Hives That Wont Go Away: The Basics Of Ciu
Hives, those annoying itchy red bumps, often occur with an allergic reaction or sometimes a viral infection. Or sometimes, they can be more serious when they happen with a severe allergic reaction called anaphylaxis.
Most of the time, you can find what caused them. But what if you cant?
There is a condition called chronic idiopathic urticaria . Simply put, it means hives that stick around for more than six weeks for no known reason. Many people call it CIU. About 1.5 million people in the U.S. have it.
What Are Chronic Hives Treatments
Treatments for chronic hives include:
- Allergy medications: Daily over-the-counter or prescription allergy medications like antihistamines relieve itching and reduce or prevent allergic reactions.
- Allergy shots: A monthly injection of a drug called omalizumab blocks your bodys production of immunoglobin E . People with severe allergies can make too much IgE, leading to problems like chronic hives and asthma.
- Steroids: Corticosteroids like prednisone can ease symptoms that dont respond to allergy medicines.
- Hydroxychloroquine: A study found that 8 in 10 people with autoimmune disease-induced chronic hives got symptom relief after taking hydroxychloroquine , an antimalarial drug, for three or more months.
- Cyclosporine: This immunosuppressant is highly effective at clearing up severe chronic hives. But it can cause serious side effects when taken for too long.
Signs And Symptoms Of Hives
Symptoms of hives can last from minutes to months, or even years. Patients with hives present with raised, itchy, bumpy skin, or swollen, blistered and red patches on their body.
Swollen patches on the skin are called wheals, and those resulting from hives have clearly defined edges. Wheals can sometimes spread and enlarge, and several wheals may even join together to form a larger wheal. The appearance of wheals can change, disappear, and reappear within minutes to hours.
A simple test for hives is to press the center of a wheal and notice if it turns white. This is known as blanching, and is a common symptom of hives.
Hives do not typically form bruises, and do not leave permanent scars.
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Do Some Basic Testing
The definition of chronic spontaneous urticaria is hives for more than 6 weeks with no known cause, says Jeffrey Cohen, MD, a dermatologist at the Yale School of Medicine. Itâs also unclear why some cases are more severe or last longer than others.
But thereâs evidence that up to half of people with this condition have an underlying autoimmune disorder. The most common one is Hashimotoâs thyroiditis, Cohen says. Itâs a form of hypothyroidism, when the thyroid gland doesnât make enough hormones.
CSU has also been linked to rheumatoid arthritis, lupus, type 1 diabetes, and even celiac disease. To check for these things, your doctor will most likely do blood tests on things like your thyroid hormones as well as something called your erythrocyte sedimentation rate , which measures the degree of inflammation in your body.
âIf you do have an underlying autoimmune disorder, then your urticaria will most likely improve with standard treatment for the disease,â Cohen says.
Causes Of Localized Hives
- Irritants. Hives just in one spot are usually due to skin contact with an irritant. They are not an allergy.
- Plants. Many plants cause skin reactions. Sap from evergreens can cause local hives.
- Pollen. Playing in the grass can cause hives on exposed skin.
- Pet Saliva. Some people get hives where a dog or cat has licked them.
- Food. Some children get hives if a food is rubbed on the skin. An example could be a fresh fruit. Some babies get hives around their mouth from drooling a new food.
- Insect Bite. Local hives are a reaction to the insect’s saliva. Can be very large without being an allergy.
- Bee Sting. This is a reaction to the bee’s venom. Can be very large without being an allergy.
- Localized hives are not caused by drugs, infections or swallowed foods. These get into the bloodstream and cause widespread hives.
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Do Use Otc Antihistamines
A 24-hour over-the-counter antihistamine like loratadine and pseudoephedrine , cetirizine , or fexofenadine , or a short-acting allergy medication like diphenhydramine can help relieve itching and discomfort, says Sarina Elmariah, MD, PhD, a board-certified dermatologist at Massachusetts General Hospital in Boston.
Antihistamines are designed to reduce or block histamine, a chemical in your body thats responsible for hives welt-like bumps and itching. If you break out in hives again after the medicine wears off, take it for three to five days and then stop to see if you get more hives. If so, you should see your doctor, Dr. Elmariah says and you can continue taking the antihistamine until you do so or your doctor tells you otherwise.
Taking medication at this point is more about preventing another versus treating the existing one, says Adam Friedman, MD, a professor and chair of dermatology at the George Washington University School of Medicine and Health Sciences in Washington, DC.
