I see enough patients with #hives that I sometimes get frustrated with our current treatment options and it doesn’t help when patients have the wrong idea or views about how hives behave. Vicki Lawrence to the rescue! I applaud her commitment to the truth about “idiopathic hives” and encourage you to listen to her video below (then learn how to avoid frustration with your own hives).
A little information about how hives behave can go a long way in understanding how to treat them.
- Remember, idiopathic hives have a mind of their own! It’s rare to be able to predict when hives will appear. When I interview patients on when the hives appear and what triggers occurred before the onset of the hives, I rarely get a consistent story. Here’s what I mean by this. I eat red meat one day and the hives appear 4 hours later, but the next five ingestions of red meat cause absolutely no hives. Probably not the red meat or the occurrence would be more consistent. Usually when you can identify a consistent cause of your hives, you don’t show up in my office!
- You would think in this day and age of modern medicine that a lab test could find the cause of your hives. Did you know that in 70% of hives, there is no test that can find the cause of your hives. I know it’s frustrating but true. What tests are usually performed? I will routinely test for allergy to inhalants (that’s the mold, pollen, animals) and foods in case you’re part of the 30% with a food allergy. Medications can always be implicated in hives, but usually a good history can find the culprit. Now that means if you stop the medication and the hives persist, it’s probably not the discontinued prescription. I also like to test for inflammation in the body using complete blood count, sedimentation rate, C-reactive protein, and complete metabolic panel. #Autoimmunity is also a good condition to identify if present. Autoimmunity occurs when the body reacts against itself producing symptoms of joint & muscle aches and occasionally hives. Testing can be performed with blood work to find “auto antibodies” that serve as markers for this condition.
- Patients are petrified that their hives will last for many years, resulting in many side effects from medications such as prednisone. (and who wants to gain all that weight?) The good news is that most hives will disappear within one year of their onset. Unfortunately, I (or anyone else) can’t predict who will outgrow their hives and who will be left with chronic hives lasting for years. This is my advice to those who have chronic hives: stay on your medication (usually antihistamines) for at least 6 months before you experiment, stop your medication and see if you still need them. Every time your hives get worse (we call this an exacerbation or flare), you need more medication to control the flare. Imagine this scenario that I wish was more rare than it is. You develop hives and have to use steroids, antihistamines, and montelukast to control the symptoms. No one told you that hives can last for many months at a time, so you stop your medication and to your dismay, the hives return. Back on the prednisone and off to the gym to lose the added pounds. Now if you would just stay on the antihistamine for a good 6 months, you should be able to break the cycle.
- This leads me to my next suggestion on how to avoid the frustration of treating hives. Most of the antihistamines you use for hives are safe when used as prescribed for many years in a row. It’s good news that most of the potent antihistamines that previously require a prescription are now OTC and readily available almost 24 hours a day. I like the combination of Zyrtec (cetirizine) 10mg at bedtime combined with Zantac (ranitidine) 150mg twice daily. Other alternatives include Allegra (fexofenadine) and Claritin (loratadine), but please don’t use Benadryl unless you have no other choice. Why? Benadryl isn’t a very strong antihistamine, but it does make you tired. So….if you don’t want to sleep through work, there are better alternatives.
So what if the above treatment doesn’t work for your hives? Fortunately, you’re not left with a life of prednisone or it’s side effects. Other medications that reduce your need for steroids include dapsone, cyclosporine, and my favorite, #omalizumab (Xolair).
For those really tough cases of hives, Xolair can be very helpful with 1-2 injections every month to control the hives and avoid the side effects of steroids. Believe me it’s better than puffy cheeks and excessive weight gain. So next time you’re frustrated with your hives, remember the advice from Vicki Lawrence and give our office a call (918-495-2636) to see if you qualify for something other than Urgent Care visits and steroid shots.