Urticaria: When a Patient Gets Hives
Hives are very common. In fact, 10-20% of the population will have hives at least once during their lifetime. When hives occur around the lips, around the eyes or the genitals then there may be tremendous swelling and this is referred to as angioedema. Angioedema is associated with hives in 50% of patients and these episodes may be quite frightening to the individual. Rarely, angioedema may even compromise the airway interfering with the ability to easily move air into and out of the lungs thus resulting in a potential for a life threatening event, although this would be uncommon.
Urticaria is one of the most vexing and challenging skin conditions seen by the primary care physician, the allergist or the dermatologist. Perhaps, it is best to think about hives simply as a symptom, much as a fever is a symptom usually with some underlying cause. There are occasions when one' s primary care physician may wish to refer to a specialist for help in diagnosing and treating hives. Allergists are uniquely trained to evaluate patients with hives and they understand the many complexities associated with this disease. It is important to make certain that the American Board of Allergy and Immunology certify the allergist whom you consult with since there are surgeons (ENT surgeons) who sometimes practice " allergy" without the detailed knowledge of allergy & immunology required to be able to adequately evaluate this condition. Dermatology is another specialty which may be called upon to evaluate patients with urticaria and, although they don' t have the expertise in immunology that a board-certified allergist might have, they do understand the cutaneous mechanisms of hives and they are usually willing to work with your allergist is trying to diagnose and treat this condition.
Foods are an obvious candidate to consider as a cause for acute hives. The most common foods that cause hives are nuts, milk, fish, shellfish, eggs, soy and peanuts. Despite a popular conception that strawberries and chocolate are a frequent cause of hives, there is little real scientific evidence to support this common belief. Food allergy in general is much more common in children and this certainly holds true for foods being a cause of hives. It is important to realize that hives may be part of a generalized reaction which has the potential to be life threatening. This generalized reaction is referred to as anaphylaxis and it may occur within minutes of ingesting food to which an individual has developed allergic antibodies. The symptoms of anaphylaxis may include hives all over, difficulty breathing with symptoms that mimic asthma. There may be associated nausea, vomiting and diarrhea. This may eventually result in a drop in blood pressure and a feeling as if one is going to pass out. Hives in this setting represent an emergency and immediate treatment with adrenalin (epinephrine) and antihistamines is imperative. The most common foods associated with anaphylaxis include peanuts, fish, shellfish and nuts and it would be most unusual for one to "out grow" this type of food allergy.
Drugs are another common cause of acute hives. Almost any prescription or over-the-counter (OTC) medication can cause hives. One should not forget to include OTC vitamins, herbs, mineral supplements and cold and sinus medications as potential causes for acute hives. Some of the drugs associated with hives include antibiotics, pain medications, sedatives, tranquilizers and diuretics (fluid pills). Diet supplements, antacids, OTC arthritis medications, laxatives and even eye medications should be considered. In other words, if you have hives it is important to write down all medication and OTC products that you have been taking, and this should be reviewed with your allergist.
The Texas Allergy, Asthma and Immunology Society (TAAIS) is a group of more than 220 board-certified Allergists/Immunologists in Texas.
An Allergist/Immunologist is a physician, usually an Internist or Pediatrician, who has had special training and experience in the field of Allergy and Immunology and who is considered to be an expert in the diagnosis and management of immune system disorders such as asthma, allergic rhinitis (hay fever), eczema, urticaria (hives), drug reactions, food allergies, immune deficiencies, and all general aspects of anaphylaxis.
A Board Certified Allergist/Immunologist is a physician who has passed the certifying examination of the American Board of Allergy and Immunology. A list of Board Certified Allergists can be found here. Those with “ABAI” under Board Certification are Board Certified Allergists/Immunologist.