M.D. Claiborne & Associates, L.L.C. - Dermatology Specialists
Hives, also known as urticaria, are raised red bumps on the skin caused by the release of histamine and other inflammatory substances. Sensations with these lesions include itch, stinging, prickling, and pain may occur with these lesions. Urticaria can be triggered by many factors, the most common of which is an upper respiratory tract infection. Drugs are the 2nd most common cause, often barbiturates, aspirin, non-steroidal anti-inflammatories (NSAIDs), opiates, alcohol, antibiotics, blood pressure medications and radiographic contrast media are implicated. Foods cause urticaria in 1% of cases. Other causes include systemic illnesses/infections, blood disorders, pregnancy, and physical stimuli (such as heat, cold, water, pressure, vibration). Unfortunately, in the overwhelming majority of cases, the cause of urticaria is not found. This is called idiopathic urticaria. Each individual lesion typically lasts less than 24 hours, but the condition may last much longer.
Urticaria lasting less than 6 weeks duration is classified as acute, while urticaria lasting over 6 weeks is classified as chronic urticaria. Chronic urticaria is more common in middle aged females, while acute urticaria is more common in children. Chronic urticaria typically warrants systemic workup for potential causes.
First-line therapy typically consists of various antihistamines, which can be combined with other therapies. Alternative therapies include oral steroids, phototherapy, leukotriene inhibitors, and cyclosporine to name a few. A novel injectable biologic therapy, Xolair (omalizumab), was approved by the FDA in March 2014 for treatment of chronic urticaria in patients over 12 years of age that failed antihistamines.