General Information

  • Hives are raised, red, itchy bumps / welts with different sizes and shapes that can appear on any part of the body
  • In most cases hives come and go within a few hours
  • Some patients with hives also have angioedema which is swelling that is less itchy than hives and usually around the eyes, lips, hands, feet and genitals
  • Hives are considered chronic if they are happening for more than 6 weeks
  • Most patients have chronic spontaneous hives meaning they are not caused by a specific trigger and they appear randomly
  • People often struggle to find an underlying cause of the hives but the cause is known in less than 2% of patients
  • Some patients have physical triggers such as pressure, heat, cold, exercise, sun and water which bring out the hives
  • Hives that are chronic are not caused by an allergy to food or medication or by environmental exposures such as laundry detergents
  • Skin testing for allergies is not necessary for patients with chronic hives
  • If you develop any of the following symptoms please notify your doctor, as these can indicate another underlying condition
    • Hives that are burning / painful and leave bruising / discoloration to the skin
    • Fevers, weight loss
    • Joint swelling, joint pain
    • Eye pain / blurred vision
    • Abdominal pain
    • Breathing problems

Treatment

  • The first step is to identify physical triggers for your hives and take steps to lessen your exposure to them. For example, patients with cold induced hives should keep their skin covered durin the colder winter months and patients with pressure induced urticaria should avoid tight-fitted clothing
  • Avoid medications such as non steroidal anti inflammatories (ex aspirin, ibuprofen), pain medications (ex opiates) and alcohol as these may make hives worse
  • Non-drowsy oral antihistamines such as cetirizine (Reactine), loratadine (Claritin), desloratadine (Aerius) and fexofenadine (Allergra) are the first line of treatment
  • These newer antihistamines are recommended over Benadryl because this medication has more side effects and does not last as long
  • If the antihistamines are not effective after a couple of weeks your doctor may advise an increase in the dose
  • If the antihistamines are not working at a higher dose your doctor will discuss the other treatment options some of which include
    • Another type of antihistamine
    • H2 blockers such as ranitidine
    • Montelukast tablets
    • Oral steroids
    • Omalizumab (Xolair) monthly injections
    • Immunosuppressive agents

Assessing the Effect of Treatments

  • Your doctor may ask that you keep a record of the number of hives you are having and how bad the itching is
  • Hives will go away in 30 - 50% of people after 1 year and only 20% of people still hives after 5 years
  • Average duration of hives for most patients is 2 - 5 years