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NEWS & NOTES
Written By:
Sakina N. Bharani, M.D. HIVESSYMPTOMS*Itchy, red, raised swellings of skin….*Swelling under the skin, lip, eye, hands, feet…. HIVES (Urticaria)/ANGIOEDEMA One out of every five individuals has hives at some time in their life. Hives are red, raised swellings of the skin and may occur in a number of forms, small or large. They are caused by the leakage of fluid from the blood vessels into the skin. The leakage of fluid occurs as a result of the release of histamine and other chemicals. Angioedema involves the same process but occurs in the deeper layers of skin leading to an uneven swelling of the tissues. Hives are bothersome because of the accompanying itching of the skin and because they could be disfiguring. The hives may come and go, and shift from place to place on the body. They may last from a few hours to days, and may become chronic, lasting for months to years. When hives last for a period longer than six weeks, it is categorized as chronic. In 80% of such individuals, it maybe impossible to figure out a definitive causative factor. WHAT CAUSES HIVES? FOODS: Although the most likely foods to cause hives are tree nuts, peanuts, shell fish, eggs, fish, cow’s milk, and soybeans, any food can cause hives in sensitive individuals. Artificial coloring, like FDA yellow No. 5 (Tartazine), FDA red No. 2, and rarely green dyes, may also cause hives. MEDICATIONS like penicillin, aspirin, sulfa drugs, newer arthritis medications, laxatives, and even vitamins (like B1) can cause hives. One has to always suspect a medication as a cause of hives until proven otherwise. INHALANTS, such as pollen, rarely cause hives but, at times, cooking odors from foods can cause severe hives or swelling in the throat in food allergic patients. CONTACT with dog and cat saliva and dander produce hives in sensitive individuals. Similarly, contact with grass and weeds in freshly cut lawns could be a problem. Fertilizers, weed killers and insecticide sprays are found to be increasingly common factors causing hives. COSMETICS like perfumes, eye shadows and liners, lipstick, nail polish, hair sprays and hair dyes can cause hives and swelling on contact. HOT and COLD temperatures can cause hives. Exercise and showers with hot water can bring on hives. SUNLIGHT can cause hives on exposed parts of the body in certain individuals. PRESSURE points, carrying a heavy handbag over the shoulder, as well as belt areas, can cause swelling similar to hives even four to six hours after the pressure contact. INSECT BITES from honey bees, hornets, wasps, and yellow jackets can cause hives which may involve the whole body and the condition may be life threatening. INFECTIONS of viral origin anywhere in the body can bring on hives, more so in children. Parasitic infections (intestinal worms) are an infrequent entity causing hives. HORMONES, such as birth control pills, hormone replacement and overworking or underworking thyroid conditions may cause hives. Because of hormonal changes in the body, hives are aggravated before menstruation and during or after pregnancy. UNDERLYING ILLNESSES, such as lupus, rheumatoid arthritis, and vasculitis can present as persistent hives. EMOTIONAL FACTORS can aggravate existing hives. MALIGNANCY Very rarely chronic hives may indicate the presence of an undiagnosed malignancy. CHRONICITY: When hives last for a period longer than six weeks, it is categorized as chronic. In 80% of such individuals, it maybe impossible to figure out a definitive causative factor. CAN HIVES BE DANGEROUS? When hives occur in deeper tissues, they present as swelling (angioedema) of any part of the body. When swelling occurs in the throat/larynx (voice box), breathing becomes difficult and labored. This requires emergency treatment. HOW CAN HIVES BE TREATED? Thorough history is necessary to identify the triggering factor(s) or activity. Keeping a food diary may help to delineate the common factor. Certain substances known to release histamine, such as morphine and codeine, should be avoided in susceptible individuals as these may cause aggravation of hives. Specific antihistamines are frequently helpful in reducing the severity and frequency of hives. Some situations may require a combination of two or more antihistamines to control symptoms. Cortisones are useful in the management of severe and persistent hives. Drugs, such as Epinephrine, are occasionally required when life-threatening emergencies, such as when swelling of the throat, occurs. This is prescribed in the form of an emergency kit. Generally, hives are self-limited and only a temporary nuisance to the sufferer. However, some cases are troublesome and do require specific medical treatment for a longer period. Allergists are physicians who have received special training in the care of the patient with urticaria and angioedema.
TIPS ON WINTER ALLERGIES: To allergy sufferers, winter means the beginning of indoor allergy season. Allergens, such as dust, molds, and mites, though present year round, are particularly troublesome in winter when cold weather means more time spent indoors. Frequent and thorough dust cleaning, as well as maintaining adequate humidity (40%), may help to better control the symptoms. A small percentage of allergy sufferers are allergic to Christmas trees. The culprit is either the terpin in the tree (the substance that produces its scent) or the mold on the tree. Other holiday items, like scented candles, dusty decorations and smoke from fireplaces, can aggravate asthma and allergies.
PLEASE NOTE:
The information in this “News and Notes” represents general guidance in the
field of Allergy.
Nothing
herein stated shall be construed as a specific or implied treatment for an
ailment.
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