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Hives: Diagnosis and treatment


How do dermatologists diagnose hives?

When a patient has hives, a dermatologist can often make the diagnosis by looking at the skin. Finding the cause of hives, however, can be a challenge. This is especially true for hives that have been around for more than six weeks.

To find out what is causing your hives, a dermatologist will review your health history, ask questions, and do a physical exam. You may also need the following tests:

  • Allergy tests (on the skin or blood tests)

  • Blood work (to rule out an illness or infection)

  • A skin biopsy

To perform a skin biopsy, your dermatologist removes a small piece of affected skin so that it can be examined under a microscope.

How do dermatologists treat hives?

For a mild or moderate case of hives, the most common treatment is a non-sedating (does not cause drowsiness) antihistamine. Antihistamines relieve symptoms like itching.

Antihistamines are also prescribed to treat chronic (lasting longer than six weeks) hives. When prescribed for chronic hives, you take this medicine every day to prevent hives from forming. There are many antihistamines on the market. Some make you drowsy, and some do not.

Medicines that dermatologists prescribe to treat hives include:

  • Antihistamines.

  • Corticosteroids like prednisone. These are prescribed for short-term use due to side effects with long-term use.

  • Dapsone. This is an antibiotic that can also relieve redness and swelling

  • Omalizumab. This injectable medicine can help patients with chronic idiopathic urticaria (CIU), a type of hives that can last for months or even years.

  • Other medicines that fight inflammation. These treat redness and swelling.

Ask your dermatologist about possible side effects (health problems that can result from the medicines).

For some cases of hives or angioedema (a condition similar to hives, but the swelling occurs deeper in the skin), you may need an injection of epinephrine (shot of adrenaline).

All medicines have possible side effects. Be sure to ask your dermatologist about possible side effects (health problems that can result from the medicines).

Treatment for chronic hives

To treat a type of chronic hives called CIU, which can last for six weeks or longer and sometimes years, the Food and Drug Administration has approved two medications—antihistamines and omalizumab.

Research shows that up to 50% of people with CIU continue to have hives after treatment with antihistamines. Omalizumab, which is injected under the skin, has been shown to relieve the itch and clear hives in some people with CIU. In one research study, 36% of patients treated with omalizumab reported no itch and no hives after treatment.

Outcome

For most people, hives are not serious. Children may outgrow the allergies that cause their hives.

Some people with chronic (lasting more than six weeks) hives, see the hives go away on their own, often within a year. For many people with a chronic case, however, the hives come and go for months or years.

If the hives remain or becomes severe, it’s important to get medical care. Hives can be a sign of an internal disease. Some people develop severe swelling .

If you have hives and trouble breathing or swallowing, get emergency care right away.

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