Hives: Causes and Treatment
Hives, in short, are just uncomfortable. Typically, they’ll show up as patches of swollen red bumps that can appear very suddenly. They also tend to be very itchy, but they can also burn and sting.
There are two main types of hives: acute and chronic. Acute hives occur with specific triggers, and luckily last for only a day or so. Chronic hives occur most days for more than six weeks.
If hives come on suddenly, look for triggers including foods, medications, and environmental exposures. Hives usually begin within two hours of being exposed to the offending item, and the relationship is usually consistent. For example, if a person is allergic to peanuts, they will most likely have a reaction every time they eat peanuts. Hives that occur at random times with no relation to a specific item are unlikely to be allergic in nature. In that case, there’s no need to test multiple foods for allergic reactions.
Hives that occur most days for more than six weeks are considered chronic hives. These are unlikely to be due to a specific allergic trigger and instead are a malfunction of the patient’s Mast Cells, allergic cells that are found in the skin, respiratory tract and gut.
Chronic hives are usually due to some sort of chronic inflammation or irritation. This can be due to chronic environmental allergies but is rarely from new food allergies. Other causes could include autoimmune diseases, thyroid problems, or rarely certain malignancies.
People with allergies have allergic antibodies (IgE) which are specific to certain proteins – IgE for ragweed will not react to cat dander. When the specific IgE antibody finds protein that it is looking for, it binds the protein to form a complex. This complex attaches to the Mast Cell, which causes the Mast Cell to open and release its contents – Histamine, Leukotrienes and other chemicals that cause allergic reactions. Picture a zipper on the Mast Cell opening up and releasing the pre-stored chemicals from inside the cell.
In chronic hives, the zipper on the Mast Cells breaks and the contents dump out at random times. Triggers for this happening can include allergies, infections, trauma, hormones, or stress. Fortunately, chronic hives almost always go away on their own eventually.
For acute hives, we try to determine what the allergens are and treat the hives by avoiding the allergens altogether. For chronic hives, we treat the hives by limiting environmental allergens and treating underlying allergies. But usually, the best way to treat chronic hives is to control the symptoms with medication while the body heals itself. This may take a few weeks, but often it can take several years. In the meantime, we have several medications we can try to help relieve your symptoms.