Urticaria is a rash causing round, swollen areas on the skin. It can be tender, itchy and/or painful. People with light skin may see red, raised bumps or welts.
BPT - If you've had hives, you know how challenging they can be. But you may not know that there is more than one type of hives, or urticaria, and that treatments are available. A brief episode of hives is a nuisance, but when symptoms persist for weeks, months or years, it can take a physical and psychological toll.
What is urticaria?
Urticaria is a rash causing round, swollen areas on the skin. It can be tender, itchy and/or painful. People with light skin may see red, raised bumps or welts. In people of color, hives may match the color of surrounding skin or appear slightly lighter or darker. They may appear all over your body or in one area.
Urticaria occurs when chemical compounds involved in the body's inflammatory and immune responses are released. One of these chemicals is histamine, which is released by mast cells and basophils. When this release happens in the skin's outer layers, it results in hives.
Most hives resolve quickly, but they can become chronic. Acute urticaria refers to hives lasting one day to six weeks. Chronic urticaria means the hives have lasted for six weeks or longer. For many people, the cause is unknown.
Chronic urticaria eventually goes away by itself.
Chronic urticaria is a rare condition that occurs in only 23 out of 10,000 people, though the actual number may be higher, since many people do not report or recognize the symptoms. Chronic urticaria is most common in adults aged 40-59. More women than men are affected, and more Black Americans and other ethnic groups are affected. There are two types:
Chronic idiopathic urticaria (also called chronic spontaneous urticaria) is not triggered by external factors. In many cases, the cause could be an autoimmune condition, another systemic disease like cancer, or unknown.
Chronic inducible urticaria is caused by certain environmental and physical factors.
Identifying urticaria triggers
Common triggers include:
Allergens, including certain foods
Exposure to heat/cold
Tight clothing
Insect stings and bites
Infections and viruses
Medications such as antibiotics and NSAIDs
Diseases including asthma, celiac disease, diabetes, lupus, rheumatoid arthritis, thyroid disease, vasculitis and vitiligo
Stress
Diagnosis and treatment
The cause of your chronic urticaria may be hard to identify. It's best to see a specialist such as a board-certified allergist or dermatologist for diagnosis and treatment.
Your doctor may perform allergy tests, lab tests or a skin biopsy to rule out other conditions that involve or resemble hives. You can help by keeping a diary that tracks your symptoms.
Chronic urticaria eventually goes away by itself. Management focuses on the most appropriate treatment to control symptoms, usually starting with the first line of treatment: a long-lasting antihistamine.
Antihistamines block production of histamine to reduce or eliminate hives and ease itch and swelling. Ask your doctor for a non-sedating antihistamine.
Topical itch creams may provide mild relief for hives that do not cover the entire body.
Corticosteroids: Topical corticosteroids reduce inflammation, irritation and itching. By reducing inflammation, they also promote healing. For a severe hives flare-up, a short course of oral corticosteroids (prednisone) can help reduce inflammation and itching. These medications can cause serious side effects, especially if taken long-term. It's important to follow your doctor's instructions when taking oral corticosteroids.
Advanced treatments
It's important to work closely with your doctor if your hives don't respond to treatment. If antihistamines alone do not help, your doctor may recommend combining them with other medications, including leukotriene modifiers or H2 blockers. New advanced treatments are available, and more are in clinical trials or undergoing FDA review.
Biologics: Omalizumab is a biologic medication used to treat chronic urticaria when antihistamines haven't worked. Two more biologics are in development as chronic urticaria treatments: dupilumab is in FDA review and briquilimab is in clinical trials. Biologics work by targeting cells and interrupting the inflammatory process. This stops or reduces symptoms. Biologics are injectable medications typically given once per month.
Cyclosporine: This is an oral medication that calms the immune system to prevent hives from occurring. It can be taken along with antihistamines. Since cyclosporine is an immunosuppressive, it can decrease the body's ability to fight infections. Talk with your doctor about side effects and the benefits vs. risks of taking this medication.
