Hives

Question 1

What is the classic look of hives?

Answer 1

welts above the plane of the skin
movement and shape change
itchy

Question 2

True or false: hives is only allergic based

Answer 2

false
hives is allergic and non-allergic based, anything is fair game

Question 3

What are the allergic causes of hives?

Answer 3

foods
drugs

Question 4

What are the non-allergic causes of hives?

Answer 4

URTIs (especially in kids)
pressure/vibration
cold temperature
nerves

Question 5

What percentage of hives are caused by medications?

Answer 5

10%

Question 6

What type of medication is the most common for causing hives?

Answer 6

antibiotics

Question 7

What is dermatographism?

Answer 7

immunologic response to pressure applied to the skin
erythema and itch
begins within 5min of stimulation and persists for 15-30min

Question 8

True or false: stress can cause hives

Answer 8

true

Question 9

What is the clinical presentation of hives?

Answer 9

lesions last 1-24 hours up to several days
lesion location changes over time
very itchy
~20% of the population has had it
chronic form ~1%
usually benign

Question 10

Why do we say that hives are USUALLY benign?

Answer 10

hives can be part of anaphylaxis or angioedema, thus they are no longer benign

Question 11

What is the most common cause of hives in kids?

Answer 11

URTIs

Question 12

When should we start to re-consider our hives diagnosis?

Answer 12

no itch
lesions have lasted longer than 24hrs in one spot

Question 13

True or false: hives are worse during the day

Answer 13

false
worse at night due to lower cortisol levels

Question 14

What percentage of penicillin skin reactions are allergic based?

Answer 14

1-3%

Question 15

Will someone who had a previous reaction to penicillin have a worse reaction upon second exposure to the penicillin?

Answer 15

most people will not

Question 16

Which treatment for hives is easier said than done?

Answer 16

avoiding the trigger(s)

Question 17

What is the drug of choice for hives?

Answer 17

2nd gen antihistamines
-for itch!!

Question 18

What is the dosing of 2nd gen antihistamines for hives?

Answer 18

regular dosing for a few days to weeks

Question 19

What might an MD do if a 2nd gen antihistamine has not been helpful for hives after 2 weeks?

Answer 19

increasing the dose to 2-4 times a day

Question 20

What are the adjunct therapies for hives?

Answer 20

1st gen antihistamines (maybe HS dose)
H2 blockers (not as valuable as H1 blockers)
leukotriene antagonists (not recommended)
oral steroid burst (severe cases)

Question 21

What is chronic spontaneous urticaria?

Answer 21

recurrence of itchy wheals for at least 6 weeks

Question 22

Are H1 antihistamines the perfect treatment for chronic spontaneous urticaria?

Answer 22

no, 10% of cases fail to control the disease

Question 23

What should you never recommend for hives?

Answer 23

Benadryl cream

Question 24

What is the verdict on using clobetasone or hydrocortisone for hives?

Answer 24

totally safe and makes sense but you are playing catch up because the hives move

Question 25

What is the verdict on using calamine for hives?

Answer 25

same as topical steroids, makes sense but you are playing catch up

Question 26

Can you use ice packs for hives?

Answer 26

yes
helps with itch and welts

Question 27

When can menthol be an option for hives?

Answer 27

if it is less than 1%
greater than 1% is a non-option

Question 28

What is a big feature that can help you distinguish between hives and contact dermatitis?

Answer 28

contact dermatitis can have blistering
hives has no blistering

Question 29

When a cause for hives can be found, what is the likely cause?

Answer 29

infection