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Urticaria (Hives)/Angioedema (Tissue Swelling)

Urticaria (Hives)/Angioedema (Tissue Swelling)

Most “hives” are caused by histamine and other mediators “released” in the upper layers of the skin.

Histamine can be released from special cells, mast cells and basophils, which are found in everyone’s skin.

Patients with hives release “too much” histamine when it is not needed and are classified as:

  • “Acute hivers” only when they take in an identifiable “trigger”, i.e., drug, food, etc. or if hives last less than 6 weeks.
  • “Chronic hivers” daily or almost daily without an identifiable “trigger” and lasting for greater than six weeks.

In “chronic” urticaria or persistent hives, a “trigger” is rarely found. A “complete” history is needed to look for identifiable “triggers”.

The etiology for chronic urticaria such as medication, heat, pressure or infection is found in less than 5% of patients.

For most cases of chronic urticaria the etiology will remain idiopathic (cause unknown) although an autoimmune etiology can sometimes be found.

  • Angioedema (tissue swelling), occurs in 90% of patients with chronic urticaria

For chronic urticaria laboratory evaluation can be performed: Thyroid auto-antibody profile, CU Index, complete metabolic profile, complete blood count and autoimmunity tests.

Fortunately, most chronic hives go away with or without treatment:

  • 50% of patients hives go away in 3-12 months
  • 20% of patients hives go away in 12-36 months
  • 20% of patients hives go away in 36-60 months
  • 1.5% of patients can have hives for up to 25 years

60% of “chronic” hivers have recurrences of the hives

Management is directed toward keeping patients “comfortable” with or without some hives being present. This can be achieved with “appropriate” antihistamine therapy, and occasionally with “other” medications. Prednisone (steroid) should be avoided if at all possible.

Remember the potency of:

  • Benadryl 50mg. is considered — a strength of 1
  • Clarinex, Claritin, Allegra — a strength of 2-3
  • Atarax (hydroxyzine 25mg.), Zyrtec, Xyzal — a strength of 88
  • Doxepin (Sinequan) 25mg — a strength of 779

 

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Stinging Insect Allergy Can Ruin Outdoor Activities

When most people get stung by an insect, the sting site gets red, swells and itches. However, for those who are allergic to insect stings, their immune system overreacts to the venom in the sting. For some, a sting might be life-threatening. The reaction – anaphylaxis – is a medical emergency and could be fatal. Symptoms might include two or more of the following – itching and hives, swelling in the throat or tongue, difficulty breathing, dizziness, stomach cramps, nausea or diarrhea. Severe cases could bring a rapid blood pressure fall resulting in shock and loss of consciousness.

“If you’ve ever had a reaction to a sting, you may be allergic,” said OAAC’s Board-Certified Allergist Dr. Dean Atkinson. “If you’ve had an anaphylactic reaction, you should ask for a referral to an allergist to learn how to stay safe in the future.”

Indentifying Stinging Insects

“If you do get stung and have a reaction, pay attention to what the insect was so you can tell your allergist,” Dr. Atkinson said.

Honeybees and bumblebees only sting when provoked. Africanized honeybees also known as killer bees have been found in the Southwestern U.S. are more aggressive and may sting in swarms.  Domesticated honeybees live in man-made hives. Wild honeybees live in colonies or honeycombs in hollow trees or building cavities.

Paper wasps have nests made of a paper-like material that forms a circular comb of cells which open downward. Nests are often located under eaves, behind shutters, or in shrubs or woodpiles.

Yellow jackets have nests made of a paper-mache type material and are usually underground but can also be found in frame building walls, masonry cracks or woodpiles.

Hornets are usually larger in size than yellow jackets. Their nests are gray or brown, football-shaped and made of a paper material similar to yellow jacket nests. Hornets’ nests are usually found up in trees and shrubs, on gables or in tree hollows.

Fire ants build nests of dirt in the ground – sometimes the nests can be 18 inches tall in the right kinds of soil.

“Preventing stings is of upmost importance,” said Dr. Atkinson. “If you find a nest around your home, you should call an exterminator to have it removed.”

Insects usually sting when their homes are disturbed. If you encounter stinging insects flying around you, remain calm and move away. Avoid wearing brightly colored clothing and perfume outdoors.  The smell of food attracts insects. Be extra careful when cooking, eating or drinking sweet drinks like soda or juice. Insects can crawl inside straws or canned drinks. Keep food covered until eaten. Wear closed-toe shoes outdoors and avoid going barefoot.

Treating Stings

If the insect stinger is in your skin, remove the stinger within 30 seconds to avoid receiving more venom. A quick scrape of your fingernail will remove the stinger and venom sac. Avoid squeezing the sac – this will force more venom through the stinger and into your skin.

“Raise the limb and apply a cold compress to reduce swelling and pain,” Dr. Atkinson said. “Gently clean the area with soap and water to prevent secondary infections. Don’t break any blisters. You can use topical steroid ointments or oral antihistamines to relieve the itching.”

Dr.  Atkinson adds that if swelling progresses or the sting site seems infected, contact your physician.

“If you are severely insect-allergy allergic, carry auto-injectable epinephrine,” Dr. Atkinson said.  “Learn how to use it and keep it with you at all times. Also, some patients especially with frequent exposure to the outdoors start venom immunotherapy (allergy shots). It reduces the risk of a future severe reaction to less than 5 percent.”

Epinephrine is a rescue medication and someone will need to take you to the emergency room. Dr. Atkinson also suggests wearing a bracelet or necklace that identifies the wearer as having severe allergies.

“For those who have had a serious reaction to an insect sting, make an appointment with an allergist,” he said. “With proper testing, your allergist can diagnose your allergy and determine the best form of treatment.”

The post Stinging Insect Allergy Can Ruin Outdoor Activities appeared first on Oklahoma Allergy and Asthma Clinic.

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