What can you do if you get hives the day before your event?

The first thing to remember is that stress and panic makes them worse. I know this is easy to say when you are not covered in itchy red bumps but if you can tell yourself it will all be ok that is a good place to start.

If your eyes swell shut, your lips swell or throat feels tight GET TO THE HOSPITAL IMMEDIATELY! If your hives are not as severe these steps might be helpful:

• Firstly, send someone out to buy the following: packet of diphenhydramine (Snuzaid), packet of cetirizine (Zyrtec), bar of Pinetarsol soap, Pinetarsol ointment, Animine or calamine lotion, frozen peas and some cream of tartar.

• Take antihistamine. Diphenhydramine will make you drowsy so this is not a good option if you need to drive or operate machinery, take the Cetirizine instead. If you are able to rest then the Diphenhydramine might be a better option.

• Take off any clothing that has tight seams and that is constrictive or rubs and put on something cool and loose like a long night gown.

• Make up a drink of water with a teaspoon of cream of tartar and sip. Drink plenty of water, avoid other drinks especially fizzy, processed things or anything with caffeine.

• Run a cool bath (avoid heat at all costs, it will make your hives worse) and add Pintarsol lotion, relax in the bath, use Pinetarsol soap to wash face and scalp if it is itchy.

• Dress again in cool loose clothing that doesn't touch your skin too much.

• Apply frozen peas to any particularly itchy or nasty areas. You can also use ice on individual hives.

• Apply calamine lotion/animine lotion to the hives.

• Go and have a nap or at least lie down and give your body time to recover. Keep yourself and the room cool.

If you find there is no improvement after a few hours and your hives are still plaguing you then the best course of action is to go to a doctor or hospital (just go to bulk billing in Australia if you can't see your own doctor, most doctors have seen urticaria before and it will be a fairly routine appointment) and they may start steroid treatment. Remembering that I am writing this advice for people who have a major event, their wedding, a birthday, graduation, something where looking and feeling your best is really important, not just a regular day! Steroids are of course a last resort due to side affects.

Progress week 1-3

The first few days showed only a little improvement, hence why it is so important to start treatment as early as possible.

By day 3 I was pretty down as I hoped for the miracle cure. The night time hives had really gone down but during the day I was still getting a lot on my face and body and they were still raised and itchy.

By the fourth and fifth day they began to calm a little more. By the end of week one there no wheals on my body, no itching and instead just really, really bright red patches up to half a centimetre wide where the hives would be if they weren't being suppressed by the drugs.

So, in summary I could still see that my body was having the hives reaction, but the actual result was not as intense as the drugs were calming it down. I was still embarrassed by the randomly appearing bright red dots all over me though as they were really noticable still and kept appearing and disappearing throughout the day, in particular on my face and neck. Not a good look!

By end of week 2 the hives had really improved. I was starting to relax about them thinking perhaps my wedding would be saved, and I am sure that this was helping too. I was still getting a lot of redness around my neck and on my forearms so I wore a scarf and long sleeves and tried to forget they were there which was certainly easier without the itching.

Now I am at the end of week 3 and I continue to keep the hives under control. I don't seem to be getting as many dots on me and they are a lot smaller so less noticable. I wake up completely clear of hives and dots but within a few hours of waking I might have a couple of spots on my neck or chest however they are barely noticable with a little bit of concealer.

Towards the end of the day I get a few more dots if I have been particularly stressed or rushing around a lot. To make up for this I am trying to make sure I get 9 hours sleep and plenty of down time, relaxing about work, not taking on anything extra, doing some exercise each day like swimming which helps me switch off.

My wedding is on November 10th 2012 so I will continue to update with any changes!

Treatment Summary

My daily medication list:

First thing in the morning: 1 tablet cetirizine hydrochloride (Zyrtec) 10mg

With breakfast: 25mg Prednisolone

With lunch: 25mg Prednisolone

Before bed: 1 tablet diphenhydramine

Treatment Options

As I couldn't identify much in the way of a cause or trigger I researched every single thing that I possibly could about treatments for urticaria. The thing that resonated most with me was a passage I read that said 'people tend to under treat their urticaria'. Yep, that was me. I was taking antihistamine when I had an attack and wondered why nothing really improved.

So, I needed to come down hard on my urticaria and kick it into check.

Phase 2: Demand the right treatment:

From my internet based research I tried to consolidate the information into something I could discuss with my doctor. As my wedding was fast approaching I didn't have time to visit an allergy specialist, go through testing and trial new drugs, especially after I had such limited success in the past so I needed to treat myself. So, what to ask for?

