Hives May Be a Symptom of a Severe Dermatological Problem


As many as 15 to 24 percent of people in the United States during their lifetime, caused by an allergic reaction, a common viral infection, or a serious illness, according to new medical guidelines developed by a joint task force of allergists, based in Englewood, Colorado.

The guidelines, The Diagnosis and Management of Urticaria: A Practice Parameter, are published as a supplement to the December 2000 issue of Annals of Allergy, Asthma, and Immunology.

Most cases of hives are acute, lasting from a few hours to less than six weeks. Some cases are chronic, lasting more than six weeks.

“Urticaria, commonly known as hives, is one of the most common dermatological conditions seen by allergists,” said co-editor Dr. David L. Goodman, Englewood, Colorado.

“Traditional allergies to foods or medications and viral illness are frequent causes of acute urticaria. Chronic urticaria is more complex, given the vast number of potential triggers and multiple causes and the difficulty in identifying them. The interaction between the immune system and some autoimmune diseases, such as autoimmune thyroid disease, has come to light as a potential important trigger for chronic urticaria.”

Hives usually strikes suddenly. First the skin itches, then it erupts into red welts. The itching may be severe, sometimes painful or burning, and can keep people from working or sleeping.

“Urticaria is not just an allergic disease, said co-editor Dr. Alan A. Wanderer. “It can be caused by metabolic diseases, medications, infectious diseases, autoimmune disease, or physical sensitivity,”

In contrast to urticaria, angioedema is a deeper, subcutaneous swelling, usually in the areas of the face or mucous membranes involving tho lips or tongue. If angioedema involves the upper respiratory tract, life-threatening obstruction of the laryngeal airway may occur.

Many patients with acute urticaria seek care from their primary care physicians who, in many instances, can determine the probable cause by reviewing the patient's history and performing a physical examination and a few simple laboratory tests.

“The problem is, first of all, making sure you are dealing with the correct diagnosis of urticaria and not some other disease process that mimics urticaria. Chronic urticaria with angioedema presents a challenge in its treatment in that it often requires long-term follow-up,” said Dr. Wanderer

“Treatment of chronic urticaria/angioedema is more difficult because symptoms can persist for a long duration, and affected patients are frustrated, as they expect their physician to pinpoint the cause of their symptoms. Unfortunately, the cause can be established in only one out of five or six adult patients with chronic urticaria,” Dr. Wanderer said.

According to the literature on which the guidelines were based, the duration of chronic urticaria/angioedema cannot be predicted. Spontaneous remissions often occur within twelve months, but many patients continue to have symptoms for years.

“It's common for patients with chronic urticaria or angioedema to go from one physician to another, in part, because the physicians themselves are frustrated identifying the cause of the problem. If a patient has a perplexing form of urticaria or angioedema, it may be useful for them to seek out an allergy specialist to make sure the more serious, underlying diseases have been ruled out,” Dr. Wanderer said.

“Some mastery of the treatment is important in terms of identifying the right combination of medications that can suppress the urticaria symptoms to the best extent possible with the least side effects,”

A free patient brochure, Advice from Your Allergist on Urticaria, and allergist referral information are available by calling (800) 842-7777 or visiting

(Adapted from Annals of Allergy, Asthma, and Immunology, 2000; Vol. 85 (6,Pt 2): 521-544.)

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