For the past few years, summertime at my allergy practice has meant a sudden influx of patients with itchy, red welts. These breakouts come in patches all over their bodies, or just on their arms or legs. Often their lips, eyelids or ears are swollen, too.
Recently, I saw a law student trying to get through exams but unable to focus because of intense itching. A few days later, it was a single mom with two jobs who can't sleep because she's scratching until she bleeds.
They and countless others are suffering from hives. The summer heat makes the misery worse, just at the time seasonal viruses emerge that likely account for many breakouts.
I have special empathy for these patients because I am a sufferer also. For the past six months I've been struggling to gain control of the itchy welts on my legs and abdomen. Either I'm awake at night scratching, or I'm drowsy in the daytime from medications to control the itching.
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Urticaria (the medical term for hives) affects one in five people at some point in their lives. The itchy areas of skin can be rounded or flat-topped but are always elevated above the surrounding skin. Bouts can last from several minutes to days or even months, but no one hive should last for more than 24 hours.
It's thought that most hives are caused by immune cells in our skin, called mast cells. When mast cells go on the defense against a perceived enemy or allergen, they release chemicals like histamine that lead to swelling and itching.
If these cells happen to be found in deeper layers of the skin they can lead to swelling of eyelids, ears, lips, nose and joints. This condition, angioedema, occurs in about half the cases of hives.
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Of course, not all hives attacks are related to the summer season. Acute episodes are often caused by allergies to certain foods, medications, insect stings and infections.
Even foods you've eaten for years can bring on an attack if you develop a sensitivity — nuts and shellfish are notorious. Medications such as aspirin and antibiotics are also common causes of hives. Infections causing hives include the common cold, strep throat, infectious mononucleosis and hepatitis.
Most cases of acute hives are easily treated with antihistamines or short courses of oral steroids. It is important to realize that when treating hives it is often not possible to stop the immune cells from releasing the offending chemicals. We simply try to block the effects of the chemicals until the immune system calms down.
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When hives last more than six weeks, or recur for years, they're said to be chronic. In a few cases, perhaps about 5 percent, hives may be associated with an underlying condition, such as thyroid disease (especially in women), liver disease, chronic infections, other autoimmune disorders (like rheumatoid arthritis or Crohn's disease) or, very rarely, cancer.
Those cases are exceptional, but they make it worthwhile to visit a doctor if your hives are chronic.
In most cases hives will gradually disappear. But they often flare up in times of great stress, like a death in the family, a job loss or marital strife.
Most cases of chronic hives can be controlled with oral antihistamines, some nonsedating (Claritin, Zyrtec, etc.) and some sedating (Benadryl). Only rarely will patients need long-term oral steroids, but these must be closely monitored since they can lead to problems with blood pressure, blood sugar and bone loss.
Environmental factors also may be at work. If your hives are triggered by sunlight, pressure, cold or heat, identify and avoid the trigger. If sunlight is the problem, sunblock lotions or fabrics that block specific wavelengths of light can be effective.
Hives is one of the most frustrating conditions I know of. It requires doctor and patient to work together closely to diagnose triggers and find the right combination of medication and lifestyle changes that will offer long term relief. Researchers are investigating this complex condition, and hopefully their work will lead to even better treatment options.
Dr. Mona Mangat, M.D., is board certified in allergy/immunology, pediatrics and internal medicine, and opened Bay Area Allergy & Asthma in 2007. She lives in St. Petersburg with her husband and their four children.