Urticaria, commonly known as hives, is a skin condition that affects up to 20% of people at some point in their lives. That’s 1 out of every 5 people! The swelling that sometimes accompanies hives is called “angioedema” and can lead to swelling of the face, hands and feet. Hives usually feel very itchy and burning (although angioedema can even feel painful) or cause a tingling sensation — and these symptoms often make people miserable. Hives are caused by histamine being released into the skin, which causes raised, red itchy bumps of various shapes and sizes.
It’s nice to know that hives are a common problem but this isn’t much of a comfort to people when their lives are consumed with not knowing why they have their symptoms. Hives can truly turn a person’s life upside down. They’re uncomfortable and patients HATE not knowing what’s causing their hives, why they can’t sleep and why they don’t want to leave their homes to go to work or school — all of this can lead to emotional distress. Yet hives are usually easily treated with medications.
Some people have had hives for a few days while others have had symptoms for decades, and yet, each and every one of them is extremely bothered by their symptoms. Most hives are temporary and will resolve spontaneously after days, weeks or sometimes months. Only a small number of patients suffer with hives for an extended period of time. Through a proper evaluation and treatment plan almost all people who suffer from hives can achieve good control of their symptoms.
Most patients have suspicions about what is causing their hives. The majority are concerned with some type of food allergy. Some think that a medication or environmental trigger (such as an odor or chemical) is the cause, while others are concerned with a physical trigger, such as heat or cold.
While any of the above triggers are possible, overwhelmingly the most common cause of acute hives (those lasting less than 6 weeks) are viral infections (such as the common cold), and the most common cause of chronic hives (those lasting greater than 6 weeks) are autoimmune causes. An allergic trigger, surprisingly, is almost never the cause for chronic hives.
High levels of stress can worsen hives, although it’s probably not the main underlying reason for the problem.
Physical causes for hives occur in up to 20% of people with chronic hives. These physical triggers may include skin pressure (called “dermatographism”), heat (called “cholinergic”), cold, sunlight (solar urticaria) and exercise (exercise-induced anaphylaxis). Each one of these forms of physical hives has unique features that warrant special consideration.
Most often, a simple avoidable cause of hives cannot be found. In these cases, medications are used to control symptoms until the problem resolves on its own. Antihistamines, taken by mouth every day, are the medications of choice for the treatment and prevention of hives. Many times, a higher than normal dose of an antihistamine can be used safely and effectively. Corticosteroids are often given to people with severe problems, but this medication can have strong side effects if used too often.
Xolair was initially approved for the treatment of allergic asthma but, several years ago, patients with hives (urticaria) noticed that their hives would disappear when they received their Xolair shot. As a results the medication was investigated for the treatment of hives and, in April 2014, it was approved by the FDA for this purpose. This medication has led to dramatic reductions in hives for many patients and improvements in their quality of life.