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Hives…those ugly, itchy bumps that seem to suddenly pop up on our skin…are more scientifically called urticaria. And, actually, it's not the skin itself that's reacting to allergens, but tiny blood vessels in the skin, which release histamine and other substances that cause the skin to swell, burn and itch. Dr. Amanda Bittner of our Allergy & Asthma Center has a passion for both allergies and baseball, especially the Phillies. One of her favorite subjects is hives, which she has been very successful in treating. Here she offers come insight and suggestions about hives…what they are, the symptoms, what causes them, how they are diagnosed, treatment and more.
Dr. Bittner: They are the activation of the allergic cells in the skin cells called mast cells. They're throughout your body. They're in your nose and when they get activated in your nose you get hay fever. They're in your lungs and when the mast cells in the lungs become activated you have asthma. They are also in the skin. If the ones in the superficial skin get activated, hives develop. If the ones in the skin that's a little deeper get activated, there is swelling of the skin, called angioedema. Q: Does everyone who gets hives automatically also get swelling? Dr. Bittner: Not necessarily. Forty percent of people who suffer from hives get hives alone. Another forty percent who suffer from this problem have both hives and swelling. Most commonly the swelling is of the lips, the eyelids, the earlobes, the hands and the feet. Twenty percent of patients get swelling alone without the hives at all. Q: Don't hives also itch? Dr. Bittner: Well, when these allergic mast
cells get activated, they release Q: I know you get itching when you have hives but can you also get itching, for example, if your feet are swollen or if your lips swell from an allergic reaction? Dr. Bittner: The swelling may itch a little bit but frequently it tingles first. A lot of my patients know when they are going to get angioedema because their lips start to tingle before they start to swell and they almost get a burning sensation more so than the itching. It can also take longer for the itching to go away than for the hives. Q: What does a hive look like? Dr. Bittner: Hives can vary in character. They can look like anything from little pin point raised bumps to big raised welts. Sometimes they have a red outline and a raised white center and kind of look like big mosquito bites. In the very deep tissues areas as large as 5 to 10 inches or more can rise, swell, itch, and give a burning sensation. Q: How long do they usually last? Dr. Bittner: Hives typically will last less
than 24 to 36 hours, but the swelling can Q: Let's go back to some of the more common cases. What causes them? Dr. Bittner: It's not unusual for hives to occur for a day or two sporadically. Twenty percent of the population gets hives at one point or another. The causes of hives are based on how long the hives last. If hives last longer then six weeks, they are considered chronic hives. And, when you are talking about chronic hives, 85 to 90 percent of them are what we call idiopathic. What that means is that it's an internal process and it is nothing you are eating, touching, wearing, using, or breathing, etc., is causing the hives. Q: That must be very frustrating for people. Dr. Bittner: Oh, yes. Patients who suffer from hives are frequently frustrated because they think everything they are coming in contact with could be causing their symptoms. Of that remaining 15 percent we consider such causes as medications (most commonly aspirin, non-steroidal anti-inflammatories and antibiotics), bee stings, latex exposure (in health care workers), physical triggers (such as sunlight, heat, cold, exercise), viral illnesses, vasculitic diseases (which are diseases like lupus or rheumatoid arthritis) and, of course, foods. Most people believe their hives are being caused by foods, but in reality, approximately 1 percent of all chronic hives is caused by a food allergy. Q: Can you get just one hive or do they always come as a rash or a series of hives? Dr. Bittner: It can really vary. Most people
typically don't get just one hive, but Q: So, the amount of hives doesn't necessarily equal the seriousness of the hives? Dr. Bittner: Not exactly. Hives are typically a nuisance problem. Patients frequently feel uncomfortable and embarrassed especially if there is swelling of the eyes, lips, and face, in addition to the hives. Many people don't want to go out in public. Unfortunately, it can be more severe than that. Symptoms of a more serious condition include throat tightness, chest tightness, hoarseness, severe abdominal cramps or profuse diarrhea in addition to the hives. These are signs that the whole body is reacting. That's more serious and we have to be more aggressive in treating them. Q: How aggressive? Dr. Bittner: Typically we treat hives with
antihistamines because the Q: That sounds very serious. How do you know when to go to an allergist? Dr. Bittner: As I mentioned before, hives are very common and, if you only have them for a few days, you probably don't need to be seen by an allergist. However, if the hives go on for days to weeks to months, you would probably want an evaluation. Quite honestly, for most hive patients I don't do a lot of skin testing. It is just a matter of finding which combination of antihistamines works, and sometimes it can take a little bit of time until we find the right combination, because every body is different and responds differently to the medications. So, sometimes there is a little bit of trial and error until we find the exact combination that gets the hives under control for that particular patient. That's the challenge of hives and, as an allergist, it's one I relish.
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