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MoonDragon's Health & Wellness
Disorders
Hives
(Urticaria)




BASIC INFORMATION

DESCRIPTION

baby with hives Hives, called uticaria by the medical profession, is a skin condition that is characterized by sudden outbreaks of red, itchy, swollen bumps (welts) or patches (Wheals) on the skin. Any area of the body may be affected. The welts may vary in appearance, from tiny, goosebump-like spots to rashes that cover significant areas of the body.

Many cases of hives are brought on as allergic reactions and coincide with the release of histamine in the body. The release of histamine into the skin produces an inflammatory reaction, with itching, swelling, and redness. Hives can cause significant discomfort, but it does not cause injury or damage to any vital organs. Sometimes hives occur as a result of unknown reasons.

The skin is the largest organ of the body. It is important part of the excretory system. The skin acts in conjunction with other systems in our body to remove toxins and waste. Hives can be a natural reaction to the presence of a foreign substance in the body. However, an offending substance need not enter the body to trigger an outbreak of hives. Merely coming into contact with various substances, such as pesticides, soaps, shampoos, hair sprays, residues from laundry products or dry cleaning chemicals on clothing, or any other of a vast array of other seemingly innocuous household items can unleash a maddening attack of hives.

Angioedema is a condition that is similar to hives but affects deeper layers of the skin and causes larger wheals or anaphylaxis. Anaphylaxis is a systemic allergic reaction causing generalized itching and difficulty breathing.

CAUSES

Hives and angioedema form when, in response to histamine, blood plasma leaks out of small blood vessels in the skin. Histamine is a chemical released from specialized cells (mast cells) along the skin's blood vessels. Allergic reactions, chemicals in foods, insect stings, sunlight exposure, or medicines can all cause histamine release. Sometimes it's impossible to find out exactly why hives have formed.

Hives are very common - 10-20 percent of the population will have at least one episode in their lifetime. Most episodes of hives disappear quickly in a few days to a few weeks. Occasionally, a person will continue to have hives for many years.

A typical outbreak of hives may form anywhere on the body. When hives form around the eyes, lips, and genitals, the tissue may swell excessively. Although frightening, the swelling usually goes away in less than 24 hours. However if you have difficulty breathing or swallowing you should go to the emergency room.

There are several different types of hives, including: hives (urticaria)


Causes of Hives

Chemicals are a major cause of hives for many people. These may include anything from perfumes, to household cleaners. These can trigger a reactions. Cosmetics, pesticides, latex, laundry soaps and cleansers. Metals such as nickel, gold, mercury, and others used alone or in metal alloys can also trigger a reaction. Latex allergies are common among health care workers.

Nervous conditions and stress can trigger hives.

Viruses also can cause hives. Hepatitis B and Epstein-Barr virus, the virus that causes infectious mononucleosis, are the two most common culprits. Some bacterial infections likewise can cause outbreaks of hives, both chronic and acute. An association between Candida albicans and chronic hives has been established in several clinical studies over the past several years.

Drugs, such as antibiotics (penicillin and related compounds) are the most common cause of drug-induced hives. At least 10 percent of American population is thought to be allergic to penicillin. Nearly one quarter of those people will develop hives, angioedema, or anaphylaxis if they ingest penicillin.

Plants can cause hive reactions in sensitive individuals. The most common known plants are poison ivy, poison oak, poison sumac, and stinging nettle. Pollen or contact with the plant itself can occur. Insects and insect stings can also cause hives along with animal dander allergies or contact with animal excretions.

Food sensitivities such as dairy, eggs, nuts, fish, shellfish, soy, wheat, and others can result in hives. Food additives, food preservatives, and molds are included. Alcohol may produce hives. Other hives-producing substances are being identified with increasing frequency. Meat, dairy, and poultry products, especially frozen or fast foods are increasingly associated with hives, probably because many farmers and ranchers routinely give their livestock antibiotics in an effort to prevent disease or infection. These antibiotics are not affected by any subsequent amount of processing, or cooking. Allergic reactions have been traced to antibiotics in milk, soft drinks, and even frozen dinners,

