Itchy Skin and Daily Hives -- Causes and Treatment

Frequently I see patients who develop rashes or hives for unclear reasons.

Unfortunately when people experience hives on nearly a daily basis, finding the cause is even harder than if the patient experienced them only infrequently. Even so, it is still important to visit the doctor to have an evaluation.

During the doctor visit

What I usually do when a patient comes in with hives is to first ask the patient if they have been using any new soaps, detergents or beauty products. Sometimes people can develop allergies or hives from these products.

We also ask about any other changes in health such as unexplained weight loss, joint pains, night sweats.

We will want to know how long the hives last and what they look like.

One good thing to do is to take a picture of the hives and bring in that picture to the doctor.

Although food allergy is rarely a cause of almost daily hives, we also ask if there is any relationship between eating specific foods and the hives.

The foods that tend to be the most problematic in adults when it comes to food allergy are peanuts, tree nuts (such as walnut, almonds, hazelnuts, cashews, etc), shellfish and fish. We may sometimes ask a patient to keep a “food diary” to record what they eat and if there was any reaction after eating. We can also learn if food allergy is causing the hives (usually not likely) by a blood test.

Also when people get hives, we want to know if it is related to exercise or cold water as these can sometimes cause hives.

Hives may also be caused by something called “dermatographism” which basically means that you can take your fingernail and rub it against the skin and it will cause a hive just from the mild pressure.

There are also other causes of hives which need to be excluded such as certain types of cancer, lupus, thyroid disease and liver diseases. Allergists can determine if these causes are leading to the development of hives by doing a blood test and possibly a chest X-ray. We can also learn if food allergy is causing the hives (usually not likely) by a blood test.

Treatment for daily hives

However, as I mentioned before, many times we can not find what causes the hives. It may be that a person’s body is producing antibodies that irritate some of the inflammatory cells, causing them to produce proteins which lead to hives.

Then we just try to treat the hives, even though we don’t know the cause. The first medication that we use is antihistamines, some of which can be bought over the counter. Many times we need to increase the dose to the higher than normal. If antihistamines don’t work, we can add on additional medications such as antacids, like Pepcid. However, I would like to stress the importance of seeing an allergist or another doctor for the evaluation of hives that happen daily.