Acute urticaria is transient and does not last more than 6 weeks. When hives last more than 6 weeks, it is called chronic hives or chronic urticaria. Hives or urticaria is not a disease, but it is rather a symptom reflecting several underlying medical conditions or diseases. Thus, a multitude of triggers can cause a same presentation, which is hives. 

Chronic urticaria can be very debilitating and significantly affect patients' quality of life. Current understanding in the literature about this condition only focuses solely in the skin where we see hives and feel the itchiness from it. Therefore, most recommendations for treatment of this condition only focus on the skin as a stand alone disease. However, mast cell activation that leads to spontaneous hives does not just colonize in the skin itself. In fact, mast cells are being produced in the bone marrow. From there, it is dissipated throughout the body, not just to the skin. When similar actions occuring in the nasal cavities, it is named sinuses. When symptoms progress down to the airway, it is called asthma. Similarly, activation of mast cells in the skin is called with different names depending how aggressive it is presented like hives, urticaria (spontaneous hives), dermatographism (inducitble hives), sensitive skin and so on...

In our clinical experience, we see mast cells being activated in multiple organ epithelia starting from the sinuses, then to the airways. From there, the inflammation due to activated mast cells can progress remotely to the gut causing symptoms similar to IBS (irritable bowel syndrome), bladder causing symptoms similar to overactive bladder, skin (hives) and so on... Therefore, it is more successful to control hives in the skin when inflammation is also controlled elsewhere. 

Rarely, food allergy cause chronic hives as evident in several studies. The goal of treatment of hives is not to use glucocorticosteroids or commonly known as steroids. Steroids are not the long-term treatment for chronic urticaria since its prolonged use carries significant side effects. There are several layers of steroid-sparing medications that can be used to manage and suppress chronic hives. The commonly use biologics called Xolair is just focused on controlling of mast cells in the skin but does not emphasize in controlling inflammation elsewhere inside the body that we do not have sensation of itchiness. 

Chronic urticaria clinic offers most up-to-date, state-of-the-art expertise and standardized approach in diagnosis and treatment for patients suffering from chronic urticaria. Controlling of activated mast cells in multiple organ system is key in controlling mast cells activations in the skin which we call hives. If you have or suspect to have chronic urticaria, please come for a discussion to see how we would help with our expertise in the field.

Below are services and procedures we offer at Texas Allergy.

• Evaluating of etiologies
• Evaluation of systemic inflammation due to mast cell activation elsewhere, not just at the skin
• Quality Allergy testing and allergy treatment
• Immune modulators, immunosuppressants or other non-steroid sparing agents for symptom control
• Xolair® injection or other biologics treatment in case of failure to control symptoms due to all of those treatments mentioned above or due to significant side effects of using medications.

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