ANTIHISTAMINE: H1 Receptor Antagonists

I am based in Australia so I will use the 'technical' names for the drugs rather than the brand names I have used as this confused the hell out of me when researching and different brand names contain different ingredients in other countries.

I have tried Fexofenadine (some success but not a lot, I got this from the allergy clinic in the UK but have not used this in Australia), loratedine (no success) and cetirizine.

I take cetirizine each morning and although I am unsure as to whether it really helps I figure it is better to take it than not, especially as I have air borne allergies too so it kills two birds with one stone. The idea is to build up a level of antihistamine over time to help to supress the allergic reaction. Cetirizine was mentioned a lot as a good daily tablet for hives and can be taken with an additional antihistamine tablet of another type at night I believe, however I am not a doctor so don't quote me on that. My doctor told me that it is possible to take a higher than normal dose of antihistamine with no adverse affects if you require it.

There are numerous other options when it comes to antihistamines and as I had only had limited success I did a ton of research on them.

I found that the majority of people online mentioned Benadryl as being the best antihistamine available for the treatment of hives. Benadryl in the United States is not the same as Benadryl in the UK or Australia. In the UK it is a brand name and does not have the same ingredients, in Australia it is a cough mixture and does not have the same ingredients so neither of these will be any use to urticaria sufferers. As I had never tried this dru I decided it was worth a shot.

The clinical name for the US version Benadryl, the one that kept being mentioned, is Diphenhydramine. I asked my doctor to give me a prescription for Diphenhydramine, as it turned out I didn't need a prescription. You can buy Diphenhydramine over the counter. It is sold as a sleep aid and is called SnuzAid. It comes in packs of 10 and is about $10. It is an older antihistamine, hence why not commonly available for the treatment of hives/allergies due to the drowsiness it causes.

http://en.wikipedia.org/wiki/Diphenhydramine

So I began taking one diphenhydramine tablet every night (and cetirizine each morning as it is non drowsy) and as if by magic, my night time hives have calmed considerably. Previously I woke every morning covered in hives on my legs and often my face and had trouble sleeping as they were so uncomfortable. Since I started taking the SnuzAid I have not had any new wheals appear overnight and no itching at all, plus the fact that the tablet is a sleep aid helps to counteract the insomnia caused by the steroids I am taking. I attribute the decent sleep and lack of hives to the Diphenhydramine as there is such a big time break between my taking the steroids at lunchtime and then the following morning and I am still getting evidence of hives during the day which I don't have at night or when I wake. I would like to take the diphenhydramine in the day but am concerned about the side effects of it so not really a possibility unless I have a terrible attack closer to the wedding.

ANTIHISTAMINES: H2 Receptor Antagonists

Cimetidine (I have tried this with no success) There are others including Famotidine, Lafutidine, Nizatidine, Ranitidine, Roxatidine but I haven't tried these. I discussed this with my doctor but he was frankly clueless when it came to treatment of urticaria. I decided not to try taking H2 and H1 and just see if I could control it without.

STEROIDS:

Yep. This is an emergency situation so I chose to go down the steroid route. If it was not the most important day of my life perhaps I would have chosen not to use steroids but desperate times call for desperate measures. I railroaded my doctor into prescribing me prenisolone 25mg. I take one tablet in the morning with food, one at lunch time with food so 50mg a day. To date I have been taking them for 3 weeks.

Previously when I had attacks of urticaria steroids were of very little help. I even took them as a preventative when I had special events coming up so as my uni ball and my graduation and still had horrendous attacks of hives on both of these days. I was hopeful but skeptical that they would work this time. Originally I was only going to start taking them 3 days before the wedding but I decided that this was too risky in case they didn't work so I started them about 5 weeks before the wedding.

My doctor suggested two weeks at 50mg, then a week at 25mg and then gradually weening myself off them by taking half a tablet and then every other day and so on. However I found that when I was late taking the tablets one day my hives returned so I am continuing the high dose and will attempt to lower the dosage nearer to the date.

It took about a week for the prednisolone to begin to work and I was so disappointed because I really had hoped it would be a miracle cure, and other people online said they got immediate relief or even a dramatic change after 3 days. It took a long time (at least thats what it felt like to me) for any real improvement and I started all treatments in one go so who knows which element has really helped my hives but I'm not cutting anything out right now.

ALTERNATIVE THERAPIES/ NATURAL STUFF:

I cut out apple cider vinegar as some sites said that vinegars actually make hives worse, and as it wasn't making them better there was no benefit.

I did find out that some people put cream of tartar on hives. I also read about a lady who drank it and that cured her hives. So now each morning I make up a drink bottle of water and teaspoon of cream of tarter and drink it. Even if it has no real affect it isn't doing me any harm.