Bruton's tyrosine kinase (BTK) inhibitor: Remibrutinib is an oral medication in clinical trials. It works by blocking the activation of mast cells and basophils. These cells release histamine and other inflammatory mediators that cause hives, swelling and itching. By blocking this process, remibrutinib can reduce or eliminate symptoms.
Hives and mental health
It's important not to blame yourself for your hives. If you're feeling anxiety, depression or embarrassment about your skin condition, talk with your healthcare provider or a mental health specialist. Support groups for people with urticaria also let you share experiences and know you are not alone.
Don't let chronic urticaria impact your quality of life. Talk to your doctor. Check out the Chronic Urticaria Toolkit at ChronicHives.info.
This spring, protect yourself from those triggers that you know will make you uncomfortable.
Photo: Corina/Pixabay
by Paul Arco OSF Healthcare
ESCANABA, MI - If you grew up without suffering from seasonal allergies, consider yourself one of the lucky ones.
But if you’ve reached your 40s or 50s and are now feeling miserable during the spring and fall months, welcome to the club. Adult-onset allergies are a real thing. And it happens to a lot of people.
Nearly 1 in 3 adults in the U.S. have seasonal allergies, eczema, or food allergies, according to recent data released by the Centers for Disease Control and Prevention (CDC). Nearly 75% of those are older than 45. Many of those people developed allergies in adulthood or were not diagnosed until they were adults.
Experts are unclear why or how allergies develop in adulthood. Some theories include moving from one geographic region to another, having a reduced immune system or owning a pet for the first time in your life. There is a belief, however, that having one severe allergic reaction or symptoms during childhood can increase your chances of developing allergies as an adult.
Breanne Gendron OSF Nurse Practitioner
Many people who develop allergy symptoms early in life will outgrow their allergies by their 20s or 30s. But, really, it’s possible to develop an allergy to something – whether it’s an animal or pollen – at any point in life.
“People will have them as kids and sometimes grow out of it,” says Breanne Gendron, a nurse practitioner with OSF HealthCare. “Then the alternative happens, where something starts bothering you as you age. That’s when we teach you about all the different medications you can use to control your symptoms.”
Gendron says most people are bothered by things that bloom and that includes trees and grass in the spring. Ragweed pollen or other weed pollen are problematic in the fall. Spores from molds and fungi are typically around in warm-weather months. And don’t forget about house dust mite allergens, which tend to be present throughout the year.
Most allergy symptoms, while annoying, are mild. Examples are sneezing, itchy eyes and runny nose. In her practice, Gendron notices more adults suffering from sinus infections with their allergy issues, more so than her younger patients.
“The dilemma about having untreated allergies is that you can get extra congestion in your sinuses, which could lead to a sinus infection,” Gendron says. “When you get pressure in your face, and you generally feel a little rundown, then we want to treat you for that.”
Gendron recommends treating allergies with a combination of oral antihistamines, eye drops and steroid nasal sprays. Allergy shots may be in order as well. But first, talk to your doctor to see if you are a candidate for a skin test to determine your specific allergies. “Once the medication gets your symptoms to calm down, you can generally keep it in check with less medication,” she says.
There are other things you can do to help minimize your symptoms. Gendron recommends things like eliminating carpet in your bedroom and washing your sheets regularly to eliminate dust. Consider taking a shower before bedtime, especially after being outside, and keep the windows closed at night to prevent pollen from entering the home.
This spring, protect yourself from those triggers that you know will make you uncomfortable.
“If you are bothered by something in the environment and you know that it bothers you, such as mowing the grass or raking leaves, do yourself a favor by wearing a mask to prevent yourself from breathing in more allergens,” she adds. “And take your allergy pills before you do those things, to make sure that you're going to have less of a reaction.”
DANVILLE - Spring allergies will be here soon. If you’re suffering from a runny or congested nose, watery or itchy eyes or sneezing, it’s tempting to grab the first medicine that catches your eye at the pharmacy or rifle through the bathroom drawer for some pills you’re hanging on to.
Not so fast, says Maddy Draper, APRN, a health care provider at OSF OnCall. She says it’s important to know what to take and when in order to avoid side effects that can be serious.
