Hives (Urticaria)

Acute Urticaria

• Defined as hives lasting less than 6 weeks. It is estimated to affect 15-25% of the population at least once in their life.
• Possible causes include:
  • Medication reaction (Penicillin, Sulfa, or other antibiotics) (Motrin, Ibuprofen, Aspirin, etc.)
  • Fixed food allergies (nuts, chocolate, fish, eggs, berries, tomatoes, milk)
  • Latex exposure
  • Insect sting
  • Allergies to pollens or chemicals
  • Infections
• Treatment involves identifying and avoiding the obvious triggers and possible adding non­sedating antihistamines such as over the counter Zyrtec, Xyzal, Allegra, or Claritin.

Chronic Urticaria

• Defined as hives lasting more than 6 weeks and 70% of the time no cause can be found.
• Identifiable causes include:
  • Autoimmune diseases such as thyroiditis, Rheumatic diseases such as Lupus or Sjogren's.
  • Alpha-galactose
  • Infectious causes such as Hepatitis B&C, Mononucleosis, or bacterial infections of the sinuses, teeth, etc.
  • Physical causes such as cold exposure, stress, exercise, water exposure, sunlight exposure, and pressure applied to the skin.
  • Inflammation of the vessels in the skin caused by medications (ACE inhibitors, Penicillin's, Sulfamides, Thiazides, Fluoxetine, etc.)
• Work up includes blood tests and allergy screening.
• Treatment includes:
  • Possible food avoidance
  • Non- sedating antihistamine in the morning (may increase the dose if necessary)
  • May add Benadryl at night if needed
  • May add histamine blocker such as over the counter Zantac
  • May add Singulair
  • May add oral steroids