In her quest to find the triggers of her chronic hives, Holly Swoape has tried it all. She’s seen many different doctors, endured allergy testing, spent a month on a “whole foods” healthy diet. And off-and-on over the years, she’s tried to keep a chronic hives diary to record her symptoms and potential triggers—which in her case appear to be food-related.
But the task was time consuming and left this busy mom of two young children feeling overwhelmed. She would often give up journaling after just a few weeks.
“I’ve seen many doctors over time and I’m sure they’ve all recommended me keeping a diary. But in reality, it’s not that feasible,” said Swoape, who has had chronic hives for a decade. “Of course I want to get better, but... most days I feel like I’m doggy paddling, just trying to get through life.”
Swoape isn’t alone in her frustration, said Dr. Spencer Hawkins, a dermatology resident at the University of Michigan.
The key to keeping up with journaling long enough to determine triggers, Hawkins says, is to find ways to streamline the process and to help patients understand just how helpful the journal can be.
The Basics of How to Keep a Chronic Hives Diary
Hives are red, swollen welts, or wheals, on the skin that are often extremely itchy. They can vary in size and appear quickly and fade within a few hours. Hives are often a reaction to something a person came in contact with, including foods, medication, allergens, or something in the environment. At times, they can be a symptom of an underlying medical condition.
Chronic hives, also known as urticaria, is when this condition lasts longer than six weeks, often leaving people feeling miserable and frustrated as they try to determine the cause. A chronic hives diary can be a helpful tool to determine triggers and can help patients feel more invested in their treatment, Hawkins said.
A basic hives diary records whenever you have a hives episode, the date and approximate time, and the location of the hives. You should also record and any other symptoms, including angioedema, which is a swelling similar to hives, but in the deeper layers of the skin.
You should note any possible triggers, anything that you think could be causing hives, such as stress, certain foods, medications, sun or heat, exercise, pressure on skin, insect bites, and exposure to cold, Hawkins said. You should also note changes in health or illness, as well as logging treatments or medications, and if they were helpful or not.
“In some cases, triggers can be identified and with elimination, symptoms may improve or resolve completely,” he said.
Tools to Streamline the Process
There are both high-tech options and traditional tools that can help patients track chronic hives symptoms, triggers, and treatments. One tool is likely close at hand: your smartphone, and more specifically, the applications available for download on your smartphone.
Such apps include AAD Hives, My Hives Diary, and CIU Tracker. Target My Hives is another app that helps connect the chronic urticaria community, including tracking day-to-day conditions to get support through painful stretches. These apps include easy-to-use templates that a user can quickly fill in to track symptoms.
Hawkins, who has developed several dermatology-related websites, is most familiar with AAD Hives, which he likes because it was developed by the American Academy of Dermatology. AAD Hives allows users to add their own notes; track symptoms using drop-down menus; and snap pictures of their hives during flares. Hawkins reviewed the app’s pros and cons for the magazine, The Dermatologist.
Using a notebook and taking photos to log symptoms
For those who prefer to stay low-tech, paper and pen work fine, too, Hawkins said. You may find it effective to keep a notebook handy in your backpack or purse.
The website, www.Uticariaday.org, an international group hosted by nonprofit Irish Skin Foundation, offers a downloadable worksheet that can be printed out and used to keep track of hives breakouts and related triggers.
Hawkins also recommends keeping a photo diary of your hives, which you can do using the camera feature on your cell phone. This will help your doctor get a visual on your symptoms over time, but may also help determine if there’s something else going on, he said.
“One of my patients was frustrated that he developed urticaria on his wrist, however, he took pictures of the lesion over several days and realized the site happened to coincide with the band of his new watch. Removing the watch eliminated his symptoms,” Hawkins said.
Patients may not know the difference, but a picture can help show the subtle differences between different skin conditions, he said.
Getting patients get more involved in their care
For patients with chronic hives, keeping a symptom diary, whether through a notebook or an app, can have other benefits as well, Hawkins said.
A diary can prompt you to take your medications on time and keep symptoms under control. Over time, many patients begin to drift away from following their treatment regimen, Hawkins said. Also, if you use a diary with template, if can serve to remind you of common triggers which you may forget to look for.
"We’re looking for tools that will make patients more invested in their condition," Hawkins said. “Anything that helps patients learn more about their condition and help them feel empowered to control it has the potential to improve the outcome.”
However, even with following all the recommendations above, some chronic hives patients may not be able to identify triggers, and in these cases it is important to work with your dermatologist on a medical treatment regimen to improve symptoms, Hawkins said.
Sometimes it takes trial and error
As for Swoape, even after keeping a diary for 30 days straight, she still hasn’t been able to determine exact triggers. Over time, however, she has realized that her hives may be connected to eating foods high in histamine, such as tomatoes, olives and avocados, or eating junk food. She’s discovered that when she’s having a flare-up, taking cetirizine hydrochloride (Zyrtec) will usually bring her hives under control. And she knows she needs to engage in self-care to keep up her overall health.
“I know that I need to really take good care of myself. I need a full-night’s sleep, I need exercise and positivity. And, I need to eat well,” Swoape said.