Chronic Hives and Angioedema Survey
My Experience With Hives
While serving in the U.S. Navy, I had occasion to render first aid to folks who were injured. On an aircraft carrier, one of the routine chores, which can sometimes be boring and lead to dangerous inattentiveness, is an underway replenishment. This activity involves stores being brought on board while moving at sea. During such a maneuver, pallets of everything from bombs to toilet paper are brought across from other ships via huge cables. As a result of treating a sailor injured during an underway replenishment, I experienced hives.
A sailor had been drenched with naval distillate, which is the ship's propulsion fuel. If one is not careful uncoupling the hoses used for transferring fuel, it can splash out in large quantities. This sailor arrived at the sick bay looking like a soaked pet, with blood-red and painful eyes. He needed immediate help. Distillate also has an obnoxious smell.
I rinsed his eyes with sterile saline that dripped from an IV bag, and I got him into a decontamination shower. Things turned out well for him, but not for me. While rinsing the eyes, my shirt sleeves got fuel-soaked, and soon after, I had hives on my forearms. In the course of my treatment, I learned a few things from the doctor about urticaria hives. Since I've had a few skin problems in my lifetime, I developed a personal interest in understanding more about hives.
The other times I witnessed hives were when a sailor had a new fresh insect bite (suspected) and when another had a food allergy. Chocolate was thought to be the culprit there. Treatment with antihistamines began, and all symptoms subsided in a few days. In my case, it was one full day. The doctor tried to piece together what the patient believed brought it on and when it was first noticed. It was a detective story of sorts, but the treatment seemed to always be the same. Benadryl was used in all cases and worked well (this was in the early 1970s). Today, there are many new antihistamines, many of which do not cause drowsiness.
Consult Your Doctor
I recommend always consulting a physician when hives appear.
Chronic Hives
If you have ever experienced red round skin splotches, called welts or wheals, you know that they can appear suddenly developing into a full scale rash. The hives are also swollen, and terribly itchy. The tissue below the welts swells giving them a raised appearance. When the hives appear soon after ingesting an allergen or coming in contact with something known to be an allergen, the label of acute hives (also known as acute urticaria) is given. What this article will discuss is CHRONIC HIVES. There is a difference.
Chronic hives are usually caused by some kind of underlying disease process. The most common disease process causing chronic hives is autoimmune disease. Another defining element in the diagnosis of chronic hives is if the hives last longer than 6 weeks. In this case, the hives can resolve themselves for awhile but repeated episodes will occur beyond a 6 week period. Individual hives last not more than 45 minutes, but others will pop up in other places. Chronic hives can appear daily or nearly daily.
Even though 20% of patients with chronic hives will experience outbreaks for years, 50% of sufferers will get resolution to the problem in less than a year. Dealing with underlying medical problems can result in a lessening of the chronic hives. This kind of hives can be a nuisance and very frustrating since their frequency interferes with the patient's daily life. Difficulty at work, disrupted sleep, and other situations affect the individual's life.
An initial instance of chronic hives would be difficult to diagnose since there is a time element involved in diagnosing chronic hives. Also, tests might have to be performed to determine food allergies or contact allergies (eliminate from diagnosis). It usually takes awhile to be classified as having chronic hives. Chronic hives do not cause death.
Underlying Diseases
Many cases involving chronic hives resolve themselves. Whatever systemic problem was giving rise to the hives the body takes care of, and, in many cases, the patient never has another episode of hives.
As mentioned earlier, underlying disease processes can result in chronic hives. Some examples of these diseases are:
1. thyroid disease
2. liver disease
3. kidney disease
4. lupus
The list is non-inclusive. When treating chronic hives, a physician will have the patient undergo a battery of tests to try to find an underlying medical condition. Even so, often the physician cannot account for the cause of the hives. Since diseases manifest themselves with different symptoms, other symptoms besides the hives (for chronic sufferers) are often present and a diagnosis can be pinpointed more easily. Twenty-five to forty-five percent of chronic hive patients have an autoimmune disease and this sub-category of chronic hives is called chronic autoimmune urticaria.
In this case, the body's system relating to fighting infection or responding to foreign material gets confused and starts to attack healthy tissue in the body. Rheumatoid arthritis, ulcerative colitis, and psoriasis are examples of autoimmune disease. People with these autoimmune diseases may have to deal with chronic hives.
What Causes the Redness and Puffiness?
The appearance of the wheal or welt is actually well understood. The immediate cause of the hive that makes it raised and swollen is called angioedema. This reaction causes swelling under the skin elevating the wheal. Angioedema does not affect the surface skin.
