Hives
A common presenting complaint, do not simply pass off these individuals as a hypersensitivity reaction or benign condition without ruling out the multiple causes of hives precipitation. It’s best to isolate them into 5 broad categories…
| Infectious |
Environmental |
Physical |
Malignant |
Autoimmune |
| Pharyngitis | Heat/cold exposure | Pregnancy (PUPPP) | Lymphoma | Rheumatoid arthritis |
| URI/GI/GU infx | Food allergies | Stress | Leukemia | SLE |
| Fungal/parasitic infx | Dust, molds, pollens, danders | Exercise | Other carcinoma | Polymyositis |
| Virus (coxsackie, hepatitis, EBV, etc) | Sulfites, tartrazine, benzoates | Vasculitides | ||
| Mycoplasma | Water exposure | Amyloidosis | ||
| Syphillis | Sun exposure | Sarcoidosis | ||
| Malaria | Hyperthyroid |
- Workup
- Physical exam
- HEENT: pharyngitis? thyroid dz? Lymphadenopathy
- CV/Resp: URI? axial lymph nodes
- Abd: Signs of liver dz?
- Skin: Signs of autoimmune dz, check feet for fungemia
- Definition of a “Hive”
- Well-circumscribed, raised, blanching lesion w/ erythematous borders and central pallor
- Linear, circular, or serpiginous; tend to be migratory and transient
- Physical exam
- Labs
- If acute, not needed
- If chronic (>1wk), consider CBC, CMP, ESR, CRP, CXR
- Eosinophilia? Leukocytosis? LFT elevation? Inflammation?
- Treatment
- Antihistamines
- First-line, should be initial treatment of choice
- Hydroxyzine, Benadryl, brompheniramine, loratadine, fexofenadine, certrazine
- For cold urticaria, cyproheptadine (2-4mg bit/tid) might be best
- For cholinergic urticaria (exercise/stress/heat) , hydroxyzine might be best
- First-line, should be initial treatment of choice
- Steroids
- Second-line, employ only if antihistamines fail