The following are some of the drugs and other substances that most commonly cause outbreaks of hives in susceptible people. This list is not exhaustive, and we do not mean to imply that these items will cause a hives outbreak, only that they at least contribute to the condition in some people:
  • Aspirin.
  • Antimony, a metallic element that is present in various metal alloys.
  • Antipyrine, an agent used to relieve pain and inflammation.
  • Barbituates.
  • BHA and BHT, preservatives used in many food products.
  • Bismuth, another metallic element present in certain metal alloys.
  • Chloral hydrate, a sedative used in the treatment of tetany.
  • Chlorpromazine (Thorazine), a tranquilizer and anti-emetic.
  • Corticotropin (also known as adrenocorticotropic hormone, or ACTH, and sold for medicinal purposes under the brand names Acthar and Cortrosyn).
  • Eucalyptus, a tree whose leaves yield an aromatic oil that is used in cough remedies and other medicines.
  • Fluorides, which are found in certain dental care products and in fluoridated drinking water.
  • Food colorings.
  • Gold.
  • Griseofulvin (Fulvicin, Grisactin, and others), an antifungal medication.
  • Insulin.
  • Iodines, used in certain antiseptics and dyes.
  • Liver extract.
  • Menthol, an extract of peppermint oil used in perfumes, as a mild anesthetic, and as a mint flavoring in candy and cigarettes.
  • Meprobamate (Miltown, Equanil, Meprospan), a tranquilizer.
  • Mercury, a toxic metallic element found in dental fillings, certain antacids, and some first-aid preparations, among other things.
  • Morphine.
  • Opium.
  • Para-aminosalicylic acid, an anti-inflammatory drug.
  • Penicillin.
  • Phenacetin, an ingredient in some pain medications.
  • Phenobarbitol, a sedative and anticonvulsant.
  • Pilocarpine, a glaucoma medication.
  • Poliomyelitis vaccine.
  • Potassium sulfocyanate, a preservative.
  • Preservatives.
  • Procaine (Novocaine), an anesthetic.
  • Promethazine (Phenergan), and antihistamine, sedative, and anti-emetic.
  • Quinine, used in quinine water and anti-malaria medications.
  • Reserpine, a heart medication.
  • Saccharin, an artificial sweetener found in Sweet'n Low, many toothpastes, and many dietetic and "sugarless" products.
  • Salicylates, chemicals used as food flavorings and preservatives.
  • Sulfites, chemicals used as food preservatives and in the production of dried fruits such as raisins.
  • Tartrazine, a food dye and an ingredient in Alka-Seltzer.
  • Thiamine hydrochloride, an ingredient in some cough medications.


SIGNS & SYMPTOMS

The severity of a hives outbreak can vary from case to case as well as from person to person. Some people can break out in hives if they merely touch a certain type of plant or bush; others may develop hives only with considerable exposure, such as over consumption of a certain food.

Hives usually cause itching, but may also burn or sting. They can appear anywhere on the body, including the face, lips, tongue, throat, or ears. Hives vary in size (from a pencil eraser size to the size of a dinner plate), and may join together to form larger areas known as plaques. They can last for hours, or up to three to four days before fading.

Angioedema is similar to urticaria, but the swelling occurs beneath the skin instead of on the surface. Angioedema is characterized by deep swelling around the eyes and lips and sometimes of the genitals, hands, and feet. It generally lasts longer than urticaria, but the swelling usually goes away in less than 24 hours.

Occasionally, severe, prolonged tissue swelling can be disfiguring. Hives cause discomfort, skin irritation and breakdown, and can result in skin infection. Rarely, angioedema of the throat, tongue, or lungs can block the airways, causing difficulty breathing. This may become life threatening.

RISK FACTORS

There are several known factors that cause histamines to be released, and hives to form. These include allergies to medications or substances in the environment, chronic infections, foods, underlying systemic disease such as asthma (a condition that causes inflammation and obstruction of the airways in the lungs), blood products given intravenously (into the vein), scratching, heat or cold, and exposure to sunlight. Anaphylaxis is a medical emergency that cause difficulty in breathing and lead to death. It is important to call 911 immediately if anaphylaxis is suspected.

Hives are not contagious.

PREVENTION

Remove yourself from triggers that may cause hives and other allergic reactions. If a hives outbreak is the result of a food or drug that you have ingested, you obviously do not want that substance in your body again. If you cannot isolate whatever food or drug it might be that causes hives, having a health care provider do some blood work or skin testing to find the allergen may be your only solution, even though this approach can be relatively expensive.

