What causes these mystery waves of hives on my arms?
February 24, 2021 5:34 PM   Subscribe

For the last couple of weeks, I've been having large hives forming on my arms and hands. Bilastine prescription helps a bit. YANMD, YANAD, but … what gives?

They form as a roundish pink lump about the size of a quarter, then grow to be a hand span or more across. They're very warm to the touch, light pink, with a darker pink border to them but no well-defined centre. They form, grow, move and disappear over about two days. They start with a maddening deep itch, and seem to alternate between arms. The couple of times they've formed on my hands they've been extremely uncomfortable. I've never had anything like this before. They're only on my arms.

What they're not:
  1. not cellulitis. The first virtual doctor I saw put me on strong antibiotics as a precautionary measure. Made no difference. When I finally managed to see a doctor (most clinics are closed; my family doctor has vanished) he said that they were hives (huge ones) and antibiotics can't help.
  2. not contact dermatitis. This rash coincided exactly with getting a new desk with a lightly-sanded surface. The hives appear mostly on parts that haven't touched the desk.
I've changed nothing in my diet and routine. These appeared a couple of days before I got notice that my job was going away (and I had no warning) so it's not entirely stress. Chances of getting a referral to a specialist are slim to none right now.
posted by scruss to Health & Fitness (25 answers total) 1 user marked this as a favorite
That desk is looking pretty suss. Have you tried isolating yourself from it? It might have been cleaned, or treated with, or is otherwise offgassing something that you are reacting to.
posted by rodlymight at 6:00 PM on February 24, 2021 [2 favorites]

Did you rule out Covid-19? It can cause a hives-like rash in some patients.
posted by capricorn at 6:00 PM on February 24, 2021 [3 favorites]

Vote #2 for the desk.

Mango wood desks are a big thing right now, and Mango is a member of the Anacardiaceae, which also contains Poison Oak, Poison Ivy, Poison Sumac, etc. and etc.

Varnish it or put a glass top on it and see what happens.
posted by jamjam at 6:18 PM on February 24, 2021 [1 favorite]

Response by poster: Probably not the desk. I was away from it for a week, and the hives were still lively. I've put a cover on it and they're still coming back.

Unlikely to be COVID-19. None of the rashes pictured look anything like this. I'm not going out, either.
posted by scruss at 6:45 PM on February 24, 2021

Pityriasis rosea? I had it once on my arms, it went away by itself. Seems to be viral?
posted by jenkinsEar at 6:49 PM on February 24, 2021

Sounds like hives (not contact dermatitis). New lotion? Hand sanitizer? Soap?

Failing that, on preview I agree with pityriasis rosea. It’s uncommon to only have it on your arms without trunk involvement but it does happen. It’ll go away in a few months (sorry)
posted by shesdeadimalive at 6:52 PM on February 24, 2021

Did you have chicken pox as a child? Have you been vaccinated for shingles?

The fact that you feel them before they erupt and they're isolated to one part of your body is similar to other shingles cases I've seen in friends/family. (Though usually it's one side of the body, not both and usually the trunk, not arms.)
posted by typetive at 6:57 PM on February 24, 2021

Also check into tinea versicolor. Pretty easily treated, as I found out by accident.
posted by Grok Lobster at 8:35 PM on February 24, 2021

Hives can be autoimmune, and have nothing to do with what's in your environment. Quite often, the cause of hives remains unknown. I had chronic idiopathic urticaria for a number of years. It was rough. Primary care doctors will often want to put you on prednisone, which brings instant relief but is really rough on your body. The hope is that the hives go away on their own, coincidentally, while you're on a few days' course. It's not curative. When I stopped the prednisone, the hives came back, full force. You don't want to be on prednisone for more than a few days, unless you're in treatment for something more serious.

I was lucky - I saw a dermatologist who is well-known for working with hives. What I heard at the time is that most allergists do not want to have anything to do with hives, because they are such a mystery. (I'm in the US) If it isn't laundry detergent or an allergy to NSAIDs (seriously, look into that. It could be an allergy to NSAIDs, which is dangerous), they don't have much they can do. In fact, I did see an allergist who tested me for nut allergies, gave me the incorrect results over the phone, told me to avoid eating nuts, and didn't even schedule a follow up visit or warn me about cross-contamination in facilities that process nuts. Offered me nothing about the hives. I've oversimplified, but you get the picture. I did meet a hives-specialist allergist later on, who is a colleague of my dermatologist, so my comment *is* a gross oversimplification. Five years later, turns out I didn't have a nut allergy.

