Hives–Sensitive Skin, Part 3

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.

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