An elimination diet is important. See Allergies for more information.

Occasionally, hives can persist for weeks or even months, resisting all attempts at treatment. for this reason alone, it is best to learn what the cause of the outbreak is in order to avoid it. If you suffer from chronic hives and cannot isolate the cause, eliminating all the possible allergens from your home may be your only resort. This can be a long and drawn out process. See Allergies for more information.

Chronic hives may be linked to Candida albicans. If you suspect this may be the cause of hives, adopting a yeast-free diet can be of some benefit. See Candidiasis for more information.

Antihistamine medications, such as diphenhydramine, cetirizine or loratadine, can be used to prevent hives. An individual should also avoid substances that provoked the reaction if it is known. Epinephrine is used to treat severe reactions such as anaphylaxis. If you have severe reactions, you should carry with you at all times injectable epinephrine to be used in case of emergency to prevent anaphylaxis.

TREATMENT

DIAGNOSIS & TESTS

Exams and Tests

Your health care provider will need to ask many questions in an attempt to find the possible cause. In addition to asking questions, your health care provider will perform a complete physical examination. Your skin, eyes, nose, ears, and throat will be examined. Your health care provider will look for inflammation (redness and swelling), drainage, or other signs of allergy symptoms. Since there are no specific tests for hives, or for the associated swelling of angioedema, testing will depend on your medical history and a thorough examination by your health care provider.

Skin tests may be performed to determine the substance that you are allergic to. Routine blood tests are done to determine if a system-wide illness is present.

SKIN TESTS

An allergy skin test, also called a scratch test, is used to identify the substances that are causing your allergy symptoms. It is performed by applying an extract of an allergen to your skin, scratching or pricking the skin to allow exposure, and then evaluating the skin's reaction.

First, a health care provider will examine the skin on your forearm and clean it with alcohol. (Sometimes, the skin test is performed on an area of your back.) Areas on your skin are then marked with a pen to identify each allergen that will be tested. A drop of extract for each potential allergen -- such as pollen, animal dander, or insect venom -- is placed on the corresponding mark. A small disposable pricking device is then used so the extract can enter into the outer layer of the skin, called the epidermis. The skin prick is not a shot and doesn't cause bleeding. Sometimes, instead of the skin pricking method, a small amount of the allergen is injected just under the skin. If there are allergic antibodies in your system, your skin will become irritated and may itch, much like a mosquito bite. This reaction means you are allergic to that substance.

Plan to spend about an hour for the entire appointment. The allergen placement part of the test takes about 5 to 10 minutes. Then you will have to wait about 15 minutes to see how your skin reacts.

Preparing for the skin test: Inform the health care provider who is going to perform the skin test about all medicines you are taking, including over-the-counter medications. Since over-the-counter antihistamines stop allergic reactions, you should not take them for at least 48 hours before the test. Prescription antihistamines should be discontinued five to seven days before the test. Talk to your health care provider about discontinuing your prescription medicines prior to the test. Your health care provider will give you a list of medicines to avoid before the test, since there are other drugs that can interfere with the results. Since you may not be able to discontinue certain medicines, the health care provider may perform a separate "control" test to determine if that particular drug will interfere with the scratch test.

The test may be mildly irritating, but most people say it doesn't hurt too much.

Although small amounts of allergens are introduced into your system, a skin test is considered safe when performed properly.

After the test, the extracts and ink marks will be cleaned off your skin with alcohol. A mild cortisone cream will be applied to your arm to relieve any itching at the sites of the skin pricks. Keep the tested area on your arm uncovered when you go home. Your health care provider or allergist will use the results of the test to help develop a management plan for you.

Call your health care provider if you experience any of the following symptoms:


BLOOD TESTS

Blood tests are sometimes performed to find out what triggers an allergic reaction. Blood tests are often used if patients have a skin condition or are taking medications, such as antihistamines, that could interfere with an allergy skin test, the most common test used to identify allergy triggers. The radioallergosorbent test (RAST) and the enzyme-linked immunosorbent assay (ELISA) test are two types of blood tests used to diagnose allergies. In both, a small amount of blood is taken from the allergy sufferer and analyzed for antibodies. High levels of antibodies in the blood indicate an allergic reaction. These blood tests are not as effective as skin testing and tend to be somewhat more expensive, but can be useful in some situations.



