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Ask An Expert

Hives: Causes and Treatment

Steven Rubinstein

Steven Rubinstein, M.D.

Palo Alto Medical Foundation

Question:

My wife just developed hives for the first time in her life -- on her face, arms and chest. What is known about hives, and what can she do to eliminate the symptoms?

Answer:

Acute hives are actually fairly common, but finding the cause can be challenging. Hives occur when the immune system is stimulated into releasing histamine from inside the blood stream, resulting in the dilation of blood vessels from underneath the skin. This must be distinguished from rashes that occur when the skin reacts to something from the outside (like poison oak), where the histamine is released within the skin itself.

Assuming your wife's rash is hives, the most common cause would be a reaction to a medication, including vitamins or any supplement. Ibuprofen (Motrin, Advil) or Aleve are the most common over-the-counter medications that cause allergic reactions. Another potential cause would be a reaction to a food or food additive. This reaction would likely start within a few hours of ingesting an offending food and would almost always resolve within 24 hours.

Frequently hives can be associated with an overreaction of the immune system to any type of infection, including colds, flu, viruses, skin infections, bladder infections, etc. If there are symptoms in any other part of her body, the possibility of these infections needs to be investigated.

If hives continue for more than one to two months, they can be associated with the onset of other medical conditions, especially auto-immune diseases like thyroid or arthritis conditions.

Once hives occur, they are aggravated by heat, dry skin, stress, and by scratching. Over-the-counter antihistamines are effective at minimizing symptoms. For daytime use, loratadine (Claritin) or cetirizine (Zyrtec) work well, with diphenhydramine (Benadryl) the best nighttime option. If these medicines do not help, or are needed for more than a few days, be sure to see a doctor.

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Back to Breathing and Allergies

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