Photo provided
Maddy Draper, APRN
What to take
Draper says an antihistamine like Astepro, Zyrtec, Allegra or Benadryl is a typical first line of defense.
“There are also decongestants for severe nasal congestion or sinus pain and pressure,” Draper adds. Sudafed is a well-known decongestant.
If a more severe case brings symptoms like face swelling or wheezing, Draper says treatment could be a steroid like Flonase or prednisone.
For more chronic (in other words, long term) allergy cases, the U.S. Food and Drug Administration says a provider may recommend immunotherapy to build up a tolerance. This could be an injection or a tablet under the tongue.
Misuse
It may not seem like over the counter allergy medications are ripe for misuse, but it can happen.
Draper says antihistamines, especially Benadryl, can make you drowsy. If you take too much or take it at the wrong time, you could, for example, find yourself sleepy behind the wheel. Or your attentiveness at work or school could suffer.
On the flip side, Draper says Sudafed can make you jittery, irritable or cause heart palpitations (the feeling of an irregular heartbeat). This could be a big issue, she says, for people with a heart condition.
“We want to avoid nasal sprays for people with nasal trauma. Things like a deviated septum or nasal sores,” Draper adds. “Putting something up the nose could cause further tissue damage.”
Draper says to take medication as directed by your provider. Or if it’s over the counter, follow the label instructions. She says these medications typically take a couple days to start working. So don’t be tempted to take an extra dose if you’re not seeing relief right away.
Think of the children! (and seniors)
Children and seniors may be more impacted by the side effects of allergy medications. An older adult who takes Benadryl, for example, may be drowsy to the point that they fall and suffer a serious injury.
So, Draper says providers will typically start with an antihistamine that doesn’t make you super drowsy. She says Zyrtec is approved for ages six months and up, and that’s often where providers will start.
“Any antihistamine label is going to tell you to consult your provider for use under the age of two,” Draper says. “So you’ll need to be seen by a provider or your pediatrician.” This could be a virtual visit or a message to your provider in your patient portal.
Plan ahead
Draper says knowing your allergy triggers and acting accordingly is key to avoiding unpleasant symptoms. For example, you know grass clippings will cause an allergic reaction, but you have no choice but to mow the lawn.
“Primary care providers and allergists typically recommend starting the medication prior to exposure,” Draper explains. “If you know you’re going to be outside on that windy, dry day to mow, start the antihistamine a couple days prior so it can fully take effect.”
If you can’t get a handle on a known allergy, or if you have unexpected allergy symptoms, Draper says it’s never a bad idea to go to an urgent care.
Or if you find yourself looking for an over the counter medication option: “Just ask the pharmacist,” Draper suggests. “They’ll give you recommendations.
“There’s usually a specific aisle for allergies,” she adds. “Find the right antihistamine. Flonase is another big one we see people use.”
DANVILLE - When the temperature starts to warm up, so does the concern for allergies. But one condition – allergic rhinitis, commonly known as hay fever – isn’t confined to March, April and May.
Edward Jenner/PEXELS
“It’s the most common pediatric medical condition that exists,” says Luis Garcia, MD, a pediatrician at OSF HealthCare. That adds up to 40% of children, he says.
Dr. Garcia says allergic rhinitis describes chronic swelling of the tissue inside your nose due to an allergic reaction. It’s commonly triggered by inhaling irritants like dust, pollen and bacteria through the nose. Sneezing, itchiness and a blocked or runny nose often follow.
Dr. Garcia says risk factors include a family history of allergies, being a first-born child, being male, being born in the spring or summer and a heavy exposure to antibiotics in the first year of life.
The first line of treatment for allergic rhinitis is prevention, Dr. Garcia says. How does a person avoid the irritants that cause the condition? We can’t all move to climates that suit our health, he jokingly points out. So other options include:
Close doors and windows in your home.
Use an air purifier to remove dust from the air.
Avoid touching your face.
Keep your home clean, especially if you have pets.
Watch the weather forecast. If you know a dry, dusty day is coming, stay indoors.
Keep a journal of when your allergies are at their worst. You may be able to pick up on patterns and avoid triggers.
