Urticaria/Hives

urticariaUrticaria (also known as hives) occurs when an irritant breaks open white blood cells (mast cells) found in the skin. Broken mast cells release histamine onto nearby skin/tissues; histamine causes blood vessels to dilate (open), then leak fluid, in part producing the classic “raised, red wheal” of hives.

The wheals are usually itchy, red, and raised; they blanch when touched, occur anywhere on the skin, and may rapidly merge to cover large areas. Those who can write on their skin (dermatographism) or have angioedema (allergic large, firm, non-itchy red swellings) tend to produce hives. While most often benign and resolving in minutes-to-hours, certain associations or findings cause concern. Occurrences on the lips/tongue or larynx and/or shortness of breath require immediate emergency department evaluation. Painful or prolonged lesions leaving behind dark patches require specialist evaluation.

Irritants that break open the mast cells to trigger urticaria include heat, cold, pressure, exercise, sunlight, emotional stress, travel, infection, chronic medical conditions, medications (NSAIDs), and other chemicals. Food, perfumes or animal contact (allergic/IgE complexes) can trigger mast cell damage in some individuals, and there is an association between urticaria and autoimmune diseases such as Lupus. Urticaria resulting from exercise or emotional stress is referred to as cholinergic urticaria: sweat may trigger it, or there may a marked absence of sweat in these patients.

In acute cases, the diagnosis is usually made visually. For chronic cases lasting longer than six weeks, blood work for thyroid or autoimmune conditions may be helpful.

If there is no threat to life, conventional medical management includes antihistamines (specifically Zyrtec, others) and medication in the antacid class (Zantac, others) to help acute and chronic cases. In more severe cases, steroids, doxepin, and medications in the anticancer class can be used for prevention or acute/chronic treatment.[1]

In Traditional Chinese Medicine (TCM), urticaria causes vary by appearance and chronicity. As with any itchy skin condition, all hives in TCM have some component of “Wind” at the level of the skin. “Wind” conditions come on quickly, migrate rapidly, and resolve quickly. In acute cases, the “Wind” is accompanied by “Heat,” especially in when the lesions are hot to the touch. In chronic cases, the “Wind” can produce skin “Dryness” and accompany “Dryness of Blood.” If associated with “Spleen and Stomach Qi deficiencies and Dampness” (roughly correlates to allergic type), the lesions may leak clear fluid. Those whose symptoms occur with worry may have “Internal or Liver Wind” as the predisposing factor.

From the TCM perspective, It is interesting that Zantac may help urticaria. When urticaria appears on the face, it may be the result of “Stomach Heat or Stomach Phlegm/Fire”, which correlate to stomach acidic or inflammatory conditions.

Since the lesions of urticaria are temporary, acupuncture is less useful in the moment, but Chinese Herbal Medicine for both acute treatment and prevention is rather effective. Additionally, One-Needle Allergy Desensitization Therapy may actually eliminate or attenuate certain allergic responses, and could significantly reduce recurrence of certain cases of urticaria. Once the correct TCM diagnosis/underlying causative pattern is made, urticaria usually responds well.[2,3]

Learn more about Urticaria

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These brief overviews of conditions represent distillations of basic and current medical reviews from the following sources:

[1] Conventional Medical Sources

“Harrison’s Principles of Internal Medicine: Volumes 1 and 2, 18th Edition”. Dan Longo Anthony Fauci, Dennis Kasper, Stephen Hauser, J. Jameson, Joseph Loscalzo. McGraw-Hill Professional; (July, 2011)

Medscape eMedicine Physician’s online resource. Various review articles:

Allergic and Environmental Asthma: an Overview of Asthma
William F Kelly III, MD  Associate Professor of Medicine, Uniformed Services University of the Health Sciences; Staff physician, Division of Pulmonary/Critical Care Medicine, Department of Medicine, Walter Reed National Military Medical Center

Allergic Rhinitis
Javed Sheikh, MD  Assistant Professor of Medicine, Harvard Medical School; Clinical Director, Division of Allergy and Inflammation, Clinical Director, Center for Eosinophilic Disorders, Beth Israel Deaconess Medical Center

Food Allergies
Scott H Sicherer, MD  Professor of Pediatrics, Jaffe Food Allergy Institute, Mount Sinai School of Medicine of New York University

Atopic Dermatitis
Brian S Kim, MD  Clinical Instructor, Department of Dermatology, Hospital of the University of Pennsylvania, Perelman School of Medicine, University of Pennsylvania

Seborrheic Dermatitis
Samuel T Selden, MD  Assistant Professor Department of Dermatology Eastern Virginia Medical School; Consulting Staff, Chesapeake General Hospital; Private Practice

Psoriasis
Jeffrey Meffert, MD  Assistant Clinical Professor of Dermatology, University of Texas School of Medicine at San Antonio

Urticaria
M Scott Linscott, MD, FACEP  Adjunct Professor of Surgery (Clinical), Division of Emergency Medicine, University of Utah School of Medicine

Cholinergic Urticaria
Robert A Schwartz, MD, MPH  Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, University of Medicine and Dentistry of New Jersey-New Jersey Medical School

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