[19F] With spreading hives

Patient Description

A 19-year-old female has been experiencing hives for the past three days. The hives started on the arms and legs as smaller lesions but have gradually increased in size and spread to the face and neck. The hives are itchy and causing swelling. The patient finds that cold helps to relieve the hives, but they have not gone away at all. She wore a new hoodie recently, which might have triggered the hives, but she has stopped wearing it. The patient is not experiencing any difficulty breathing or swelling of the lips, tongue, or throat. She has no recent infections or illnesses, no known allergies, and no family history of allergies, asthma, or eczema. She has not used any new personal care products recently. Her only medication is Vestura, a birth control pill, which she has been taking for 31 days. Additionally, she takes creatine, a multivitamin, and a probiotic vitamin, which she has been taking for months.

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Arora's Assessment

What might be happening

Based on the information you have provided, here are some possible explanations for your hives:

  • Allergic Reaction: Hives are often caused by an allergic reaction to something you have come into contact with, such as a new piece of clothing (like your new hoodie), food, medication, or an environmental factor. Even though you have stopped wearing the hoodie, the allergen might still be present in your environment or on your skin.

    • Treatment: Allergic reactions are typically treated with antihistamines, which can help reduce itching and swelling. In more severe cases, a doctor might prescribe corticosteroids or other medications.
  • Chronic Urticaria: This is a condition where hives persist for more than six weeks and can be triggered by various factors, including stress, infections, or an underlying health condition.

    • Treatment: Chronic urticaria is often managed with antihistamines and sometimes with other medications like leukotriene inhibitors or immunosuppressants.
  • Physical Urticaria: This type of hives can be triggered by physical stimuli such as pressure, cold, heat, exercise, or sunlight. Since you mentioned that cold helps relieve your hives, it's possible that your hives could be related to a physical trigger.

    • Treatment: Avoiding the triggering physical stimuli and using antihistamines can help manage symptoms.

What you can do

While it's important to consult a healthcare professional for a formal diagnosis and treatment plan, here are some steps you can take to help manage your symptoms:

  1. Avoid Known Triggers: Since you suspect the new hoodie might have triggered your hives, avoid wearing it and wash it thoroughly to remove any potential allergens.
  2. Use Antihistamines: Over-the-counter antihistamines like cetirizine (Zyrtec), loratadine (Claritin), or diphenhydramine (Benadryl) can help reduce itching and swelling. Follow the dosage instructions on the package.
  3. Apply Cold Compresses: Applying a cold compress to the affected areas can help reduce itching and swelling.
  4. Keep a Symptom Journal: Use MDandMe to journal your symptoms, track your progress, and identify any potential triggers. This information can be very helpful for your healthcare provider.
  5. Stay Hydrated and Maintain a Healthy Diet: Drinking plenty of water and eating a balanced diet can help support your overall health and immune system.

What you should look out for

Seek medical attention more urgently if you experience any of the following:

  • Difficulty Breathing or Swelling of the Lips, Tongue, or Throat: These could be signs of a severe allergic reaction (anaphylaxis) and require immediate medical attention.
  • Hives Persisting for More Than a Week: If your hives do not improve or continue to spread, consult a healthcare professional for further evaluation and treatment.
  • Development of Additional Symptoms: If you develop a fever, joint pain, or other unusual symptoms, seek medical advice.

Remember, while these tips can help manage your symptoms, it's important to consult a healthcare professional for a formal diagnosis and appropriate treatment.

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4 mo ago


People Also Ask


What are common triggers for hives?

Common triggers for hives include allergens such as certain foods, medications, insect stings, and environmental factors like pollen or pet dander. Physical triggers like pressure, temperature changes, and stress can also cause hives.


How can antihistamines help with hives?

Antihistamines help with hives by blocking the action of histamine, a chemical released during an allergic reaction that causes itching, swelling, and redness. This can help reduce the symptoms of hives.


What is the difference between acute and chronic urticaria?

Acute urticaria refers to hives that last less than six weeks and are often triggered by an allergic reaction or infection. Chronic urticaria lasts more than six weeks and may be related to underlying health conditions or persistent triggers.


When should I seek medical attention for hives?

You should seek medical attention for hives if you experience difficulty breathing, swelling of the lips, tongue, or throat, if the hives persist for more than a week, or if you develop additional symptoms like fever or joint pain.

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