My dermatologist biopsied a tissue sample and prescribed a cocktail of medications and it suppressed/controlled the hives so that I could feel like a human being again. I was able to taper off some of the medications, very slowly (over months), but the hives always started coming back. As it happened, I had also gained a lot of weight, I saw advice on AskMe about eating keto. I followed the advice and, although I had only intended to lose weight, I was able to get off all of the remaining hives medications within 2 months. My dermatologist agreed with me that eating keto had put the hives into remission and it's been 5 years and they haven't come back. Also - I no longer have seasonal allergies, or mild chronic asthma.
posted by vitabellosi at 5:52 AM on February 25, 2021 [1 favorite]

You might want to Google the names and brands of any lotion, sunscreens, laundry detergent, etc that you use. I used one brand of lotion for 12 years with no problem, then suddenly developed a terrible rash after using it. Turns out they had changed their formula. I found that out by accident after idlely reading reviews of the product on Amazon and seeing other people reporting the same sudden onset of symptoms after a long trouble free period of use.
posted by WalkerWestridge at 6:19 AM on February 25, 2021 [1 favorite]

Just want to mention that allergies can pop up at any time and are not necessarily a reaction to something new or changed*. It may be that you’ve developed an allergy to something you’ve been using for years (eg. my new allergy to the unscented laundry detergent I’ve been using for years).

If it is allergies, try a couple types of anti-histamines because some will probably work better for you than others. Also maybe check your moisturizing levels because I know when my skin is generally dry (winter, crap moisturizer) it makes all my skin stuff worse.

*Mechanistically, allergies develop from a prior exposure so it’s the next exposure that is the problem. It can be first-second but it can be 100th-101st.
posted by hydrobatidae at 7:08 AM on February 25, 2021

NB: shingles outbreaks generally don't cross the spine. They can go into your arms, based on my wife's outbreak, but it would probably only be one arm. Her rash was EXTREMELY ANGRY for a bit over a week, and took around a month from symptom onset to fade mostly away.

I would not discount Covid as a cause, and I wouldn't trust pictures of Covid-related rashes as a guide to your own. We still don't really know what all is happening during an infection or after it, and I'm about 90% certain the outbreak of hives and rashes I'm currently living with is a post-Covid symptom for me (no recent exposure to anything but I most likely had it way back in March when testing was very unreliable). I've also got two swollen, purple toes, which I didn't even realize could be"Covid toes" until I was trying to figure out my rash. Even if you have or had an otherwise asymptomatic Covid infection, you could still be having long term effects including multiple varieties of rash.
posted by fedward at 8:01 AM on February 25, 2021

Response by poster: Thanks for all the suggestions!

Unlikely to be shingles: I've been vaccinated, and it doesn't look like shingles my family members suffered from. Also, the pain (if any) is mild.
posted by scruss at 8:15 AM on February 25, 2021 [2 favorites]

Unlikely to be shingles: I've been vaccinated, and it doesn't look like shingles my family members suffered from. Also, the pain (if any) is mild.

Others have given other reasons why it's not likely to be shingles, but also note that my mom got shingles despite being vaccinated and she had no pain and it did not look like typical shingles (likely BECAUSE she was vaccinated). They also don't look like what you're describing, but I just wanted to throw it out there that A) Vaccinated people can get shingles and B) It would likely be milder and look a little different from other shingles.
posted by If only I had a penguin... at 8:36 PM on February 25, 2021

You can develop an allergy to a substance at any time, but definitely check any lotion, soap and detergent for formula changes. That said, hives can be caused by anxiety alone. I hope you find some relief soon.
posted by ruddlehead at 4:59 AM on February 26, 2021

does taking a benadryl get rid of them and/or stop the itch? If so, it's probably an allergy. If you take otc meds the dyes in them can sometimes cause weird reactions. So can changing to a different generic with prescription drugs. And the meds themselves can do it. I know someone who can't take tylenol because it suddenly started causing hives, for example.
posted by Morpeth at 5:10 AM on February 26, 2021

Could it be nightshade sensitivity? I am a 50+ female and I had been experiencing something similar to you over the last year. I would get hives mostly on my arms and sometimes on my cheeks. I started to pay attention to things especially my diet, and I think I have traced it to nightshades, mostly uncooked tomatoes of salsa in my case. Apparently this is a common thing. It can develop over time, so even if you have not changed your diet, you may be sensitive now. Nightshades include tomatoes, potatoes, eggplant, and peppers.
posted by jraz at 11:07 AM on February 26, 2021

Like vitabellosi, I had chronic idiopathic urticaria once upon a time, and my experience was fairly similar to what you're describing. (The hives on the palms of my hands and soles of my feet were the worst.) A barrage of tests turned up no particular cause -- hence the "idiopathic" -- but the allergist was supposing it was autoimmune.

In terms of treatment, what worked for me -- and I think this is a pretty standard treatment for chronic urticaria -- is an OTC antihistamine, at a higher daily dosage than what you'd take for normal seasonal allergies. (Zyrtec for me, but different antihistamines work for different people.) Once we hit on the right dosage level, my hives went away completely. Eventually (after a few test taper-downs where the hives returned) I was able to taper off of the meds completely, and the hives haven't been back since.

