There I was, sitting on a plane ready for a much-needed vacation, when I heard “If any physicians are on the plane, please press your call button.” As a pediatric allergist, the last time I cared for an adult in an emergency was as a 3rd year medical student. To my relief, after hitting my call button I was asked to weigh in on a little girl experiencing hives.
Hives – red bumps that can quickly overtake the entire skin – are extremely itchy and uncomfortable and can be alarming. As a community, we are used to thinking about hives as an allergic reaction. It is for good reason we think about allergies when we see hives: up to 90% of people experiencing an allergic reaction can have hives, but that is only one possible cause. Most hives are not actually caused by an allergic reaction. Lucky for us, the little girl on the plane was not having an allergic reaction.
What Causes Hives?
If it’s not an allergy, what else can cause hives? The list is endless: stress, viral infections, activity, skin irritation…and sometimes nothing at all. Some people just have a tendency towards developing hives and are not reacting to an external trigger. Imagine a situation where a smoke alarm sounds off no matter what is going on: turning on the kitchen sink, opening the trash can, getting milk out of the fridge. At some point, one would realize these activities are not causing a fire, but the smoke alarm is just going off for no reason. Sometimes, our allergy cells can behave like this over-zealous smoke alarm.
Should I Worry About Hives?
Hives are usually nothing to worry about. The first thing to make sure is the hives are not a part of an allergic reaction. Usually this is easy to distinguish. If the hives come and go without any rhyme or reason, they are not part of an allergic reaction. Hives that have been going on for longer than a few hours are rarely, if ever, part of an allergic reaction. Hives that come up suddenly while eating something may be an allergic reaction. However, allergic reactions usually also have other symptoms associated with them.
Hives very rarely can signal another problem. However, this is the exception and usually applies to hives that get progressively worse, do not respond to medication and are associated with other symptoms.
What Can I Do About Hives?
Hives can be very uncomfortable so it is important to try to suppress the hives. The best way to treat hives is by using anti-histamines, which are the same medications used to treat allergies. Sometimes the dose of antihistamines needs to be increased up to four times the usual, but normally just doubling the dose is sufficient. If your child is still having hives, check with your doctor regarding increasing the dose. There are other medicines that can be used to treat hives in the rare times that antihistamines alone are not working.
The next time you spot some hives on your child, make sure to give them some antihistamines and keep on using the medicine until the hives go away. See your child’s doctor if hives are not getting better, but keep using the medicine until the appointment.
Irene Mikhail, MD is a member of the Section of Allergy and Immunology at Nationwide Children’s Hospital. She loves improving the quality of life and safety for children with allergies, asthma and eczema. She has a particular interest in treating children with food allergies and performing research to increase our understanding of the development and treatment of food allergies,
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