Dr. Garcia says a provider can usually see how severe your case is by examining you. But a blood sample or a skin prick test may be needed to determine your triggers. Treatments a doctor may recommend include:
Flushing your nose with salt water
Medication including antihistamines
In more severe cases, a specialist like an ear, nose and throat doctor may try immunotherapy.
“Immunotherapy sort of helps your body switch on and switch off the immune responses,” Dr. Garcia explains. “You could get it in shots or take the substance under the tongue.”
Photo: sweetlouise/Pixabay
When left untreated, allergic rhinitis can cause infections, polyps and sleep issues. Problems tend to compound, Dr. Garcia says. For example, when we have a stuffy nose, we can’t breathe well. Then we can’t sleep well. Then we suffer at school or work, increasing stress and the risk for anxiety and depression.
In other words: “We function as a whole. We always try to separate ourselves into different organs, and that’s simply not true. When one part of us is not working well, there is always something else affected,” Dr. Garcia says.
BPT - If you regularly experience the symptoms of seasonal allergies, you know how miserable they can make you. The congestion, sneezing, runny nose and itchy eyes can really disrupt your daily routine. During the months when pollen counts are high for common allergens you are sensitive to, it's a good idea to take some proactive steps to help reduce the presence of those allergens in your home, as well as your exposure to them.
Photo: sweetlouise/Pixabay
Here are simple steps you can take that can make a big difference for your symptoms.
Stay updated on current pollen counts
Checking on the daily pollen counts in your area can help you make smart decisions around exposure for you and anyone else in your household who has allergies. On days when the counts are high, you may want to limit the time you spend outdoors, or wear an N95 mask if you do need to be outside for a while. This can help reduce your direct exposure to the pollen that's floating in the air.
You'll also want to make sure to keep all your windows closed on high pollen count days, and let the filter in your HVAC system (and any free-standing air purifiers you may use at home) get to work on keeping your home's air as clean as possible. Regularly replacing filters is also a good idea - and even more frequently than manufacturers' recommendations, if your allergies are severe.
Keep clothes and other items free from allergens
Did you know that you can help remove allergens from clothes and fabrics in your own home? With LG Styler® Steam Closet with TrueSteam® Technology and Exclusive Moving Hangers, you can keep all your clothing and any other items clean, refreshed and deodorized while also helping remove airborne allergens like pollen, pet dander and dust - without using any harsh chemicals.
The LG Styler Steam Closet is easy to install - all you need is a standard outlet - and has a slim design, so it's easy to find a place to use it in your laundry room, bedroom or elsewhere in your home. TrueSteam Technology is a chemical-free steam-generating powerhouse that uses hot vaporized water to penetrate all kinds of fabrics. As the hot steam circulates, the hangers included will vibrate side to side to help shake out dust, allergens and odors.
Because of its effectiveness in helping remove airborne allergens, the LG Styler Steam Closet is certified by the Asthma & Allergy Foundation of America (AAFA). You can even use it for cleaning and removing pollen from hard-to-wash items including backpacks, stuffed toys, gloves, jackets and towels.
Even better, you can pair the LG Styler Steam Closet with Alexa or Google Assistant, or use the ThinQ App to download specialty care options, remotely check on remaining cycle time and more. Visit LG.com to learn more.
Reduce pollen, dander and dust on floors
It's all too easy for allergens to settle on the floors throughout your home, so it's best to keep them as clean as possible. If you can replace carpets with flooring that's easier to keep clean, that is one recommended tactic. If not, use a vacuum cleaner with a HEPA filter to keep carpets clean, at least once or twice a week. Consider shampooing your carpet every two to three months to keep it as clean as possible, or you could hire a professional carpet cleaning service.
For hard surfaces, regular vacuuming and mopping can help keep airborne allergens from accumulating. Make sure to wear an N95 mask while you're vacuuming to help protect yourself from dust, dander or pollen that gets kicked up while you're cleaning.
You don't have to be at the mercy of allergens, even on days when the pollen count is high. Following these strategies should help you reduce your allergy symptoms this season - and throughout the year.
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