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    Heave Those Hives: Five Ways to Combat the Itch

    Majed Koleilat, MD  Allergy/Immunology, Pediatric Allergy/Immunology 02/20/2024
    Those tingling red swollen bumps that you may mistake for mosquito bites might just be urticaria (hives).  Characterized by sudden itchy red bumps that change shape and turn white if pressed (called blanching), hives are uncomfortable, annoying and troublesome. 
    Hives are a dermal reaction to an allergen, or it can be an inflammatory reaction to another trigger.  Common triggers are specific foods, latex, animal dander, pollen, medications and temperature changes, or antibodies that your body is producing.  Mitigating triggers might be as simple as avoiding a specific food or plant but living or working environments may preclude the complete exclusion of an offensive agent, or treating the underlying disease that causes the antibodies.
    Acute urticaria is relatively short term and the episodes of hives may last between a single day and up to six weeks.  Acute hives are often triggered by something in the environment.  Sufferers can work with their physicians to identify the trigger and take steps to avoid it.
    Chronic urticaria is something of a mystery because the cause often cannot be identified and patients may be symptomatic for over a year.  Patients may be advised to avoid hot showers or baths and to wear loose fitting clothing to avoid aggravating skin that is already irritated and miserable.
    Urticaria sufferers have the following options: 
    1.   Antihistamines – This class of medication is effective because it reduces the body’s allergic response.  Long acting antihistamines can protect the sufferer for up to 24 hours at a time.  However, antihistamines must be taken every day to provide protection. Usually higher doses than for “normal allergies” are required  (thus you need to consult with your physician)
    2.   Oral corticosteroids – Steroids are incredibly effective at reducing inflammation but they are not without significant risk.  Steroids can cause increased blood pressure, fluid retention and severe mood swings.  Another drawback is very often after the steroids the hives may “rebound”
    3.   Topical creams or salves – Treating hives topically doesn’t reduce the hives but may make the sufferer more comfortable and less likely to scratch.  
    4.   Anti-inflammatory medications – The class of “sulfa” drugs may reduce inflammation associated with hives.  Again, these must be taken every day to be effective and long-term antibiotic courses are not recommended.
    5.   Omalizumab/Xolair – This medication has been used for about 10 years, it is an anti- IgE therapy for severe asthma, Xolair serves to suppress the body’s inflammatory response and was recently approved by the FDA to treat chronic urticaria.  Because it’s an injection that requires weekly or biweekly administration, patient compliance is much higher. 

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