Dr. Miller: Hives, what are they? How do we get them? And what do we do about them? This is Dr. Tom Miller on Scope radio. We're going to talk about that next.
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Dr. Miller: Hi, I'm here with Dr. Mark Eliason. And he is a professor of dermatology here at the University of Utah. And Mark is going to tell us a little bit about hives. What are hives? What's a hive? I think of a beehive but I don't know if that's what a hive is.
What Are Hives?
Dr. Eliason: This is the right state for that. No, well a hive is simply... the easiest way to think about it is like a bug bite. Imagine a mosquito bite. Something that's raised, it itches, and it bothers you. Most all hives will itch. And there are a lot of things that will cause them as well. But generally speaking, they're raised areas on the skin that are red and usually they will draw your attention to them.
Dr. Miller: I mean, do they happen rarely? Do some people get them and others don't? I mean, who get's a hive?
What Causes Hives?
Dr. Eliason: So, we know that anyone who spends any time outside, especially in the morning or in the evening during mosquito season certainly knows what hives are. You can get a lot from the environment. But beyond just the hives that come from insects that bother you, a number of people develop hives spontaneously. And that can be because they have an allergy to something that they've taken, or something that they've eaten. Or they can also get hives sometimes without anything that they've done wrong, so to speak. Their body sometimes just makes their own hive.
Hives are interesting things to think about because it's an old reflex that our bodies have built into it that draws our attention to a part of us. And if you think about it, when something hurts, we pull away from something. Hurting is a way for our bodies to say, "Stop what you're doing." Itching and hives are a way to tell us that we need to pay attention to a part of our body.
Dr. Miller: Like a mosquito bite. You're near mosquitoes, move away from them.
Dr. Eliason: Right, or something is in us that's itching. Pull that thing out of us. And so it's sort of an opposite built in reflex that sometimes gets turned on inappropriately if something triggers it when it shouldn't.
Dr. Miller: Now, I think our audience might actually be interested in the spontaneous hives, because I've had patients who come in and they describe hives as being something that just pops up in an area that they didn't have any insect bite. So tell me about that a little bit. Because I think if people have hives that are due to, say mosquitoes, they kind of know what's caused that. But sometimes they just don't know.
Dr. Eliason: Sure, and hives can be scary. Because sometimes you get one or two little spots that will show up on your skin and that's not too much of a problem. But people will come in sometimes, they can be covered in hives. And not only are they just uncomfortable because they're itching like crazy, but it's frightening. Some people will feel parts of their body swelling. Like their lips can swell. They can feel like, sometimes they get nervous. Their breathing can be affected too. Hives can become something very worrisome.
Dr. Miller: But more rarely, correct?
Dr. Eliason: That's correct. I should be careful to tell you that most of the times hives that happen on the outside of the body, don't actually cause problems with breathing. But it is one of the things that people watch out for. The number one rash that people go into the emergency room for are hives.
Dr. Miller: So let's talk about that for a second. So let's say a person has never had hives before and they develop one or two episodes, do they need to see a physician? Or should they just maybe not worry about it so much?
Treatment for Hives
Dr. Eliason: That's a great question. And a lot of it depends on what the hives are doing to them. People that are developing a handful of hives, some that are bothersome but they're not affecting at all the way that they're working or their ability to do the things they do during the day, usually don't necessarily need to see a physician until they've tried some of the over the counter products that are available to treat hives easily.
Dr. Miller: And what would those be?
Dr. Eliason: Of course assuming that people don't have any reasons why they couldn't take them, simple things like Benadryl or some of the non-sedating antihistamines with names like Zyrtec or Allegra. Or of course the generic equivalents of those are very safe things for people to start to just try to treat their hives and see if you can get them to go away easily.
Dr. Miller: Is one better than the other? The non-sedating versus the sedating? Because some people will take Benadryl and fall asleep at work, which is bad. Or if they're operating expensive dangerous machinery. That could be a problem.
Dr. Eliason: Right. That's a great point because any medicine that you give someone, if you give them enough of it, you can get side effects with it. So during the day I usually advise patients to consider using things like Zyrtec or Allegra because those are non-sedating. And most people do great with them.
Spontaneous Hives (Urticaria)
Dr. Miller: Now how often do you find a reason for someone to have spontaneous urticaria? Aside from an insect bite.
Dr. Eliason: Yeah, this is a hard question. And with the spontaneous or acute urticaria, that's the kind that just shows up. It's only around for a couple of weeks. We don't always find the causes. In children it's usually related to an infection. And so it doesn't mean you have an infection that's creating your hive. You could have an infection like a common cold. You could have strep throat.
Dr. Miller: A virus.
Dr. Eliason: Exactly.
Dr. Miller: Or a bacterial pharyngitis.
Dr. Eliason: Precisely.
Dr. Miller: Sore throat.
Dr. Eliason: Those infections can, they don't cause hives, but your body's response to the infection accidentally creates hives on you. It's almost like your body makes a little bit of a mistake while it's cleaning out the infection and incidentally creates hives in the process.
Dr. Miller: Well when should that patient find their way to your office?
When Should You See a Doctor for Hives?
Dr. Eliason: We like to see patients when it bothers them. And so for some people that means that they get hives and they have a chance to try some of the over-the-counter antihistamines. And they don't work. In which case we certainly want to help them because there's a lot of other things that we have access to, prescription-wise, that can be stronger.
Dr. Miller: Do you have a definition of, sort of, mild, moderate, or severe hives in terms of how often they occur or how extensive they might be? Maybe that would help our audience know when they should seek medical advice.
Dr. Eliason: A lot of this isn't necessarily with the frequency but more of the severity. Hopefully I can make that make sense. When hives are developing and they aren't preventing people from doing what they normally do during the day, and they also are not causing any changes where parts of their body are swelling, then usually people can try over-the-counter products without having a worry that they need to rush in to see a physician for it.
If people are developing hives where they are getting swelling in their skin, so like I mentioned, lips can swell, ears can swell, or they can just have big welts. Their wrist gets too large. And it looks kind of doughy sometimes. Those are reasons to get into be seen by a physician sooner. Of course if people are having any difficulty breathing, it's a trip to the emergency room very quickly.
Sometimes when hives present, and they cause changes in breathing, people don't necessarily feel like they can't breathe. But they just start coughing sometimes. And those are things to watch for. Of course, you don't ever delay in that case. If you ever feel, if people ever feel like they can't breathe normally, it's straight to the ER.
Dr. Miller: Thank you very much. This is very helpful Mark.
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updated: August 21, 2018
originally published: February 23, 2015
