One out of every five people will get hives at some point in their life, according to the American College of Allergy, Asthma & Immunology. These raised skin welts can be as small as the tip of a pen or as large as a dinner plate. Clinically referred to as urticaria, hives can appear on the arms, legs, back or abdomen and may stand alone or join together to form a larger area. Hives may itch, burn or sting and may be very uncomfortable, especially for a child. They may last anywhere from a few hours to more than six weeks before fading.

If you or your child has developed hives multiple times, or if the hives have persisted for several weeks and you don’t know the cause, it’s time to seek the guidance of an allergist. Dr. Baxter, a board-certified allergist in Dallas, can help determine the cause of the hives and help you reduce your risk of developing them in the future.

What causes hives?

Hives are commonly triggered by an allergic reaction to a food, drug, insect bite/sting, animal or pollen. Other underlying causes include emotional stress, infection, vascular conditions and autoimmune disorders. In some cases, hives may be hereditary.

How long will hives last?

Acute hives last six weeks or less and are usually caused by foods, medications or an infection. It is more difficult to identify the cause of chronic hives — those that last or recur for more than six weeks.

What types of hives are there?

Some hives are not caused by allergies. Some of them are known as physical urticarias and are brought on by physical stimulation.

Cold urticaria

A reaction to cold temperatures. Symptoms include localized redness, swelling and itching. The most common cause of cold urticaria is swimming in extremely cold water. The condition can be linked to certain viruses. A condition called CAPS, or familial cold autoinflammatory syndrome, is a very rare disorder in which patients have painful rashes when exposed to cold environments, and it is important to diagnose because there is a wonderful medication for it. This occurs with a dominant pattern in families, but some patients will be the first in their family to have the mutation.

Hot urticaria (or “cholinergic”)

A reaction to an increase in body temperature, because of either sun exposure, exercise, a hot shower or anxiety. These hives tend to be a bit smaller.

Aquagenic urticaria

A painful skin reaction from contact with water, either due to the hot or cold temperature of the water or exposure to a chemical in the water such as chlorine.

Vibratory urticaria

The result of the skin reacting to a type of vibration. The skin condition is usually triggered by something like jogging, riding a motorcycle or rubbing the body vigorously with a towel.

How are hives diagnosed?

Dr. Baxter can tell if you have hives by examining the affected area. She will take down a detailed medical history and ask about symptoms and whether you’ve recently been sick or been exposed to anything that could have caused the hives. She will also order blood tests and ask you about the medications that you take.

Are hives contagious?

No, hives are not contagious – they do not have an infectious component. However, they can be a symptom of an infectious virus. If your child has a hive-like rash that they got from another child, it is likely a signal of a virus, like chicken pox.

How are hives treated?

The first step to managing hives is to identify the cause. However, it can be challenging to find the cause of some cases of hives. If Dr. Baxter has identified an underlying condition causing hives — such as allergies or an autoimmune disorder — the hives should improve as the condition is addressed.

Medical Treatments for Hives

In cases where the cause remains elusive, Dr. Baxter will treat the symptoms with oral medications. Antihistamine medications effectively reduce symptoms such as itching. Older antihistamines such as Benadryl and Vistaril may cause drowsiness and should only be taken before bedtime. Newer antihistamines such as Claritin, Allegra and Zyrtec are non-sedating or low-sedating medications.

If antihistamines don’t provide enough relief, Dr. Baxter may prescribe H-2 antagonist drugs (such as Zantac or Pepcid AC), oral corticosteroids or antidepressants, which can soothe itching, redness and swelling.

What steps can I take to aid in recovering from hives?

Keep in mind that tight-fitting clothing and hot baths/showers may irritate the hives further and increase itching and swelling. Also, if Dr. Baxter identifies a possible trigger (e.g., a certain drug or food allergy), you should avoid any exposure to it.

Contact Dr. Baxter

To learn more about hives and how to manage them, please call Dr. Baxter today and schedule an appointment.

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by Barbara Stark Baxter MD
Internal Medicine & Allergy Specialist