Prem Menon, M.D. Vimla Menon, M.D.
Asthma, Allergy and Immunology Center
Chronic (of more than 6 weeks duration), spontaneous Urticaria affects nearly 20 % of the population. Urticaria, especially when complicated by angioedema (swelling), can have a devastating effect on quality of life. Causes of hives are unknown in majority of cases. It is commonly considered a mast cell disease. White blood cells called basophils may also be involved. Inflammatory cells infiltrate plays a major role in initiation and perpetuation of hives. Hives in some patients may be due to an autoimmune process. Allergy may play a role in some cases. Surprisingly, allergy injections seem to be equally effective in autoimmune and non-autoimmune hives.
50% of patients with hives have extremely sensitive skin which develops hives upon scratching. This is called dermographism.
Itch is the predominant symptom. Most patients with Urticaria rub then scratch the itchy wheals.
If the trigger is not identifiable, the hives are considered to be IDIOPATHIC. Some patients with hives may undergo extensive testing. Skin biopsy may be necessary in some.
The best approach for management of hives is to identify the cause if possible and prevent the trigger. Hives are treated with high doses of one or multiple antihistamines. Intractable cases are treated with leukotriene modifiers, anti-inflammatory agents or immune suppressants. At AAIC, patients not responding to standard therapy are offered the add-on therapy, i.e. anti IgE (Xolair).
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