Help identifying cause of random hives

December 30, 2020 1:02 PM

Looking for some ideas as to what might be causing random hives and swelling. For a little over a week my daughter (22yo) has been experiencing eruptions of hives that we can't find an explanation for. Her legs will suddenly become covered with raised itchy hives, both legs, front and back, thighs and calves. Benadryl doesn't seem to make a difference, and they subside after a few hours, only to return. She has also had two weird instances of lip swelling that lasted longer, for about a day. Benadryl also had no effect on that.

The obvious explanation is an allergy, and she does have a peanut allergy, but there are no anaphylactic symptoms. She hasn't eaten anything unusual, no new laundry detergent, stopped using lotion on her legs but the hives continue. Googling turned up rash and lip swelling as unusual Covid symptoms but she was tested last Tuesday and is negative. She saw her doctor on Thursday who didn't have any ideas about what might be causing it other than allergies, prescribed Zyrtec and a short course of prednisone, neither of which has made a difference.

You are not her doctor and we're not looking for medical advice, but I'm hoping to get some ideas for avenues to pursue because searching only brings up allergies, contact dermatitis, and the like. Thank you!

posted by Bresciabouvier to Health & Fitness (26 answers total)

Has the temperature where you are changed? Is she taking hot showers or hot baths all of a sudden that might have irritated her skin?

Otherwise it could be something as annoying and vague as stress. There's a condition known as chronic hives which just means your skin freaks out over something for currently medically unknown reasons, but flares can be triggered by a bunch of different things which are unique to individuals. My dad, my brother and I all have this. My dad's condition is triggered mostly by stress and gets so bad that he has to have steroid injections into his hands and arms where it gets particularly impossible to live with. Mine tends to flare up in the summer, so I think my body has a particular problem with heat.

It might be a good idea to try to mitigate stress as well as everything else if possible (ha ha, 2020) and see if that helps.
posted by fight or flight at 1:10 PM on December 30, 2020 [4 favorites]

I had random hives like this from July through November this year. I had a bad bout of lip/face swelling that sent me to the emergency room, where they gave me a steroid and some IV antihistamines and said I should feel fine for three days, but the hives were back within 24 hours. So this sounds very familiar!

I was referred to an allergist and he said sometimes it just happens, which is wildly unhelpful, I know. He prescribed 2 bilastine (20g each) every morning - it's a different kind of antihistamine than Benadryl - and it worked way better for me, so she might need to try a few antihistamines to find one that works. (I previously tried Benadryl and cetirizine, neither of which did much.) He also sent me for a blood test for common allergens, which helped clarify that it was not an allergic reaction to a particular thing, just an overactive histamine sort of thing. It has decreased over the past month, I think, I'm just taking one bilastine a day now, and I will be going down to none soon. So there is hope, it will get better.

The allergist and pharmacist both recommended a non-prescription hydrocortisone cream to put on it when you can't take any more antihistamines that day but it's still itchy, and that also really helped.
posted by phlox at 1:20 PM on December 30, 2020 [3 favorites]

I had a similar issue about a year and a half ago. I was absolutely miserable for weeks. After seeing two doctors, I was eventually prescribed some prescription strength topical cream and heavy duty antihistimines so I could sleep at night. I was also told to take OTC antihistimines daily. It eventually went away just as mysteriously as it had returned.

YMMV, but I found my second doctor (a dermatologist) was much more helpful than my first doctor (a general practitioner). She was able to visually confirm that it was an autoimmune response rather than allergic reaction or bug bites (which was my initial thought and my first doctor's original thought). Perhaps you can make an appointment with a specialist?
posted by lucy.jakobs at 1:29 PM on December 30, 2020

I’ve had breakouts of hives for a couple of reasons. Once, they happened as a weird side effect of the tail end of a head cold. Never confirmed completely that that was the reason but that was my doctor’s suspicion. It went away within a couple of days without any treatment. Another time I had them after doing some winter hiking. They popped up later that evening and went away after I took some Zyrtec. I’m somewhat confident it was the cold that caused them because I had another instance of them the next day after doing some more winter hiking.
posted by hazel79 at 1:32 PM on December 30, 2020

I had something very similar some years ago when Seattle was having a terrible heat wave. I've never had them before, doctors were baffled, and it went away entirely when the cool rainy weather returned. Never has come back, even though I've been in much hotter conditions since. No one else in my family or friends had it. My theory is some kind of obscure plant or mold had a sudden bloom in those conditions and I reacted to it, and whatever it was died in the change of weather.
posted by The otter lady at 1:58 PM on December 30, 2020

I get hives when I'm stressed sometimes. I think there must be some other trigger as well, because it doesn't happen every time I'm stressed. But stress seems to be one of the common elements.
posted by geegollygosh at 2:31 PM on December 30, 2020

Did she get any new jammies for Christmas? My Grammie used to be allergic to sizing in new clothing. My Mom couldn't wear anything with an elastic waist, among other things. The lip swelling could be if she touched something while pulling it on and then touched her face. I guess that's contact dermatitis, but that was my first thought, my Mom was pretty allergic to those things, as was her mother.
posted by Marie Mon Dieu at 3:13 PM on December 30, 2020

This is me right now and a couple times in the past.

