Chronic Hives: Preparing for the First Doctor's Appointment

by James Thompson, M.D. Health Professional, Medical Reviewer

Did you know that one out of five people in the U.S. will at some point in their life experience an episode of hives? At any given time, 3 million people in the U.S. will be suffering from chronic urticaria (CU), and it impacts women twice as much as men. If you have CU, no one has to tell you how devastating it is to your quality of life. Things most people take for granted such as a good night sleep, a productive day at work or school, time with family, friends or spouse, may be totally disrupted by CU. Sadly a specific cause is rarely found, but 10 percent of the time doctors can beat the odds, with help from the patient and lab tests.

Hives are distinct areas of the skin that are raised, often red, itchy, and look like welts. Sometimes the raised portion is pale but surrounded by red skin. Hives may be as small as a few millimeters, or several centimeters in diameter (giant hives) or length. An individual hive typically lasts for several minutes to hours but often not more than 24 hours. The technical term for hives is “urticaria."

Anywhere from 40 to 50 percent of the time, hives are accompanied by a deeper tissue (not distinct in margins) swelling called “angioedema.” In this case, an eyelid, finger, hand, lip, tongue or scrotum or another body part may swell. Some people have isolated episodes of angioedema without hives. The deeper swelling of angioedema may be associated with sensations of numbness and tingling.

When hives and swelling recur for six or more weeks, they are diagnosed as chronic urticaria and angioedema. When they are prevalent for less than six weeks, they are diagnosed as acute urticaria and angioedema. Successful management of CU begins with a thorough history and physical exam.

How to prepare for your initial doctor’s appointment

It will be a tremendous help to your doctor if you are prepared to answer these 20 questions:

  1. The date your hives first started (or at least how many weeks you’ve had them)

  2. On what part of the body did they initially start?

  3. About how large are the hives (smaller than a dime, larger than a quarter?)

  4. How often do they occur (daily, few days/week or less?)

  5. Have the hives been accompanied by swelling, and if so, what parts of the body?

  6. Has there been any lip, tongue or throat swelling?

  7. Has shortness of breath or lightheadedness accompanied the hives or swelling?

  8. Does heat, cold, pressure (for example from shoulder straps or waistband), scratching, sweating or vibration trigger your hives?

  9. Do any foods such as shellfish other seafood or nuts ever trigger hives?

  10. Have you been on any new medications, especially antibiotics?

  11. Do you take aspirin, ibuprofen or naproxen for pain relief or other ailments?

  12. Are you on any hormone pills or therapies (birth control pills for example)?

  13. Has there been any change in your menstrual cycle or have you been late with your menstrual period? (Is there a chance you could be pregnant?)

  14. Are you up to date on all cancer screenings for age and gender?

  15. Have you taken antihistamines for treatment and if so did they help?

  16. Are you on any medications for blood pressure or diabetes? Bring all medications to your appointment (or make a list of them along with doses prescribed)

  17. Do any other relatives have a history of chronic hives and or swelling?

  18. Do you have any recurring joint or muscle pains?

  19. Does any of the hives stay the same shape and size for more than 24 hours, become painful, leave a bruise or scar?

  20. Have you traveled outside of the country, been camping, had a tick or other bug bite?

If you can, also take a picture with a digital camera or cellphone camera if you have a flare-up of hives or swelling. Chances are by the time you see the doctor the hives will be gone. It’s true, “a picture is worth a thousand words.”

The cause of chronic hives and swelling is not often identified, but the good news is that in most cases it can at least be controlled. Your doctor will decide on a course of treatment which usually starts with a long-acting, non-sedating antihistamine. Several add-on antihistamine blockers and other alternative medications may be considered.


An overview on Chronic Urticaria

Chronic Hives: Making Progress in the Management of Chronic Urticaria

James Thompson, M.D.
Meet Our Writer
James Thompson, M.D.

Dr. Thompson completed medical school and specialty training in allergy and immunology at Washington University in Saint Louis. He is board certified in Internal Medicine, Allergy and Immunology. He sees adults and children in Chicago and greater Chicago area. He is also certified in Integrative Nutrition Coaching. Dr. Thompson is dedicated to incorporating holistic nutrition concepts into the treatment of asthma and other allergic diseases in order to achieve better health and reduce the need for medications.