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Allergies

Angioedema and hives

02/10/2009

Question:

Hello, 3 years ago at the age of 29 I was awaken in the middle of the night by Hives over my entire body and my airway blocked. Since then I have been to the hospital 17 times for the same symptoms. I have had test done from Duke, UNC and 2 different allergist in Raleigh and all allergy test have come back negative. In the midst of all of this testing it was discovered that I have a Thyroid issue and I now meet with and endocronologist. My question is should there be other things I should consider looking at? There are no patterns or events that lead up to my hives or airway blockage; it just happens and I don`t know what triggers it. Please give any advice you may have to offer. Thank You!

Answer:

Hives that occur longer than 4-6 weeks are considered chronic.  30-50% of patients with chronic hives have been found to make an autoantibody against IgE receptors on allergic cells in the skin called mast cells (which are also on basophils which circulate in the blood); the functional significance of these autoantibodies are yet to be completely determined.  Over or under active thyroid disease has also been associated with hives as have thyroid autoantibodies.  Other things that should be ruled out include medications, foods (rarely causative in cases such as yours), other autoimmune disorders, infections and rarely malignancies.  Many patients have physical triggers such as sunlight, cold or heat, exercise, pressure. Patients with a physical component to their hives often have a more protracted course.  However, over 95% of the time no obvious cause can be determined and therefore we call then "idiopathic" or "unknown cause".  Treatment involves an algorithmic approach using a litany of medications in different combinations depending on your tolerance to medications and concomitant medical problems.  The fact that you have throat swelling associated with hives indicates this may be more consistent with "anaphylaxis".  Routine hives can be associated with angioedema (soft tissue swelling) usually of the lips and tongue but does not involve throat swelling.  You need to be under the care of a board certified internal medicine trained allergist/immunologist who has expertise in the evaluation and treatment of hives/anaphylaxis.  17 hospitalizations is way too many and with proper management this should be avoidable.  You can try to find an allergist in your area by going to http://www.aaaai.org/ or http://www.acaai.org/.

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Response by:

Jonathan   Bernstein, MD Jonathan Bernstein, MD
Associate Professor of Medicine
College of Medicine
University of Cincinnati