CONVENTIONAL MEDICAL TREATMENT

The best treatment for hives and associated swelling is to identify and remove the trigger, but this is not an easy task.

Many people who suffer from acute attacks find at least temporary relief from the symptoms of hives by taking antihistamines. Antihistamines are usually prescribed by your health care provider to provide relief from symptoms, but some are available over-the-counter, such as Benadryl. Chronic sufferers have less success with this approach, as antihistamines are suppressive agents and may actually contribute to the persistence of hives. Antihistamines work best if taken on a regular schedule to prevent hives from forming in the first place. No one antihistamine works best for everyone, so your health care provider may need to try more than one or different combinations to find what works best for you.

Chronic hives may be treated with antihistamines or a combination of medications. When antihistamines don't provide relief, oral corticosteroids may be prescribed.

For severe hives or angioedema outbreaks, an injection of epinephrine (adrenaline) or a cortisone medication may be needed.

MANAGEMENT:

While you're waiting for the hives and swelling to disappear, here are some tips:

  • Avoid hot water; use lukewarm water instead.
  • Use gentle, mild soap.
  • Apply cool compresses or wet cloths to the affected areas.
  • Try to work and sleep in a cool room.
  • Wear loose-fitting lightweight clothes.

MEDICATION CONSIDERATIONS

Both oral antihistamines and oral corticosteroids can have side effects, such as drowsiness, dry mouth, constipation and the inability to urinate. Antihistamines, especially the older ones such as diphenhydramine, can cause more severe reactions in the elderly.

SURGERY

Surgery is not necessary for hives.



RECOMMENDATIONS

  • Avoid alcohol and all processed foods, which put added stress on the body by depleting nutrients. Also avoid dairy products, eggs, chicken, and nuts. Especially avoid foods high in saturated fats, cholesterol, and sugar.

    Food Additives to avoid:
    • FOOD COLORINGS: Tartrazine (FD&C Yellow Dye No. 5), a food dye, has been long known to cause hives, particularly in children. This dye is added to nearly every packaged food as well as to some drugs. People who are sensitive to aspirin are especially likely to be sensitive to tartrazine. Foods that commonly contain tartrazine include ice cream, margarine, cake mixes, cloves, jam and jelly, bakery goods except plain bread, Jell-O, candies, gum, hot dogs, oil of wintergreen, toothpaste, mint flavors, lozenges, mouthwash, and lunch meats such as salami and bologna. The following liquids also commonly contain tartrazine: cider and cider vinegars, wine and wine vinegars, Kool-Aid and similar beverages, soda and soft drinks, gin and all distilled alcoholic beverages (except vodka), all tea, beer, diet drinks and supplements, and birch beer.

    • FLAVORINGS include those found in puddings, cake mixes, ice cream, chewing gum, and soft drinks. Sometimes vanilla, cinnamon, menthol, and the artificial sweetener Aspartame can cause hives.

    • SALICYLATES, found in aspirin and some over-the-counter drugs, are also naturally occurring substances found in foods. Salicylates commonly cause reactions in people who are also sensitive to tartrazine (above). Foods containing salicylates include almonds, apples, apricots, blackberries, boysenberries, cherries, cucumbers and pickles, currants, gooseberries, grapes or raisins, nectarines, oranges, peaches, plums or prunes, raspberries, strawberries, and tomatoes.

    • FOOD PRESERVATIVES: Benzoic acid and benzoates, the most commonly used food preservatives, are likely to cause hives. BHT and BHA can also be allergenic. Sulfites added to many processed foods and most beers anti wines can also cause hives. Sulfites and benzoates are commonly used on fish and shrimp to help keep them fresh, which explains why so many people develop hives after eating these foods.

    • EMULSIFIERS AND STABILIZERS: These substances are used in processed foods to ensure that the oils and solids don't separate. The polysorbate in ice cream and the vegetable gums found in other foods including acacia, gum arabic, tragacanth, quince, and carrageenan can be allergenic.

  • Tension and stress usually make hives worse. For tension and stress-related hives, practice stress relaxation.

  • Try to identify the item or substance that caused the condition. Avoid anything you suspect may be causing outbreaks of hives.

