By Martha A. Simpson, D.O., M.B.A.
Associate Professor of Family Medicine
Ohio University College of Osteopathic Medicine

READER MOST LIKELY HAS CHRONIC IDIOPATHIC URTICARIA

Question: For nearly a year now, I’ve been plagued with hives. I have been to a number of doctors and tried a number of treatments including allergy shots, steroids and avoiding many products that I like, such as wheat. I am 68 years old and basically healthy and have never had anything like this before. Can you tell me anything about hives?

Answer: Many of us experience a bout with hives from time to time. Doctors call the condition "urticaria," and it's marked by itchy, red blotches or welts all over the body, especially on the face and torso. The condition you are describing, however, is chronic urticaria. It is characterized by daily or almost daily hive outbreaks for greater than six weeks’ duration. This is a very frustrating condition and a cause can be difficult to run down.

Chronic urticaria is more common in women and affects about 25 percent of the population at one time or another. In chronic urticaria a clear cause is usually not found, even with extensive testing. When all known causes of urticaria have been ruled out, it is considered chronic idiopathic urticaria. The word “idiopathic” is inserted because it means that the urticaria has arisen spontaneously from unknown cause.

In recent years about half of those cases we previously categorized as idiopathic have been discovered to actually have an autoimmune basis -- the body is allergic itself. There is, unfortunately, no easy way to test for this in individual cases.

In a minority of cases we can identify an underlying factor that’s causing a person’s chronic urticaria. This can be very difficult detective work for you and your doctor. I can, though, give you a few tips about the kinds of things to be on the lookout for.

Medications -- even over-the-counter drugs, vitamins and herbal remedies -- can cause urticaria. Foods and food additives can be the cause of hives. Food additives can be difficult to eliminate from the diet and difficult to identify as a cause of hives.

Some infections can cause chronic hives, like hepatitis B and C. Patients with autoimmune diseases like rheumatoid arthritis can also, at times, experience chronic urticaria. Infestations with intestinal parasites can cause hives as well.

Substances in the environment like animals, plants and jewelry can cause hives shortly after contact. In these cases, the hives are usually at the site of the contact.

There has been speculation about a relationship between H. pylori (a stomach bacteria that causes ulcers) and hives. This link, however, has not been definitively established.

Finally, let me end with some good news. Since you and your doctor have not been able to identify a cause, it sounds like you have chronic idiopathic urticaria. This condition is seldom a symptom of a serious underlying medical problem. Also, there are new antihistamines that can be used to control many of the outbreaks of urticaria welts and the itching that goes along with them. More good news is that over 50 percent of people with chronic urticaria are better in about a year.

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701, or via e-mail to readerquestions@familymedicinenews.org. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnose and recommend treatment for any medical conditions. Past columns are available online at www.familymedicinenews.org.