Hives: The Allergist's role in helping patients

This summer I have been seeing a number of cases of hives, or urticaria (medical term). In some cases it is just annoying, but at other times it can be incapacitating. Hives can appear anywhere on the body or face, and typically are very itchy. They look like small or giant mosquito bites and usually will come and go. My job as an allergist in New York is to try and find the cause of the hives, so that hopefully by eliminating the trigger the problem will resolve. Dermatologists and Family Practitioners will normally recommend antihistamines to relieve the symptoms- this should give temporary relief, however, typically the hives will return despite medication.

My approach to find out what is causing the hives is a good history: I find out what you are eating and drinking and see if there are any potential allergens. I will ask any medications that you may be taking- any medication, an antibiotic or common pain reliever like aspirin or Motrin can be a cause. And of course, I will try to see if you have had any unusual exposure by an environmental or contact allergen. After the history, I will usually do some form of testing either simple skin tests (which are like plastic toothpicks) or with a blood test to investigate for any internal problems. Finding the cause in chronic hives takes a good medical detective, and a good patient to give the clues.

Interesting case: Several years ago, a man in his 50’s came to me suffering terribly from chronic hives. He brought in a bagful of medicines that he was given by other doctors. He still wasn’t better. He was on cortisone pills and antihistamines, but still had daily hives. After a few visits, and carefully reviewing all his medicines I had the answer: he was taking aspirin for prevention of heart disease and I had him stop the aspirin and within a week the hives disappeared. The funny part was he was great for several years, when I got a phone call from him that the hives had come back- he was panic stricken. I carefully reviewed with him if anything was different. He mentioned his stomach was upset recently and he took Alka-Seltzer for relief.

I asked him to check the ingredients on the Alka-Seltzer- sure enough, it contained aspirin. My advice to him, next time he has stomach upset, choose Mylanta.

Dr. Dean Mitchell
Mitchell Medical Group, NYC & Long Island

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