  • For the typical case of hives, avoid using prednisones or other steroids. Instead use the nutrients and herbs listed below. Try nettle first.

  • For topical treatment, use cornstarch or colloidal oatmeal added to bath water. A good oatmeal product for this purpose is Aveeno Bath Treatment, available at drugstores. Bathing in cool water with baking soda added also may relieve symptoms.

  • If you have had hives for longer than six weeks, or if you are developing an acute case of hives, consult your health care provider.

  • If hives develop in your mouth or throat, and especially if it causes swelling around the throat or interferes with swallowing or breathing to any extent at all, seek medical help immediately. Go to the emergency room of the nearest hospital or call for emergency assistance. Hives can signal or accompany the onset of anaphylaxis, a dangerous allergic reaction that can block the breathing passages. The possibility of anaphylaxis is what makes allergies to insect stings, such as those from bees, a potentially serious concern. If you have ever had this type of reaction, you should be under a health care provider's care and have an epinephrine injection kit on hand. Make sure you know how to use it, and keep the kit with you at all times.



    HERBS

  • Alfalfa, cat's claw, chamomile, echinacea, ginseng, licorice, nettle, sarsaparilla, and yellow dock are all beneficial to the hives sufferer. Alfalfa can also be used as a preventive blood tonic. It cleanses the blood and helps keep the body free of toxins. Caution: Do not use chamomile on an ongoing basis, and avoid it completely if you are allergic to ragweed. Do not use ginseng or licorice if you have high blood pressure.

  • Applying aloe vera gel to the affected area can be helpful.

  • Black nightshade leaves may help. Wash and boil the leaves in water, put them on a cloth, and apply as a poultice to the affected area. See Using A Poultice for more information. Caution: Do not take this herb internally, and avoid getting it in your eyes.

  • The leaves and the bark of the red alder tree, when brewed into a strong tea, can help hives. Apply it locally to the affected area, and take a couple of tablespoons internally as well. Reapply several times daily until the hives abate. Red alder contains the astringent tannin.



    NUTRITIONAL SUPPLEMENTS

    NUTRIENTS
    SupplementSuggested DosageComments
    Helpful
    Acidophilus As directed on label. Take on an empty stomach. Reduces allergic reactions and helps replenish "friendly" bacteria. Use nondairy formula.
    Garlic (Kyolic) 10 drops of oil in water 3 times daily. Aids in destroying bacteria.
    Herpanacine from Diamond-Herpanacine Associates As directed on label. A nutrient and herb combination that supports overall skin health.
    Multivitamin and mineral complex As directed on label. To correct any nutrient or mineral deficiencies that may be contributing to outbreaks.
    Quercetin As directed on label. Reduces inflammation and reactions to substances that may cause hives.
    Or
    AntiAllergy Formula from Freeda Vitamins    		 As directed on label. A combination of "kosher" ingredients consisting of quercetin, calcium pantothenate, and calcium ascorbate.
    Vitamin B complex As directed on label. Needed for the functioning of the nervous system and for healthy skin.
    Plus extra
    Vitamin B12    		 2,000 mcg daily. Prevents nerve damage and promotes normal growth of the skin. Use a lozenge or sublingual form.
    Vitamin C 1,000 mg 3 times daily. Enhances immune response, acts as an anti-inflammatory.
    Vitamin D 400 IU daily. To reduce outbreaks.
    Vitamin E
    Plus
    Selenium    		 600 IU daily.

    100 mcg daily.    		 A powerful antioxidant that improves circulation to the skin tissues.
    Zinc 50 mg daily. Do not exceed a total of 100 mg daily from all supplements. Promotes a healthy immune system and healing of skin tissues. Needed for proper concentrations of vitamin E in the blood. Use zinc gluconate lozenges or OptiZinc for best absorption.

    Mountain Rose Herbs. A Herbs, Health and Harmony Company. Since 1987


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    NOTIFY YOUR MIDWIFE OR HEALTH CARE PROVIDER IF...

    If hives or angioedema occur with any of the following symptoms, contact your health care provider right away or call 911 and go to the emergency room for treatment:

  • Prescription for Nutritional Healing: The A-To-Z Guide To Supplements
      -- by Phyllis A. Balch, James F. Balch




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