(Note, of course, that even though these antihistamines are OTC, I am decidedly not recommending experimenting yourself with dosage levels. Just providing info to go in better armed to the next doctor visit or consult you can manage to get. Also, even though the hives have thus far been confined to your arms, you might want to discuss getting an epipen to have on hand, just in case at some point you start experiencing angioedema to go with the urticaria. Allergic reactions can sometimes escalate quickly!)
posted by alyxstarr at 10:36 AM on March 1, 2021

Response by poster: Semi-update: well, they've gone — mostly. The Blexten works, and I noticed I needed to take it less and less. I did manage to see my doctor eventually, and he didn't have suggestions.

I have discovered one hilarious trigger for hives on my hands, though. Sometimes I'm required to wear inspection gloves if I'm handling eqipment that's going to a client. Since many of our clients have latex allergies, we use latex-free blue vinyl gloves. I don't know what's in/on these (they're powder-free, and marked hypoallergenic), but I can wear them for ten minutes and reliably have my hands swell up painfully for the next couple of days. Go figure … ☹
posted by scruss at 10:57 AM on March 12, 2021

Hey, so, reading your update makes me wonder if you may have a sensitivity to salt, specifically the salt in your own sweat. I have this, and sometimes it's worse than others. Bad times generally coincide with times I'm tired, poorly nourished, under a great deal of stress, or a combo of those things. Hands get sweaty in gloves and maybe that's what is triggering you. I personally, also get hives when I go in the ocean or when I work out really hard. Just a thought...
posted by WalkerWestridge at 8:27 AM on March 16, 2021 [1 favorite]

Response by poster: They're still coming. Pretty much limited to my arms, but what used to limit itself to a hand-sized patch now typical grows (almost like it's flowing) to cover at least half of my arm over a couple of days. Sometimes as it fades it forms weird blobby red/white patterns. I can manage the itching with OTC-strength antihistamine.

While it's still almost entirely confined to my arms, I've woken on a couple of occasions to find half of one of my lips swollen to a grotesque size. This is at least as swollen as if I'd bitten my lip really hard, but there's no welt or blood. This fades over the course of a day, but while it's swollen it's almost impossible to eat or drink without spilling stuff everywhere
posted by scruss at 3:51 PM on April 28, 2021

Your update about the gloves got me thinking in terms of the sanded desk and a possible connection with plants of the poison ivy family (Anacardiaceae) again because some vinyl gloves are coated with benzalkonium chloride disinfectant, which has a structural resemblance to the urushiol of the Anacardiaceae, and some people have reported that it smells a bit like pistachios and cashews, which are members of that family.

You objected that you didn't think it could be the desk because you'd been away from it for a week and the hives were "still lively", but reactions to urushiol typically take a couple of weeks to subside and often much longer.

Another answerer remarked that it sounded like a allergy rather than contact dermatitis, but urushiol is a very potent allergen in addition to its ability to induce contact dermatitis.

Finally, in reading the Wikipedia urushiol article I discovered that Chinese lacquer is derived from a tree which is a member of the Anacardiaceae, and the polymerizing agent which confers its admirable hardness is actually the highly irritating urushiol itself, which means that if the desk you sanded happened to have been finished with Chinese lacquer and you weren't wearing a mask, you almost certainly were exposed to a significant dose of urushiol.
posted by jamjam at 2:10 AM on April 29, 2021

Response by poster: Thanks, but I haven't been near that desk for three weeks. I didn't sand it, either. The desk is pine, lacquered with acrylic: Ikea were able to confirm that for me.
posted by scruss at 7:28 AM on April 29, 2021

I don't know if my rash and hives are the same as yours, but over the past couple months I've seen three different doctors and had two full rounds of skin tests for allergies, plus two rounds of blood work, and the best the doctors have come up with is "eczema, probably." The allergy tests didn't reveal any new allergens since the last time I was tested, but here I am, having eczema for the first time in my life at age 50. On doctor's orders I'm now taking two different antihistamines (one in the morning, one at night) and I have my choice of topical steroids for flare-ups (along with a warning not to overuse them because they'll thin the skin). I've been given the option of getting shots to desensitize myself to the worst offenders, and while I'm considering it I have to wonder if it would be a lot of expense and bother (the recommended allergist's office is not convenient) for a solution that doesn't sound guaranteed.

Long story short, I'm right there with you, only I'm pushing up against my health care deductible for the year without being that much more reliably informed.
posted by fedward at 8:31 AM on April 29, 2021

Response by poster: final update: it's mostly gone. I still need to keep the occasional Blexten around to head off a flare up, but that's maybe once a week.
posted by scruss at 8:27 AM on January 29

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