Hives are the result of fluid leakage in the small blood vessels. the leakage is frequently the result of an allergic reaction. however, there are other non-allergic immune processes that also can cause inflammation of the capillaries that dilate to produce the angry, red coloration. the dilated blood vessels also leak edema fluid that, in turn, raises the skin. Hives are the result when the leakage is superficial and near the surface of the skin. When the leakage goes deeper into the tissues, a swollen area is the result and is called angioedema. Hives can develop anywhere on the body from the scalp to the toes. Angioedema tends to involve the face, eyelids, lips, extremities, tongue, throat and genitals. these are the areas where there is a lot of spongy tissue under the skin, or internal lining.
The inflammatory edema of hives will irritate the nerve endings that are present in large number within the skin. it is the irritation of nerve endings that is responsible for the itching. Angioedema is deeper and further away from nerve endings, which is why they are generally not itchy. Sometimes angioedema may cause a tingling or burning sensation.
When hives and angioedema resolve, the skin appears normal because the edema fluid is a natural body component. if there are skin changes after the resolution of hives, an inflammatory condition called vasculitis should be considered. Hives usually last less than twenty-four hours and are then resolved. however, new crops of hives may develop one way or another within twenty-four hours. Angioedema may take longer to resolve due to the amount of fluid that is involved.
Treatment Of Hives
The key principle in treating hives is identifying the cause. if the cause is:
Food: avoid the food. Consider skin testing.
Medication: stop the medicine.
Systemic illness: treat the underlying illness.
When a causative agent is not immediately apparent, the symptoms will have to be treated. the main medications are antihistamines. There are several OTC options available. Benadryl and Chlortrimeton are medications that can be effective in controlling both the hives as well as stopping the itching. the drawback is the drowsiness that comes with the medicine. Erratic driving after taking these medications still constitutes DUI, so do not drive if you feel drowsy after taking these classic antihistamines.
The good news is that there is a new generation of non-sedating antihistamines; Claritin, Allegra and Zyrtec. When hives are mild, the first two mentioned are the first choice. if it is not effective enough, Zyrtec serves as a good middle ground between the non-sedating and classic antihistamines. There is a new, higher dosage of fexofenadine at 180 mg that is also very helpful. the management and choice of antihistamines has to be individualized, depending on tolerance and effectiveness of the medication. A combination of antihistamine also can be used.
It is important to understand that antihistamines have to be taken regularly and not as needed only when hives are present unless the hive attacks are rare. furthermore, it is important to take antihistamines several weeks beyond the last hives attack in order to prevent a relapse.
Hives usually improve at a slow gradual pace. As long as the frequency and intensity of the attacks are diminishing, the management plan is heading in the right direction.
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