Try different types of antihistamines 1st/2nd/3rd gen.

It's thought that they can't really be caused by a food allergy, but worth checking has any skin contact items changed like new laundry soap or fabric softener?

Mine seem to be related to cold temperature, using a space heater helps somewhat.
posted by mikek at 3:18 PM on December 30, 2020

Did she exercise before the hives started? My husband also has a peanut allergy and experienced some bouts of hives last year after exercising during the first cold snap. He found an allergy specialist (pulmonologist/immunologist) who suggested it could be exercise-induced anaphylaxis, even though he never had any issues breathing related to the bouts of hives.

Hives and face swelling are anaphylactic symptoms. Your daughter needs to carry an Epi-Pen with her at all times.

It was a pretty scary thought that exercise could cause anaphylaxis, and fortunately his symptoms never progressed much further than the hives. There were a number of potential triggers identified by the allergy specialist, including temperature, aspirin, alcohol, and wheat (even though a subsequent allergy test confirmed he did not have a wheat allergy).

He now takes a daily regimen of H1 and H2 blockers (Citrizine Hydrochloride and Pepcid AC), and Montelukast. He usually carries an Epi-Pen with him when he exercises, and he got a pulse oximeter so he can confirm he's getting enough oxygen just in case. He now exercises in all weather and hasn't had any issues.
posted by a red so deep at 3:49 PM on December 30, 2020 [1 favorite]

I agree with others' suggestions too, but one more to consider.... is it possible they could be reactions to bedbug bites? A friend of mine started getting giant hives, mostly on her legs but a few in other places as well (even face). At first she didn't see any pattern but eventually started noticing they seemed to pop up in the morning/during the night... some would fade quickly and others persisted for days. Turned out they had bedbugs and that she was super allergic (her partner had no hives or reaction whatsoever).

Hopefully your daughter's hives are not from bedbugs because they are a total pain, but it might be another thing to try and rule out!
posted by DTMFA at 3:53 PM on December 30, 2020 [1 favorite]

I have told this story before but my ex had a terrible bout of hives that turned out to be a Vitamin A overdose...from pumpkin seed extract, but the important bit is that it built up in his body and so wasn't immediate when he took it.

If there is something she eats every day that could build up like that, it could be worth looking for.

Or it could be a new allergy to something that she wasn't sensitive to before.

So sorry she's dealing with this!
posted by emjaybee at 4:34 PM on December 30, 2020 [1 favorite]

Longshot here, but one year I had a reaction to something our Christmas tree (off a lot) was treated with. Or maybe it was just a different variety of tree. I had leg hives off and on that holiday season until the tree went out to the curb.
posted by rekrap at 4:56 PM on December 30, 2020

She hasn't eaten anything unusual

Seconding emjaybee that you might consider things she wasn't sensitive to before--it could be something that seems really innocuous and normal. Someone in my family started getting bad outbreaks of hives in their 20s evidently from drinking milk though they had a history of drinking milk without any issues.
posted by Wobbuffet at 5:18 PM on December 30, 2020

So... I just learned about foods that contain histamine (the chemical in your body that produces hives and other allergy related symptoms) as well as foods that trigger a release of histamine in your body (your body produces histamine naturally but in regulated amounts usually). Perhaps she has had higher amounts of these foods in the last week?

Histamine containing foods:
Alcohol or other fermented beverages
Fermented foods or dairy such as sauerkraut or yogurt
Dried fruit
Avocado
Spinach
Eggplant
Processed or smoked meat
Shellfish
Aged cheese

Histamine releasing foods:
Alcohol
Tomatoes
Bananas
Wheat germ
Papaya
Chocolate
Citrus fruits
Walnuts
Cashews
Peanuts
Food dyes and other additives
posted by ananci at 5:26 PM on December 30, 2020

I guess your doctor would have considered this, but Erythema Nodosum can look a lot like hives.
posted by frumiousb at 5:29 PM on December 30, 2020

I had something similar, but didn’t take any meds, and it ended up with anaphylaxis. I have nut allergies, but my allergist felt that this was most likely a reaction to the tail end of a virus.

So that’s a plus 1 on carry an epipen (though if she already has an allergy, she may already have one). I didn’t use to, and am lucky I finally went to a walk-in clinic right before I went into anaphylaxis- which is a great way to skip the line.
posted by Valancy Rachel at 7:33 PM on December 30, 2020

This is absolutely something worth seeing a dermatologist about.