When angioedema is present, histamine has been released into the bloodstream in response to a foreign body (pathogen). Histamine is a compound of nitrogen and if bound with an antigen (foreign element), say, pollen or a virus, it takes part in the destruction of the foreign body invader. The histamine compound tends to make the vessels near the inflammation more porous, which allows fluid to move out into the tissues. This causes the swelling and redness. The swelling is most profound in the mouth and eyes of the face, the soles of the feet, and the hands. This swelling is one of the body's responses to things that don't belong; when swelling occurs, it is to get the injured or irritated area bathed in fluid and blood to promote healing.
Since there is a primary cause that results in hives, a physician should be consulted. With extreme swelling, blood blisters, and/or extreme redness, this can be indicative of very dangerous conditions, and a doctor must be consulted quickly. It can mean the difference between life and death.
Treatment for Hives
It goes without saying that treatment of the underlying cause of chronic hives is the way to treat them. When that underlying cause is discovered and treated, the hives disappear. In the meantime, there are some standard treatments for the itching and swelling symptoms.
Epinephrine is used in life-threatening situations (usually arising from an allergic reaction), but I don't think it is usually used in the treatment of chronic hives. However, it can be administered for severe cases. Epinephrine (an injectable also known as adrenaline) is a hormone and a neurotransmitter. It increases heart rate, constricts blood vessels, dilates air passages, and participates in the fight-or-flight response of the sympathetic nervous system.
Other medical treatment focuses on easing the frustrating and antagonistic symptoms. Anti-histamines are prescribed most often. Here is a partial list of anti-histamines often chosen to treat hives. Allegra (Fexofenadine), Cetirizine (Zyrtec) , Levocetirizine, (Xyzal), Loratadine, (Claritin), Desloratadine (Clarinex), Fexofenadine (Allegra). Pharmacists would be familiar with others used for chronic hives that are sold over-the-counter. Older anti-histamines include hydroxyzine (Vistaril), chlorpheniramine (Chlor-Trimeton), and diphenhydramine (Benadryl). Some of these anti-histamines can cause a fair amount of drowsiness, so if that is an issue, check with the pharmacist.
For a prescription anti-histamine, an individual would have to go to a doctor. It has been reported that Cyclosporine (prescription drug), an anti-rejection drug, is effective on chronic hives when all anti-histamines have failed. For severe cases, Prednisone has been prescribed. Anti-histamines can also help a patient with sleep. Other sedative meds can be prescribed.
Menthol rubbed on the skin can help to give relief from the itch. A warm but not hot bath or a shower may give relief from the itching. A warm bath with Aveeno or ground oatmeal can give substantial relief. Use Sarna, the sensitive skin itch relief lotion, to soothe the urticaria.
Itch cream called Cromolyn Cream helps many chronic hives patients. The recipe is given below:
- 2 tsp glycerine
- 1/2 cup of Vanicream (ordered by the pharmacist) or some other thick lotion (such as Eucerin)
- 1 whole bottle of Nasalcrom
Recommendations for home care:
- Use hypo-allergenic soaps
- Cotton clothing is recommended (soft and helps keep cool)
- Ice to stop the itching
- Keep nails trimmed to prevent serious wounding from scratching
- Be familiar with things that you have noticed make the hives worse
- Avoid heat (increases the itch response)
- Avoid salicylates in your diet. In fact, avoid salicylate in medicines like aspirin, Aleve, and Ibuprofen (a low salicylate diet is recommended at http://www.chronichives.com/pages/lowsalicylatediet.htm)
There are also home remedies (allopathic homeopathy and ayurvedic medicines) and herbal remedies that can be tried.
Concluding Remarks
Many victims of chronic hives have a rough time figuring out what medicines, foods, or other things factor into their dreadful condition. When your doctor is in the process of helping you, he will work on finding a trigger, and then move toward alleviating the itching and rash which helps you resume your life. Obtaining relief from the itching and rash can rid many folks' of the stress of dealing with the issue 24 hours a day.
What do you think hives are?
- 4% A place where bees live
- 81% A skin rash notable for pale red, raised, itchy bumps
- 15% A result of an allergic reaction
References
Mayo Clinic (1998-2016) Diseases and Conditions, Chronic Hives (urticaria) Retrieved from http://www.mayoclinic.org/diseases-conditions/chronic-hives/basics/definition/CON-20031634/
- This article cleared up the issue of what causes flares, and what can actually make hives worse.
Health Grades Editorial (November 13, 2016) Angioedema - Symptoms Retrieved from https://www.healthgrades.com/right-care/skin-hair-and-nails/angioedema--symptoms/
- The article clarifies when to seek immediate medical care due to chest, lung, and throat problems.
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