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Clinical Specialties
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Hives

DEFINITION

Hives, also known as urticaria, are an itchy, bumpy rash over the skin that comes as a result of allergy. Most of the time, hives are not serious. However, hives can be associated with angioedema, a swelling of the tongue, lips and throat that can lead to severe disease and even death. Hives are caused by the local release of a chemical called histamine from certain cells in the body called mast cells. The release of histamine can be triggered by allergy to foods, medications, or other allergens. Less frequently, hives are triggered by heat or cold, sunlight exposure, exercise, and emotional stress. Hives are called chronic when they last longer than six weeks. Risk factors for hives include previous episodes of angioedema, allergies or allergic reactions, have a medical condition (like lupus, lymphoma, or thyroid disease), or have a family history of allergies. Beginning symptoms of hives include an itchy rash, but they can progress to angioedema, difficulty breathing, passing out, and even anaphylaxis.

SYMPTOMS
Itching, bumps on skin, reddening of skin, swelling, swelling of lips, swelling of tongue, difficulty breathing, passing out, pain or warmth in area of swelling

DIAGNOSIS
The diagnosis of hives is normally based mostly on a history and physical exam. Sometimes your doctor will order blood tests to check for an allergic reaction. Your doctor will ask extensive questions about any medications and exposures you may have. To find the cause of anaphylaxis, an allergist may recommend a skin prick test. The skin prick test uses a set of tiny needles which inject very small amounts of allergen under the skin. If any of those areas become inflamed or swollen, the doctor can tell which allergens likely cause your allergies. Your physician will have you wait in the office after placing these allergens in the skin to monitor your reaction. Sometimes, a blood test can also be done to look for antibodies to common allergens. Your doctor may want to do some other testing to rule out other causes of your symptoms.

TREATMENT
Treatment of hives always begins with decreasing exposure to the cause of the hives. Your doctor may recommend medications like antihistamines or cortisone by mouth or on the skin to decrease itching and inflammation. If your symptoms do not improve with these treatments, you may try steroids like prednisone by mouth t help decrease the inflammation. If your hives are serious, your allergist may recommend a series of allergy shots, called immunotherapy, can be used to decrease your body’s reaction to allergens to attempt to prevent future episodes of hives.

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