Our skin is our largest organ, and most general practitioners are all too quick to be like “must be allergies!” But there’s all sorts of things that could be going on with the skin that are not caused by allergies and could require a different course of treatment (I had something like this around that age, it turned out to be Erythema multiforme major)
posted by wowenthusiast at 8:58 PM on December 30, 2020

Just want to suggest that you might try adding an H2 histamine blocker, such as famotidine (Pepcid) or cimetidine (Tagamet), to the H1 histamine blocker (Zyrtec or Benadryl) she is already taking. They are more effective together.
posted by chromium at 10:36 PM on December 30, 2020

Could it be urticaria? A friend of mine suddenly started breaking out in hives every time she interacted with cold water around that age, and that’s what her doctor settled on after consulting with colleagues. Two symptoms are hives on skin exposed to cold and lips swelling after drinking a cold beverage.
posted by centrifugal at 10:46 PM on December 30, 2020

I would keep a food diary and track symptoms in case a new food allergy has cropped up. They can start at any time.
posted by kinddieserzeit at 2:04 AM on December 31, 2020

As a nonexpert with food allergies, I'd say the big clue is the lips, which suggests it's something she's eaten. If there's swelling near the mouth it can be serious if there is too much inflammation.

People can also be allergic to food of all kinds: Symptoms can start while you're eating or as many as three days later. Food you have eaten for years can also be a source of allergy too. In fact, it's often the most common foods that cause allergies. The last time I saw an allergist he said allergies to sesame were skyrocketing because so many foods contain them.

I would take your daughter to an allergist ASAP. They'll stick her with tiny little drops of a large array of potential allergens on her arms, and then won't let her go until they've seen the results, and are sure she will have no further reaction. What you're describing, particularly around the mouth, is nothing to fool around with.

Also, yes, you should be tracking what she's eaten in detail, e.g. not just chicken, but chicken with onions and anchovies and garlic.
posted by Violet Blue at 2:10 AM on December 31, 2020

I developed similar issues this year, with my lips first swelling in May for about 40 hours. Over the next several months, the hives returned on my lips and also appeared on my hands, feet, legs, and abdominal region, sometimes several times a week. My partner and I were tracking foods, particularly those with histamines as noted by Ananci.

In the summer my genera doctor prescribed an epi-pen, which I luckily haven’t needed to use. I like to go for walks and a purchase of a slim Fanny pack is perfect for the pen and my keys. The pen is much bigger than I expected!

The allergist I visited in September during an outbreak ran bloodwork (I had already done allergy tests a few years prior), but during the visit advised that it’s likely Chronic Idiopathic Urticaria, acknowledging that it’s a frustrating diagnosis as it doesn’t really solve the ‘what is causing this’ question. Allergists see this present more in women and it will often last for 2-5 years and then go away.

I take a prescription Zyrtec (it’s far cheaper than OTC even with my high deductible insurance) each morning that helps to suppress the hives. When I had another hives incident later in the year, I took a second Zyrtec as directed by my doctor. If it had been closer to bedtime I would’ve taken a Benadryl instead, per the doctor.

My partner still thinks there must be something that triggers this, so I keep an electronic file of photos of the major hives and what I’ve eaten, just in case. If nothing else, it’s a good medical record in case we need to reference it for any reason later.
posted by icaicaer at 5:15 AM on December 31, 2020

As emjaybee suggested, hives aren't always allergic. They can sometimes be due to a buildup of the metabolic byproducts of something innocuous that a person ingests regularly. In my case, I suffered for weeks from repeated bouts of terrible monstrous hives--including sometimes swelled lips (and other body parts)--as a result of long-term self-treatment with aspirin for a pinched nerve.
posted by Transl3y at 3:44 PM on December 31, 2020

I had random hives recently and couldn't figure out the source. But I needed something stronger than OTC anthistamines—push your daughter's doc to prescribe something like Hydroxyzine and possibly a topical steroid cream, or have her see a specialist. A couple days of that and my hives were mostly gone.
posted by radioamy at 1:41 PM on January 1, 2021

Hives (urticaria) occurring for no apparent reason is surprisingly common. A reference says its prevalence may be as high as 1%, that it's twice as common in women as in men, and that it typically begins in the 20s-40s. As an internist, I've seen a few cases. The proper name for the condition is chronic spontaneous urticaria; we used to call it "idiopathic urticaria" (idiopathic = cause unknown) which is still an apt name. A good internist can evaluate and manage it. Diagnosis depends on thoroughly ruling out allergies.
posted by neuron at 9:40 PM on January 1, 2021 [1 favorite]

when this happened to me it was idiopathic urticaria (with angioedema). i was on steroids for a while, plus benadryl, plus clarinex. when singulair was added to the mix things finally calmed down. it lasted for two-ish years and truly was idiopathic.
posted by misanthropicsarah at 8:19 AM on January 4, 2021