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Dear Dr. Fisher,

I am a 39-year-old female who broke out in hives on February 9th.  The doctor thought it might have been a reaction from a generic form of Robitussin that I took, although I never had problems before with other brands. I had also taken Macrobid for a UTI for seven days and had been off it for a week when this occurred.   Again, I took this drug before without problems   I did not start using any new soaps, detergents, etc.   I was given a tapering dose of prednisone for eight days which did not seem to help.  After about five days, the hives that I had faded away, but I still had horrible itchy flare-ups all over my body that would come and go, sometimes with welts and other times not.  Around the tenth day, those flare-ups started to calm down, but since then I still get minor daily flare-ups  various places on my body.  Something else that has persisted is dermatographism that occurs with firm pressure like from a fingernail scratch even on non-itchy skin.  I have had a very stressful year, and when all this started, several circumstances had occurred that I was extra stressed out about.  I have taken some Claritin, but that has not changed the dermatographism at all.   My question is if stress can be 100% of the cause of all this?  Also, does having hives affect the body in any other way?  Thank you for your time.



Hives and angioedema form when, in response to histamine, blood plasma leaks out of small blood vessels in the skin. Histamine is a chemical released from specialized cells along the skin's blood vessels.

Allergic reactions, chemicals in foods, insect stings, sunlight exposure, or medicines can all cause histamine release. Sometimes it's impossible to find out exactly why hives have formed.

There are several different types of hives and angioedema, including:

Acute urticaria and/or angioedema: Hives or swelling lasting less than six weeks. The most common causes are foods, medicines, latex, or infections. Insect bites and internal disease may also be responsible. The most common foods that cause hives are nuts, chocolate, fish, tomatoes, eggs, fresh berries, soy, wheat, and milk. Fresh foods cause hives more often than cooked foods. Certain food additives and preservatives may also be to blame. Medicines that can cause hives and angioedema include aspirin and other nonsteroidal anti-inflammatorymedications (NSAIDs, such as ibuprofen), high blood pressure medications (ACE inhibitors), or painkillers such as codeine.
Chronic urticaria and/or angioedema: Hives or swelling lasting more than six weeks. The cause of this type of hives is usually more difficult to identify than those causing acute urticaria and/or angioedema. The causes can be similar to those of acute urticaria but can also include autoimmunity, chronic infections, hormonal disorders, and malignancy.
Physical urticaria: Hives caused by direct physical stimulation of the skin -- for example, cold, heat, sun exposure, vibration, pressure, sweating, and exercise. The hives usually occur right where the skin was stimulated and rarely appear anywhere else. Most of the hives appear within one hour after exposure.
Dermatographism: Hives that form after firmly stroking or scratching the skin. These hives can also occur along with other forms of urticaria.
Hereditary angioedema: This is painful swelling of tissue. It is passed on through families.
Stress can also cause this but it is unlikely.
An Allergist can test you for causes of hives.


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Michael S. Fisher, <B>Ph.D., M.D.</B>


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