[35F] With sudden onset of hives

Patient Description

A 35-year-old female experienced a sudden onset of hives 24 hours ago while lying in bed. The hives began itching almost instantly. The patient has found relief using an ice pack and avoiding touching or rubbing the skin. There are no accompanying symptoms such as swelling of the lips, tongue, or throat, and no difficulty breathing. The patient reports no recent stress or illnesses and no family history of allergies or autoimmune conditions. She has known allergies to soy, egg whites, and pigweed. Her current medications include Adderall 20mg twice daily for ADHD, Zanaflex as needed for hip and back pain from an accident, and ibuprofen 800mg as needed for inflammation. She also receives vitamins through an IV drip once a week for overall health. No other medications, supplements, or herbal remedies are being taken.

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Arora's Assessment

What might be happening

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

  • Acute Urticaria (Hives): This is a common skin reaction that can occur due to various triggers, including stress, infections, or unknown causes. Since you haven't identified a specific trigger, it might be idiopathic, meaning the exact cause is unknown. Hives can appear suddenly and are often itchy.

    • Treatment: Typically involves antihistamines to reduce itching and swelling. Over-the-counter options like cetirizine (Zyrtec) or loratadine (Claritin) can be effective. If the hives persist or worsen, a healthcare provider might prescribe stronger medications.
  • Allergic Reaction: Although you haven't been exposed to known allergens, it's possible that a new or hidden allergen could be responsible. This could include something in your environment or a new product you've used.

    • Treatment: Avoidance of the allergen once identified, and antihistamines to manage symptoms.
  • Physical Urticaria: Sometimes, hives can be triggered by physical factors like pressure, temperature changes, or even stress. Since you mentioned lying in bed, pressure or heat might have played a role.

    • Treatment: Avoiding known physical triggers and using antihistamines to manage symptoms.

What you can do

  1. Antihistamines: Consider taking an over-the-counter antihistamine to help reduce the itching and swelling. Always follow the dosage instructions on the package or consult with a pharmacist.

  2. Cool Compresses: Continue using cool compresses or ice packs to soothe the affected areas. This can help reduce itching and swelling.

  3. Avoid Known Allergens: Since you have allergies to soy, egg whites, and pigweed, ensure you're not inadvertently exposed to these allergens.

  4. Track Your Symptoms: Use MDandMe to journal your symptoms, track any potential triggers, and monitor your progress. This information can be valuable for your healthcare provider.

What you should look out for

Seek medical attention if you experience any of the following:

  • Difficulty Breathing or Swelling: If you notice any swelling of the lips, tongue, or throat, or if you have trouble breathing, seek emergency medical care immediately.

  • Persistent or Worsening Symptoms: If your hives do not improve with over-the-counter treatments or if they persist for more than a few days, consult a healthcare provider.

  • New Symptoms: If you develop additional symptoms such as fever, joint pain, or a rash that spreads, it's important to seek medical advice.

Remember, while this advice can help manage your symptoms, it's important to consult with a healthcare professional for a formal diagnosis and treatment plan.

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23 d ago


People Also Ask


What are common triggers for acute urticaria (hives)?

Common triggers for acute urticaria include stress, infections, certain foods, medications, insect stings, and environmental factors. Sometimes, the exact cause is unknown, which is referred to as idiopathic urticaria.


How can I differentiate between an allergic reaction and physical urticaria?

An allergic reaction typically occurs after exposure to a specific allergen and may include symptoms like swelling or difficulty breathing. Physical urticaria is triggered by physical factors such as pressure, temperature changes, or exercise. Keeping a symptom diary can help identify patterns and triggers.


What over-the-counter medications can help relieve hives?

Over-the-counter antihistamines like cetirizine (Zyrtec) or loratadine (Claritin) can help relieve itching and swelling associated with hives. It's important to follow the dosage instructions on the package or consult with a pharmacist.


When should I seek medical attention for hives?

You should seek medical attention if you experience difficulty breathing, swelling of the lips, tongue, or throat, if your hives persist for more than a few days despite treatment, or if you develop new symptoms such as fever or joint pain.

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