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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

 

Recent News

SuperUser Account
/ Categories: News

Very High Tree Pollen Levels Return

One of the Highest Levels of Tree Pollen Detected in the United States for 3/4/2026

March 4, 2026

VERY HIGH RANGE: ALLERGY ALERT. COMBINED TREE POLLEN COUNTS ARE AT VERY HIGH LEVELS on Wednesday, March 4th, 2026

The alert is due to cedar pollen counts in the VERY HIGH RANGE and COMBINED Cedar (Mountain Red Cedar and Ashe Juniper) and Chinese Elm tree pollen counts are at the VERY HIGH ALERT level, registering the highest in the US (according to NAB reporting).  Additionally, spring pollinators Maple, Cottonwood, and Oak tree pollens are now being detected.

This marks the ninth VERY HIGH ALERT day this season, with FIVE days in the TOP TEN days for Cedar Season (in the past five years), creating one of the highest Cedar Seasons in Oklahoma history.

This is an extreme exposure situation.  Severe symptoms may be expected in pollen-sensitive individuals. More seriously allergic people should be advised to stay indoors as much as possible. This is especially true if someone has pollen sensitivity or allergic bronchial asthma.  

Tree pollen, especially Cedar Tree pollen, affects millions of people across the United States during winter months (including an estimated 20% of the regional population), contributing to what is known as “Cedar Fever”.  Cedar fever is an allergic reaction to pollen from mountain cedar trees which thrive in regions like Oklahoma, Texas, Arkansas, and Missouri. Unlike most seasonal allergies that peak in spring and summer, Cedar Fever occurs during the winter months, with pollen levels surging from late November to February—often reaching a peak in mid-January through February.  Cedar tree pollen is very small, and a single tree can produce billions of pollen grains in season.  The pollen grains can travel hundreds of miles in Oklahoma winds.

For More Information -

The best way to combat these allergens is to stay in filtered air. OAAC’s board-certified allergists recommend avoiding allergy triggers as the best way to reduce symptoms. These triggers include:

  • Limit outdoor activities during days with high pollen counts.
  • Keep windows closed (at home or in the car) to keep pollen out.
  • Don’t wear your outdoor work clothes in the house; they may have pollen on them.
  • Take a shower after coming indoors. Otherwise, pollen in your hair may bother you all night.
  • Leave shoes outside or just inside the door so that you don’t track pollen inside your home.
  • Wash your hands often. Pollen can stick to your hands when you touch something outside or a pet if it has been outside.
  • Wear a dust mask that people like carpenters use (found in hardware stores) when you need to do outdoor tasks such as raking leaves.
  • Clean and replace furnace and air conditioner filters often. Using HEPA (high efficiency particulate air) filters is recommended, which remove at least 99 percent of pollen, as well as animal dander, dust, and other particles.

Some other options include medications like nasal sprays and antihistamines, but it needs to be the correct medicine and should be used continuously throughout the season.

Seasonal allergies (allergic rhinitis, commonly known as “hay fever”) cannot be diagnosed by history alone. A board-certified allergist can diagnose allergies and determine the specific triggers that cause them through simple tests. The allergists at OAAC evaluate and manage patients of all ages from the southwest region.  The main clinic is on the Oklahoma University Health Sciences Center campus.  For patient convenience, satellite offices are located in Edmond, Norman, and northwest Oklahoma City.

For more information about Cedar Fever, and steps to take to help minimize exposure and allergic reaction to cedar tree pollen, visit our website at:

https://oklahomaallergy.com/blog/cedar-fever-what-you-need-to-know-2/

For more information about allergic rhinitis (“hay fever”), visit: https://oklahomaallergy.com/services/allergic-rhinitis/

Daily Pollen Counts for Weed, Grass and Tree pollen, as well as Mold levels can be found at: https://oklahomaallergy.com/allergy-report/

Visit the OAAC website at www.oklahomaallergy.com to view the addresses for all Oklahoma Allergy and Asthma Clinic locations.  To make an initial appointment for an allergy, asthma, or immunology problem or to request more information, please call (405) 235-0040 or visit the website.

The post Very High Tree Pollen Levels Return appeared first on Oklahoma Allergy and Asthma Clinic.

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