Chronic Hives: The Rash and Itching that can Drive You Crazy!

[updated August 2019]

Hives, also known in medical terms as urticaria, is a skin condition that is characterized by intense itching along with red welts. It looks like a person has been stung by a swarm of bees – only it occurs at any time without warning. 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.

The problem for patients that suffer from chronic hives is that dermatologists and allergists are limited in what they can offer to give lasting relief.

At Mitchell Medical Group, I believe we have found a way to provide significant relief for those patients waiting for a solution.

The Cause of Hives

In most cases of chronic urticaria, an allergist can have difficulty finding the cause of the hives. In acute cases of urticaria, it is much easier: it could be a food a patient ate, it could be a medication a patient used or it can be due to an infection. The simple cases you don’t need a medical detective, it’s usually quite obvious.

However, chronic urticaria is more of a mystery. The latest research seems to indicate it’s a mild type of autoimmune disease that isn’t due to a food or environmental allergen. But…. I have also seen in our practice cases where the hives were due to Candida, a yeast overgrowth coming from the digestive tract.

The Testing

I mentioned that many patients I see have already seen an allergist, who may have done conventional allergy testing for foods or environmental allergens without any positive results. My approach is to look where others may have not thought to check.

The thyroid gland, whether it is overactive or more commonly underactive- hypothyroid- can be associated with hives and autoimmunity. Especially, the condition of Hashimoto’s thyroiditis. Hashimoto’s thyroiditis sounds like a scary condition, but it can be easily treated. In cases where the thyroid hormones are rebalanced the hives can go away. The key tests to look at are:

• Thyroid peroxidase antibodies
• Thyroglobulin antibodies
• TSH
• Free T3 and Free T4 and reverse T3

The Treatment

In these difficult cases of chronic urticaria or chronic hives, especially those patients that have been depended on oral corticosteroids, I have found a treatment that is safe and effective: Gamma globulin injections.

Gamma globulin is a product derived from plasma that contains protective antibodies from multiple donors. It is nano-filtered so it is considered safe from viruses. It has the antibodies that appear to block the autoantibodies frequently causing chronic hives.

A series of 8 injections in many cases is enough to see a significant disappearance of the hives.

I also put patients on an anti-inflammatory diet that decreases the overgrowth of yeast. In addition, some patients also benefit from antifungal medications and sublingual Candida drops for long-term protection.

The Allergist’s Role in Helping Patients with Hives

I have been seeing a number of cases of hives and my job as an allergist 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 because any medication, an antibiotic or common pain relievers 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 Hives 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.

If you suffer from chronic hives, please check all your options: a solution is available.

– Dr. Dean Mitchell, M.D.
Mitchell Medical Group, NYC

About the Author – Dr. Dean Mitchell, M.D.

Dr. Dean Mitchell, M.D. is a Board Certified Allergist and Immunologist based out of NYC. He graduated from the Sackler School of Medicine and completed training at the Robert Cooke Allergy Institute in New York City. He is also a Clinical Assistant Professor at Touro College of Osteopathic Medicine, a fellow of the American Academy of Allergy, Asthma, and Immunology, and the author of Dr. Dean Mitchell’s Allergy and Asthma Solution: The Ultimate Program for Reversing Your Symptoms One Drop at a Time. Dr. Dean Mitchell, M.D. has also been featured in The New York Times, The Huffington Post, Fitness Magazine, Dr. Oz and News NY 1. Dr. Mitchell also hosts the podcast The Smartest Doctor in the Room – a combination of a lively, personal and in-depth interview with top healthcare specialists.

References:

Sachdeva, Sandeep Gupta, Vibhanshu; Suhail Amin, Syed; Tahseen, Mohd. Chronic Urticaria. Indian Journal of Dermatology. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3276885/

What is Chronic Idiopathic Urticaria (Hives)?, WebMD.com. https://www.webmd.com/skin-problems-and-treatments/chronic-skin-rash

Chronic Hives and Symptoms, MayoClinic.org. https://www.mayoclinic.org/diseases-conditions/chronic-hives/symptoms-causes/syc-20352719