But dont reach for aspirin and nonsteroidal anti-inflammatory drugs, as they could make your hives worse, he says.
Mayo Clinic Q And A: Chronic Hives Come And Go With No Clear Pattern
DEAR MAYO CLINIC: I woke up this morning with itchy, red welts covering my arms and legs. These have shown up every now and then over the past few months, and now they seem worse than usual. What could be causing this? How is it treated?
ANSWER: What you may be experiencing is chronic hives. Hives are raised, red or white itchy welts on your skin. A sudden onset of hives usually has an identifiable cause or trigger such as insect stings or bites, medications, certain foods, allergens, or infections. Acute hives go away within a few weeks and are usually effectively treated with antihistamines.
Chronic hives are different in that they persist for more than six weeks. The hives seem to come and go with no clear pattern fading over the course of a day or two and then reappearing in a different location a few days later.
Anyone can develop chronic hives, but theyre more common in middle-aged women. Chronic hives can go on for months and even years. They can interfere with sleep, work and other activities. Itching can be severe and may be accompanied by painful swelling. Signs and symptoms tend to flare up with heat, exercise or stress.
One of the biggest sources of frustration with chronic hives is wondering whats causing them. The truth is that its hard to know. Up to 90 percent of cases remain unexplained no external factor or contributing disease can be pinpointed as the cause.
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Treatments Doctors Use For Hives
Doctors usually prescribe antihistamines as the first course of treatment for hives. Acute cases can generally be treated with over-the-counter antihistamines like loratadine and pseudoephedrine, cetirizine, fexofenadine, or diphenhydramine.
If your hives are persisting , your doctor may move to another class of antihistamines called histamine type 2 receptor antagonists, or H2 blockers, including cimetidine and famotidine up the dose of antihistamines or combine several antihistamines, Friedman says.
In some cases, your doctor may prescribe an oral steroid, such as prednisone , if your hives still arent responding. Oral steroids are stronger but can cause more significant side effects than antihistamines.
If youre still not seeing results, your doctor may recommend even stronger medications, like an injectable prescription medication called omalizumab . There is also evidence that off-label use of stronger medications that suppress the immune system under careful monitoring by a specialist may be helpful in patients with difficult-to-manage hives.
Its important to note that you shouldnt try taking high doses of vitamins or any other off-label medication on your own without instruction from your doctor. No one treatment works for everyone, Friedman says. And for some, such therapies may not be safe.
Should I Worry About A Severe Allergic Reaction
Chronic hives are usually not associated with any serious allergic reactions. These emergencies, also called anaphylaxis, are dangerous, potentially life-threatening allergic reactions requiring medical treatment. Hives resulting from anaphylaxis often occur with other symptoms, such as difficulty breathing, dizziness, and swollen eyelids, lips, and tongue. If you experience any of these symptoms along with hives, call 911 immediately.
Chronic hives can be difficult to live with, but there are effective treatment options to help manage symptoms. Identifying and avoiding triggers is also key to managing chronic hives. And after making a positive diagnosis, your doctor will suggest one or several treatments that may be beneficial to you.
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What Are My Treatment Options
Many people find relief from the symptoms of chronic hives by taking an antihistamine medication once every day. Your doctor may recommend a non-drowsy antihistamine to help block cells from releasing histamine into your bloodstream.
For some, antihistamines by themselves arent enough to control chronic hives. Fortunately, other medications may help relieve symptoms. In addition to an antihistamine, your doctor may suggest:
- Anti-inflammatory medications: If you suffer from angioedema or your hives are especially severe, anti-inflammatories, like certain steroids, may help control your symptoms.
- Histamine blockers: These drugs block the production of histamine in your body.
- Immunosuppressants: Your doctor may prescribe immunosuppressants, which reduce the activity of your bodys immune system.
Your specific treatment will depend on the severity of your hives, your past medical history, and any other medical conditions you may have.
If Hives Continue You May Need To See A Specialist Heres How Doctors Treat Hives
If you have only one outbreak of hives and you dont have breathing difficulties, you probably dont need medical attention. Yet if you continue to get multiple bouts of hives that continue after a couple of weeks, you may want to call a doctor, Elmariah suggests. Most often, the hives will resolve during this time or youll figure out whats causing them.
