HIVES (URTICARIA)/SWELLING (ANGIOEDEMA)
Hives, also known as urticaria, are an outbreak of swollen, pale red bumps, patches, or welts on the skin that appear suddenly — either as a result of the body’s adverse reaction to certain allergens, or for other often unknown reasons. Hives usually cause itching, but may also burn or sting. They can appear anywhere on the body, including the face, lips, tongue, throat, or ears. Hives vary in size (from a pencil eraser to a dinner plate), and may join together to form larger areas known as plaques. They can last for hours, or up to several days before fading.
Angioedema is similar to urticaria, but the swelling occurs beneath the skin instead of on the surface. Angioedema is characterized by deep swelling around the eyes and lips and sometimes of the genitals, hands and feet. It generally lasts longer than urticaria, but the swelling usually goes away in less than 24 hours. Occasionally, severe, prolonged tissue swelling can be disfiguring. Rarely, angioedema of the throat, tongue or lungs can block the airways, causing difficulty breathing and may become life threatening.
Hives can be very difficulty to evaluate and treat. Chronic hives, hives that last more the 6 weeks, are even more illusive and about 90% are not found to be caused by allergy or other medical problems, but rather are “idiopathic,” meaning of unknown cause. Generally hives involve a particular cell called the mast cell being very sensitive or irritable, so they release histamine or other mediators (chemicals) that cause the itching, pain, redness, and swelling. A detailed history of the types and patterns of symptoms along with noted precipitator or aggravators is taken.
Additionally a detailed medical history will be obtained. Present and prior hive medications as well as other medications will be assessed and previous x-rays and blood tests will be reviewed if available. A work history relating to possible adverse effects will be taken as well as a detailed home and work environmental history. Your family history specifically relating to hives will be obtained. This information along with a physical examination will then direct further evaluation. If appropriate, allergy skin testing and/or other blood tests or x-ray studies obtained.
Once the initial evaluation is completed recommendations as to a course of treatment will be discussed and agreed upon by the patient and doctor. There will also be a plan for evaluating and if necessary adjusting this treatment.
Regular return visits will be discussed and scheduled with the realization that a flair-up of symptoms may require an acute visit. The treatment plan will be discussed in detail and if appropriate the nursing staff will instruct you in the proper techniques for using medications.