Q&A: What Can I Do For Chronic Hives?

Q: What can I do for chronic hives? – E W.

A: Some substances actually cause an allergic reaction that results in hives, while others have absolutely nothing at all to do with allergies. Strawberries, for example, contain a chemical that can cause cells in your body to release histamine, a chemical also produced in allergies, which allows blood plasma to leak into the skin and form hives. In this article, we’ll scratch the surface and talk about methods to ease and prevent hives.

Sometimes only a tiny amount of the culprit is needed to set off a reaction. For example, you may have a sensitivity to seafood but break out after eating a steak — simply because the steak was cooked in a pan that had earlier been used to fry fish.

Don’t confuse hives with other skin conditions. Hives (or urticaria, as the doctors call them) occur when blood plasma leaks into the skin, causing “wheals,” or swollen areas. They can be as small as a pencil eraser or as large as a dinner plate, and they usually last only a few hours. But new wheals may form continuously. And as they form, they often itch.

Some natural remedies include:

Wet Cold Compress

Dampen a paper towel with cold water and lay it on your affected skin for 15 minutes at a time. Reapply the cold compress every few hours as needed to reduce pain and swelling. If hives are terrible it’s easiest to take as cold of a bath (covering hives with water) for 20-30 minutes and then stay cool. Taking a cold bath may just make the hives spread and worsen. It just depends on the person, and how sensitive their skin is.

Oatmeal Bath

Soak in a warm, not hot, oatmeal bath to relieve itching and soothe your skin. Use a regular carton of oatmeal and prepare it using warm water. Soak the affected area in this mixture until the mixture turns cold. This is especially helpful if the hives cover a large portion of your body or are concentrated on your legs and lower body.

If you are experiencing chronic hives you should see an allergist and have an allergy test to find out what you are allergic to that is causing this reaction. Here are FOUR temporary solutions:

1. Take non-drowsy forms of antihistamine pills.

Loratadine (Claritin, Alavert)
Fexofenadine (Allegra)
Cetirizine (Zyrtec)
Levocetirizine (Xyzal)
Desloratadine (Clarinex)

2. If the non-drowsy antihistamine pills do not work, try:

Hydroxyzine (Vistaril)
Diphenhydramine (Benadryl)
Chlorpheniramine (Chlor-Trimeton)

Check with your doctor before taking any of these medications if you are pregnant or breastfeeding, have a chronic medical condition, or are taking other medications.

3. Try other medications.

If antihistamines alone don’t relieve your symptoms, other drugs that may help include:

Histamine (H-2) blockers. Examples include cimetidine (Tagamet), ranitidine (Zantac), nizatidine (Axid) and famotidine (Pepcid). Side effects range from digestive problems to headache.
Anti-inflammation medications. Oral corticosteroids, such as prednisone, can help lessen swelling, redness and itching. These usually are used only for a short time to control severe hives or angioedema because they can cause serious side effects.

Corticosteroids creams applied to the skin usually aren’t effective for chronic hives. Corticosteroids can weaken your immune system, making it easier for you to get an infection or worsening an infection you already have.

Antidepressants. The tricyclic antidepressant doxepin (Zonalon), used in cream form, can help relieve itching. This drug may cause dizziness and drowsiness.

Allergy Shots: Are They Right For You?

4. Ask about other options.

Several medications under study show promise for people whose chronic hives resist treatment:

An injectable asthma drug. Several studies show the drug omalizumab (Xolair) is very effective against difficult-to-treat chronic hives, without side effects. But it is more costly than other options and is not usually covered by insurance.
Asthma drugs with antihistamines. Medications that interfere with the action of leukotriene modifiers may be helpful when used with antihistamines. Examples are montelukast (Singulair) and zafirlukast (Accolate). Side effects may include behavior and mood changes.
Cyclosporine. The drug cyclosporine (Gengraf, Neoral, others) affects the immune system and provides relief from chronic hives. Possible side effects range from headache and nausea to an increased risk of infection and reduced kidney function.
Tacrolimus. Similar to cyclosporine, this drug reduces the immune system response that causes hives. And it, too, may cause a range of side effects, from minor to serious.
Mycophenolate. This immune-suppressing drug also improves hives signs and symptoms. But for pregnant women, it increases the risk of miscarriage and birth defects.

Visit the BlackDoctor.org Allergy center for more articles.

If you have any questions, don’t hesitate to ‘Ask Dr. Renee’. Follow me on Twitter @AskDrRenee and on my website.