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These localized swellings (urticaria or wheals) of the skin or mucous membranes are usually very itchy. They can occur suddenly, last a few hours and then disappear, leaving no trace. No single hive lasts more than 36 hours. By circling the irregular, red swelling with a pen, you will see that it fades, even as new ones form. Each hive can be as small as a pea to larger than 30 cm (12in). When a hive forms near the eyes, lips, or genitals, there can be a frightening swelling called angioedema which lasts 12-24 hours (if the throat swells, seek urgent medical attention).

Hives are caused by the release of the natural chemical histamine from mast cells which lie along blood vessels in the skin. Histamine release can be triggered directly by certain natural chemicals in certain foods (such as strawberries and shellfish), drugs (especially aspirin and other salicyclates), or food preservatives such as tartrazine (a yellow dye often found in canned vegetables) or monosodium glutamate (MSG, frequently in Chinese food). Histamine release can also be caused by an allergy to a food or a topically applied cream or, less frequently, by a physical allergy to cold, heat, or even just pressure.

About one in every five people will have hives sometime in their lives. In most cases, a person suffers only one or two episodes which last less than six weeks. This is acute urticaria, usually caused by foods, drugs, an insect bite or an infection such as chicken pox, viral respiratory infections, mononucleosis, intestinal parasites, serum hepatitis, and rheumatic fever. People who have these brief attacks can usually be their own detectives in determining the cause by simply keeping a careful “diet diary” of everything that enters their mouths from foods, medications and vitamins to mouthwash, toothpaste and chewing gum, and then listing when the hives occur.

Hives usually appear ten minutes to eight hours after eating the offending food. A more tedious method to investigate food allergies is an elimination diet. First eliminate what you think is the culprit. If you still get hives, eat a restricted diet consisting of only four unseasoned, low-allergy foods: lamb, rice, apples and decaffeinated tea for one week. If the hives disappear, new foods can be introduced one at a time to pinpoint the culprit. If hives continue, you must eliminate even those foods one by one to detect the cause, or perhaps food is not actually the problem.

The most common medications that often cause hives are aspirin, codeine, penicillin, and sulfa drugs. Penicillin may also be found in blue and Roquefort cheeses and any dairy product. Almost every medication has been a cause of urticaria in some person somewhere. The coating of pills or capsules can also bring about hives.

Some people develop hives minutes after exposure to sun; others suffer from heat or cold urticaria, which can occur with mild temperature changes, as in taking a hot shower or plunging into a tepid swimming pool on a hot day. Urticaria may be accompanied by wheezing, flushing, and fainting if exposure is prolonged.

People with hives demonstrate dermographism or “skin writing”, so that even stroking the skin causes a wheal lasting 30 minutes to several hours. Dermographism is a minor inconvenience, but rarely a person with severe pressure urticaria is unable to grasp a steering wheel or tennis racket without itching and swelling.

Bouts of urticaria lasting more than six weeks are classified as chronic urticaria. People who have a personal or family history of asthma, hay fever, or migraine headaches seem more susceptible to stubborn chronic hives. Although the exact cause is sometimes never ascertained, it is important to do a thorough medical examination to check for infection, autoimmune disease, or hidden malignancy. Eighty percent of cases resolve spontaneously within one year.

The best treatment for hives is to discover and eliminate the cause. Meanwhile, oral antihistamines can be given for relief.

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