November 07, 2012
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Hives, or urticaria, are localized pink swellings on the skin that are produced by histamine, a chemical released into the skin from the mast cells that lie along our blood vessels.  They are usually itchy, and may occasionally burn or sting. They vary in size and are quite common in children. Up to 10-20 percent of the population will have at least one episode in their lifetime, and fortunately, most resolve quickly, but some may last for days, weeks or even longer. Occasionally, they may be severe enough to require an emergency visit for associated problems with severe facial swelling with trouble swallowing, wheezing and trouble breathing, severe abdominal pain or severe joint pain/swelling.

By definition, acute hives last less than 6 weeks, and oftentimes, a trigger can be identified and eliminated. Common foods like milk, berries, eggs, tomatoes, shellfish, nuts and chocolate may cause hives.

Any of the over the counter medications can cause hives, and a common cause that pediatricians see involves an allergic reaction to antibiotics, like penicillin and sulfa drugs. We also see hives related to bee stings, viral upper respiratory tract infections, hepatitis and occasionally from bacterial and fungal infections.

Hives that last longer than 6 weeks are considered chronic and are much rarer. It is usually much harder to identify the cause and a referral to a dermatologist or allergist may be needed, with additional blood tests or skin biopsy for diagnosis.

Other physical causes may produce hives, including sensitivity to cold, heat, exercise and pressure. Some healthy patients may even develop hives from firm stroking or scratching of the skin, and though recurrent, these causes tend to be self-limited.

Most patients respond to a short course of daily non-sedating antihistamines, but occasionally a longer course of treatment combining the use of two antihistamines may be needed, as well as the use of steroids, or even an injection of epinephrine in more severe cases. We counsel our patients that the best treatment remains working together to identify an underlying cause and eliminating it whenever possible.


Adapted from the educational pamphlet: Urticaria-Hives

A 2005 publication from the American Academy of Dermatology