post-title Hives 2012-06-27 13:23:28 yes no Posted by

Hives

By Midwest Allergy Physician Don McNeil, M.D., F.R.C.P.[C], F.A.A.A.A.I., F.A.C.A.A.I. Hives are a common reason to seek medical attention. In medical terms, these are more often referred to as Urticaria. Medical practitioners in many fields will see patients because hives occur so frequently. Pediatricians, family practice, internal medicine and subspecialties will see and treat these […]

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By Midwest Allergy Physician

Don McNeil, M.D., F.R.C.P.[C], F.A.A.A.A.I., F.A.C.A.A.I.

Hives are a common reason to seek medical attention. In medical terms, these are more often referred to as Urticaria. Medical practitioners in many fields will see patients because hives occur so frequently. Pediatricians, family practice, internal medicine and subspecialties will see and treat these patients because hives affect almost everyone at some time in their life. As allergists and immunologists, we are referred a patient with this type of condition often.  Symptoms may be very mild and affect only part of the body or they may be more generalized and cover the entire body. Often, symptoms are accompanied by itching which may be severe enough to cause incapacitating discomfort. Hives which last less than 6 – 8 weeks are classified as acute and frequently resolve spontaneously. Those which do not clear in that time are referred to as chronic hives and will usually warrant further investigation. The rash described as hives typically moves or migrates on the skin and is one of the features which will distinguish this from more serious conditions which affect other parts of the body such as a vasculitis. If the rash does not migrate, further blood testing or a biopsy of the skin may be necessary. Hives which occur in association with irritation of the skin such as pressure, hot or cold temperature are considered a physical urticaria and no further testing is needed.

Once the type and severity of the condition is established, our investigation will include a detailed collection of data with specific emphasis on what events led up the onset of symptoms and what forms of treatment have been taken or prescribed. Patients who may have taken a new medication within a short time of onset may discover that the antibiotic taken for a respiratory infection a week earlier was the cause. Other medications which may not be new for the patient are capable of causing hives even though they may have been taken for many years. Some infections (eg. Infectioius mononucleosis) is often associated with hives if the patient is given a prescription for penicillin. Rarely, hives may be associated with the ingestion of food although highly suspect are foods such as fruit (strawberries) or seafood. The  rapid onset of symptoms following a meal raises the chance that a cause may be found. Other rare causes of hives include a form of autoimmune thyroid condition referred to as Hashimoto’s thyroiditis which can be determined with a simple blood test.

The majority of patients with hives discover the condition clears spontaneously or with the addition of steroid therapy (often prescribed with an antihistamine to reduce the associated itching). We prefer to avoid steroid therapy but, if necessary, we will give this for a few days to provide immediate but temporary relief. More commonly, a much safer approach is to treat the condition entirely with antihistamines to the maximum tolerated dose. The dose necessary may be much higher than is typically prescribed. Finally, more aggressive therapy may warrant treatment with other immunosuppressive therapy such as cyclosporine or cyclophosphamide. These treatments will require careful monitoring of the blood or kidneys to ensure other side effects do not occur.

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