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Allergies

Internal hives?

08/02/2004

Question:

My boyfriend has been breaking out in hives for the past year or two, ususally they only occur when its cold *but not ALL the time* anyways, shortly after the hives started he began gettin blotches on his skin, just a couple at first.. but they`re slowly spreading. Someone told him they were "internal hives" do those even exist? and if they do.. is there a special way to treat them?

Answer:

Chronic hives or hives lasting longer than six weeks are most often of unknown etiology.  In other words, we rarely identify the underlying cause.  In your boyfriend's case, it appears that at the very least he has a form of "physical hives" where certain physical stimuli can cause hives to come out.  Your boyfriend sounds like he has "cold-induced" urticaria.  Physical hives can occur by themselves or in conjunction with generalized hives.  The traditional conditions that are excluded are drug reactions, food allergies, thyroid conditions, infections and autoimmune disorders (connective tissue disorders).  More recently, it has been suggested that up to 40% of patients with chronic hives produce autoantibodies to IgE receptors on their mast cells in their skin which further support an autoimmune cause for hives.  If he has cold induced hives, periactin (cyproheptadine), an antihistamine/antiserotonin medication, has been found to be most effective for this condition.  A very small percentage of patients with cold induced hives make a protein called "cryoglobulin" which should be excluded as part of the initial work-up of this condition.  I would recommend that your boyfriend see a board-certified allergist who can help diagnose and formulate a specific treatment plan for his chronic hives.   

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Response by:

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