By Robert J Weiss MD PC
February 15, 2015
Category: Uncategorized

Many of us have had the uncomfortable itching experience of hives or wheals(the medical term is urticaria)in

our lives. Hives result from the release  of a body chemical called histamine from mast cells.Ordinary individual hives

typically last 24 hours or less. However,the coming and going of hives persisting for more than 6 weeks is called

chronic.And,from my clinical experience in the office it becomes much more difficult to elicit their cause.

               The etiology of hives can be divided into several classifications: these include:

                  1)anti-inflammatory medications such ibuprofen,naproxen,and aspirin as well as narcotic medications

including codeine,hydrocodone,and oxycodone.

                  2)the ingestion of certain foods as well as the diluents and preservatives they contain. These foods include


                 3)physical causes such as heat and cold,water and pressure,sun and cholinergic(due to physical exertion

and sweating)

                 4)chronic causes of hives such as the autoimmune diseases of lupus and the thyroid gland(Grave's disease).

In addition,chronic infections including dental cavities,urinary tract and vaginal infections.

                5)stress and nerves-I have listed this last since it is easy to blame everything on this.

               But,patients with chronic hives in particular need a complete  history,physical exam,and lab work to rule out

internal causes (comorbidities).

             The mainstay of treatment is to correct any underlying medical disorder and the use of non-sedating 

antihistamines whenever possible.However,in my clinical experience acute exacerbations sometimes require

sedating antihistamines(especially for patients kept awake all night from the itching)and/or a short course

of corticosteroids for the worse flare-ups.

             The injectible drug omalizumab initially approved for moderate to severe persistent and allergic

asthma is now available for chronic recalcitrant and idiopathic(ie,cause unknown)urticaria.The drug opposes

the immunoglobulin antibody in the blood known as IgE which mediates allergic reactions.It is approved

for patients over 12 years old.

             However,when the monthly injections are stopped the hives recur.The good news is that the drug is still effective

when restarted.