger on and persist for more than 6 weeks, they are called chronic urticaria. Some cases of hives may last for months and even years in a small percentage of patients. Approximately 25% of the general population in the U.S. develop hives at some point in their lives. Each episode of hives generally last less than 24 hours in duration but may last for days or weeks in certain circumstances.
The diagnosis of hives begins with a comprehensive history and physical examination by a board certified allergist such as the allergists at Black & Kletz Allergy. The workup for hives will vary depending on what was discovered in the history and physical examination in conjunction with how long the hives have been present. For many individuals, a medication allergy is to blame. For others, a food may be the culprit. For those who present with chronic urticarial (i.e., hives that have persisted for more than 6 weeks), bloodwork is generally needed in order to rule out a multitude of diseases and conditions that are known to cause hives. Despite all of the bloodwork done on a patient with chronic urticaria, approximately 95% of these individuals will have normal test results. If the workup is completely negative, the term idiopathic chronic urticaria is used as a diagnosis. This basically is a fancy way of saying that no identifiable cause was discovered to cause the hives of that individual. Some of the conditions that are known to be associated with chronic urticaria include thyroid disorders, autoimmune disorders (e.g., systemic lupus erythematosus, Sjögren’s syndrome, rheumatoid arthritis), hepatitis B, other infections, cancers, complement disorders, and physical elements (e.g., heat, cold, pressure, exercise, vibration), to name a few.
The treatment of hives can range from avoidance to using medications. Antihistamines are usually the first line of defense of most cases of hives. Beta-2 agonists such as Pepcid (famotidine) are often utilized to enhance the effect of the antihistamine when an antihistamine alone is not enough to prevent hives. Leukotriene antagonists [e.g. Singulair (montelukast)] are often added to the regimen is difficult-to-treat hives. In recalcitrant disease, oral corticosteroids may be used to bring the hives under control for a short time since the use of long-term steroids is not ideal because of the risks and many side effects that may develop. Xolair (omalizumab) injections are used for idiopathic chronic urticaria in patients where other therapy is unsuccessful. Xolair injections Xolair are very effective in the management of chronic hives.
The board certified allergy specialists at Black & Kletz Allergy have the knowledge and experience needed to diagnose and treat both children and adults who have urticaria and/or angioedema. Black & Kletz Allergy has 3 office locations in the greater Washington, DC area with offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. All 3 offices have on-site parking and both the Washington, DC and McLean, VA offices are Metro accessible. If you are suffering from hives or swelling episodes, please call us today to schedule an appointment. Alternatively, you may click Request an Appointment and we will respond within 24 hours by the next business day. The allergy specialists at Black & Kletz Allergy are committed to providing the highest quality allergy care to the individuals of the greater Washington, DC metropolitan area as we have done for over 50 years.