Chronic Hives

Q:  I am a 52 year-old menopausal woman with hot flashes and periodic heavy menstrual flow. For the past five months I have had a severe case of hives. They disappear for 2-3 days and then return and cover my entire torso and legs, causing extreme itching. Periodically my face and lips swell up. My doctor put me on anti-depressant medicine, but this gives me minimal relief. The only other medicines I take are Inderal for rapid heartbeat and Levothyroxine for low thyroid.

He told me this condition can last from 6 months to 2 years and little else can be done to give me more relief. Can you please give me a diagnosis and a possible treatment to eliminate this problem?

A:  In your case the diagnosis, chronic urticaria, is easy, but the treatment is not. Urticaria, which is the medical term for "hives," can be an acute one-time event or can persist for weeks or months. If the hives last for more than 6 weeks, it is called chronic urticaria. In over half of people, chronic urticaria usually lasts less than a year, so there's still hope for you.

For those who don't know what hives are, they are raised, fluid-filled, red blotchy areas on the skin that can be small pinpoint lesions or large half-dollar size. They are usually very itchy. You also have angioedema, in which fluid accumulates around the eyes, lips, hands, and even the throat or intestinal lining.

Many different factors have been identified as causing urticaria. Certain foods and drugs are fairly common precipitants of an acute allergic reaction, particularly eggs, wheat, shellfish, peanuts, milk and penicillin or sulfa drugs. Some people get hives when exposed to cold, heat, alcohol or stressful situations. Hives have also been associated with infections like dental abscesses or hepatitis, or with diseases like thyroid disorders, rheumatoid arthritis or leukemia. Women with hives may experience flares during the premenstrual period, so perhaps your hives are also related to hormonal changes - since you are going through menopause - and will end soon.

The best treatment is obviously to avoid contact with whatever triggers the hives, but this is the tough part. Even with a thorough review and careful checking of food and dyes and toothpaste, etc., a specific cause is found in fewer than 10% of people with chronic hives. Antihistamines like Claritin and Benadryl are helpful in relieving itching. In especially stubborn cases cimetidine (used primarily for ulcers, but also a type of antihistamine), doxepin (an antidepressant), and even short courses of steroids have been used with some success.

"Dear Doctor" is a compilation of patient questions answered by doctors from the Medical College of Wisconsin.