My Aunt Mary was a beautiful talented musician who played the violin until her death at age 90. She studied Japanese at age 70, counted Lenard Bernstein as a friend, and taught me how to throw a dinner party for twenty without breaking a sweat. But at least once a week this force of nature was distraught by the appearance of hives.
She certainly had plenty of company. It is estimated that at some point in their lives, hives affect one in five people. For some individuals, like my aunt Mary, hives can be a lifelong problem. For others it can be a one time event that lasts a few hours to a few weeks.
What Causes Hives?
Hives are raised , red areas on the skin than can range for the size of a pencil eraser to an area as big as a frisbee. And unlike most other forms of sensitve skin, hives itch. In fact the irritation can be so severe that it can be impossible to sleep.
The list of causes is so long it might be easier to list what doesn’t cause hives. Heat and cold ( both weather and water), are all too common hive triggers. Medications like antibiotics and aspirin, exercise, sunlight, latex gloves, stress and food allergies ( shellfish, nuts, preservatives, eggs, and wheat) have been shown to provoke hives in sensitive people. Missing from the long laundry list of causes are skin care products. Unlike other causes of red, irritated areas on the skin, most cases of hives are triggered internally. Only about 40% of the time is it possible to actually identify what is provoking these itchy red whelts.
Best Way to Treat Hives
Whatever the cause, antihistamines are the first line of treatment for hives. The newer non-sedating antihistamines like Claritin and Zyrtec seem to help, especially when used twice a day rather than the usual once a day recommendation. If hives are persistant and last for months, adding an antidepressant can dramatically reduce itching. Cortisone in different forms can be prescribed in hard to treat cases. To provide almost instant relief in a severe hive episode, a doctor can administer an injection of cortisone. Steroid creams can offer itch relief while oral prednisone is saved for severe extensive hives that just don’t respond to anything else.
Aunt Mary struggled for years to identify the source of her hives. She came to believe that preservatives in foods were the culprits and she would read food labels carefully to spot potential problems. In restaurants she would quiz waiters exhaustively about the ingredients in a dish that tempted her. After she passed away, researchers determined that 30% of people with thyroid conditions also have hives– and my aunt had thyroid problems for most of her life. I suspect that this was the driving force behind her hives, but I learned to read while examining food labels while grocery shopping with my favorite aunt.