DEAR DR. GOTT:
My husband has a perplexing problem with hives. He is 59-years-old. He is currently taking Benicar, Toprol, simvastatin and a low-dose aspirin every day for cholesterol and blood pressure problems but is in good overall health. I don’t believe these play a role in his current affliction, however, because the hives started several years before he was prescribed these medications.
He first began getting the hives while working but now that he is retired, they still occur. He has seen his primary care physician and an allergist, both of whom have not been able to offer any suggestions. After hearing a detailed description of an “attack”, they both said they didn’t believe it was due to food or drug allergies.
He has seen his physician a few times during an attack but all they do is give him some sort of injection and a prescription for prednisone which he doesn’t like to take. He usually has three to four attacks a year but they can occur at anytime. For instance, his last attack was in January and the one before that was in August while we were on vacation in a completely different environment.
His symptoms and the frequency of the attacks seem to be worsening. I have finally decided to write because he is having yet another attack and I feel so helpless. I just want him to be able to have a more normal life. I will describe the January attack (as it is a pretty typical one) in the hopes it will help you help us.
Jan. 2 – woke up at 7 am with his left hand pink and swollen. Throughout the day the swelling and pinkness spread up his arm. He was very tired. That night he developed chills and a fever.
Jan. 3 – woke up at 5 am with sinus drainage and minor coughing. Both hands had become swollen and he had body aches. His top lip was also swollen (never affects throat or breathing) and he had large pink welts over most of his body. His fever had gone down but not away and he was still very tired. By mid-afternoon his bottom lip had become swollen. He slept most of the day due to a combination of fatigue and Benadryl (to try to alleviate the swelling).
Jan. 4 – lips were almost back to normal but he was still tired and achy. He still had the very large pink hives and felt chilly.
Jan. 5 – feeling better but still had large pink blotches.
Jan. 6 – blotches were starting to flatten.
Jan. 7 – hives almost gone.
Your husband appears to be having several attacks of acute urticaria (hives) a year. Acute in this instance means that the hives last for less than six weeks.
According to both the American Academy of Dermatology and the American College of Allergy, Asthma and Immunology, there are three common causes of urticaria. These are allergies to foods (such as shellfish, peanuts, dairy or others) and reactions to medications such as penicillin and infections. Insect bites, internal diseases, cold, or sunlight are other, less common causes.
I believe the cause of your husband’s hives is infection. Thanks to your detailed description, it appears that there are two things going on. First, he experienced swelling and redness in a small area that progressed throughout the day. He then developed upper respiratory infection symptoms (which can take 12-36 hours to appear following exposure) followed by worsening hives.
I don’t think there is any coincidence in the fact that his symptoms last approximately seven days, which is the average length of the common cold. Since I am not an allergist, I cannot give specific information about how to treat these hives. I also do not know if there is a way to prevent symptoms from appearing since each infection is likely to be due to a different strain of bacteria or virus.
If your husband improves while using prednisone, I urge him to speak with his physician about using it. Small doses for short periods of time will not cause side effects and long-term damage is avoided. The prednisone probably won’t help the cold but it will be a lot easier to deal with a simple cold by itself without having itchy, swollen blotches all over his body as well.
Bring my response to his allergist and ask his opinion. He or she should also be able to provide possible treatment options at that time.
To give you related information, I am sending you a copy of my newly written Health Report “Allergies”. Other readers who would like a copy should send a self-addressed, stamped number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.