But hives that continue for weeks warrant a trip to a specialist, such as a dermatologist or an allergist. If they continue for six weeks or longer theyre considered chronic hives, which tend to be caused by the same triggers as short-term or acute cases of hives. Because dermatologists and allergists are skilled at working with hives, theyre your best bet for getting appropriate treatment, Dr. Rossi explains.
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What Might Be Causing Your Unexpected Hives
Hives are a very common skin reaction that can come from some unexpected sources. Some causes you might not have thought of include:
- Colds and other viral infections. Sometimes hives can be caused by your immune system fighting colds and other viral infections. These hives often appear near the end of your cold or virus as youre starting to feel better. Theyre most common in children but can happen to anyone.
- Bacterial infections. Bacterial infections such as strep throat or urinary tract infections can also sometimes trigger hives as your body reacts to the bacteria. These hives will fade as the antibiotics help your body fight the infection. They might peel before healing completely.
- Chronic conditions such as lupus. Hives that last for longer than 6 weeks might be a sign of an autoimmune condition such as lupus, type 1 diabetes, thyroid disease, or rheumatoid arthritis. These hives wont go away on their own. Its a good idea to make a medical appointment to get this type of hive checked out and see if a chronic condition is the cause.
- Stress. Stress can raise your internal body temperature and release adrenalin and other chemicals that might trigger hives. Stress hives tend to be located on the face, neck, chest, and arms. Theyre common in people with eczema, allergies, or sensitive skin.
What Are Hives Or Urticaria
Hives or urticaria are a type of rash consisting of itchy, swollen, red welts. The itching may be mild or severe. Foods, medications, infections, exercise, scratching, alcoholic beverages, emotional stress and many other factors may worsen hives. The condition affects an estimated 20 percent of the population at one time or another in their lives.
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Is It Hives Or Angioedema
Angioedema swelling of tissue beneath the surface of the skin can be mistaken for, or associated with hives. It can be caused by allergic reactions, medications or a hereditary deficiency of some enzymes. The following symptoms may indicate angioedema:
- Swelling in the eyes or mouth
- Swelling of the hands, feet or throat
- Difficulty breathing, stomach cramps or swelling of the lining of the eyes
The best way to identify your symptoms is to talk to an allergist who can diagnose and treat both hives and angioedema.
What Causes Urticaria
Urticaria occurs when a trigger causes high levels of histamine and other chemical messengers to be released in the skin. These substances cause the blood vessels in the affected area of skin to open up and become leaky. This extra fluid in the tissues causes swelling and itchiness.
Histamine is released for many reasons, including:
- an allergic reaction like a food allergy or a reaction to an insect bite or sting
- cold or heat exposure
- certain medications like non-steroidal anti-inflammatory drugs or antibiotics
However, in many cases of urticaria, no obvious cause can be found.
Some cases of long-term urticaria may be caused by the immune system mistakenly attacking healthy tissue. However, this is difficult to diagnose and the treatment options are the same.
Certain triggers may also make the symptoms worse. These include:
Read more about the causes of urticaria.
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Care Advice For Hives
How Are Hives Treated
In many cases, mild hives won’t need treatment and will go away on their own. If a definite trigger is found, avoiding it is part of the treatment. If the hives feel itchy, the doctor may recommend an antihistamine medicine to block the release of histamine in the bloodstream and prevent breakouts.
For chronic hives, the doctor may suggest a non-sedating prescription or over-the-counter antihistamine to be taken every day. Not everyone responds to the same medicines, though, so it’s important to work with the doctor to find the right one for your child.
If a non-drowsy antihistamine doesn’t work, the doctor may suggest a stronger antihistamine, another medicine, or a combination of medicines. In rare cases, a doctor may prescribe a steroid pill or liquid to treat chronic hives. Usually this is done for just a short period to prevent harmful steroid side effects.
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My Daughter Has A Rash That Wont Go Away It Looks Like
Submitted:Category: Dr. Mo
Hello. Dr. Mo here. Thank you for trusting me with your question. Please give me a moment to reply, if you have anything else to add please reply here. You can always come back to this question by clicking on https://www.justanswer.com/medical/expert-dr-mo/
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where did it start and how did it spread?
it could be a bacterial infection but it could be something like a vasculitis or shingles. It’s unlikely to be monkeypox but perhaps something that should be ruled out as well. I often recommend going into the clinic or urgent care to get it checked out.
a bit of Eucerin cream to moisturize the area and a topical steroid like hydrocortisone 1% would be helpful.
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