I still take some supplements but they have not made any improvement to my hives.

THINGS I AM AVOIDING:

Alcohol: I don't drink any alcohol at all and have not drunk alcohol for some years so I would suggest to anyone struggling with hives that cutting out the booze completely is a good way to go, painful as that might be. I found a lot of info that said alcohol makes hives worse but also saw people suggest that drinking alcohol will help calm you down and improve hives, I am not convinced. I am 100% certain that the chemicals used in processing alcohol such as sulphites etc made my hives dramatically worse so I am not going near the stuff!

Tea and Coffee: I don't drink coffee but I love tea. I did find that tea seemed to be a stimulant and therefore made my hives worse so I have cut it right down to one cup of caffeine based tea every other day at most. I started drinking chamomile and green tea but too much herbal tea also seemed to make my hives worse. Instead I just try to limit myself to a few cups of peppermint and maybe one green tea.

Medications: I don't take any NSAID's, aspirin, ibruprofen etc at all.

White flour, gluten and processed foods: I have tried to stear away from anything over processed like biscuits and so on, I have switched to rye bread and try not to eat a lot of pasta and so on. As Im trying to keep my weight under control to fit into my wedding dress this isn't such a bad thing! I just found that my hives seemed worse when I'd eaten a lot of junk food.

My research into the possible causes of Hives

3 months to go until my wedding, this is how I approached the treatment of my hives.

SO, WHAT CAUSES HIVES AND DO ANY OF THESE THINGS APPLY TO ME?

Phase 1: Know your enemy:

When my hives first appeared I was so desperate that I paid about $35 (Australian) to download information from the internet on a miracle hives cure. Treatment consisted of detox, so just drinking water or juice for 3 days (I failed miserably at this) drinking apple cider vinegar morning and evening, taking supplements including Vitamin D3 and additional immune boosters such as Cats Claw. So loaded up with all of these expensive things I attempted the 'natural' route to no hives. Sadly it didn't work. My urticaria did not improve, although I felt very healthy and virtuous! The report suggested avoiding gluten rich foods such as bread and so on, and anything made with white flour or that was processed. I have tried to do this, however I don't feel that this has had a significant impact on my hives, however it is of course a healthy option.

As this natural approach was not sufficient to impact on my hives, I returned to I researching every single thing that I possibly could about causes and treatments for urticaria.

These are just some of the suggested possible triggers/causes I discovered:

• Physical urticaria: Water, cold, heat, sun, vibration, pressure, sweating and exercise.

There is a lot of information online for those people with phsycial urticaria. My urticaria is worsened with pressure from clothing etc and as such I try to avoid tight fitting clothing and things with seams when I'm having an attack.

• Physical allergies to a known item such as a cleaning product or toiletry eg. latex, pollen, animal dander, new face product etc. If you have an obvious cause then avoidance is the only option!

Virus or illness

Including urinary tract infects, strep throat, viral hepatitis, sinus infection, athletes foot, infection with Helicobacter Pylori, and even a tooth abcess were all in the list I discovered. More serious illnesses such as metabolic diseases, HIV, low or high thyroid function, lupus, rubella, cytomegalovirus, phenylketonuria, vasculitus, liver disease and kidney disease. I suffered from Glandular Fever (also called Epstein Barr or Mono) or something similar (it was never properly diagnosed) but basically a virus before I had my first attack of hives. Thoughout my hives quest I have been tested for a heap of things including having thyroid function tests which were clear,so I have no idea if any of these illnesses are the underlying cause. Generally I am very healthy and have no other symptoms so I suspect not.

• Stress/nerves

There are different schools of thought on whether stress triggers hives or hives cause stress. I personally believe that stress causes my hives. Research states that 'Many people, including some doctors and other health care specialists, believe that stress can cause hives. Stress causes the body to produce more adrenaline and cortisol, leading to a chemical imbalance. Excess hormones produced by this imbalance can lead to an outbreak of hives or exacerbate already existing cases of chronic hives'.

• Allergies to medication

For example, NSAIDS (Non Steroidal Anti Inflamatory Drugs), antibiotics such as penicillin, Ibruprofen, Codeine, Morphine, aspirin. These definitely make my hives worse and so I avoid them, they are not stand alone triggers however.

• Allergies to food and food additives

Shellfish, eggs, milk, nuts, fish, chocolate, cheese, tomatoes, soy products and strawberries are the most common but not applicable to me. Other possible food related causes are as follows:

• Gluten/Wheat allergy
• Yeast allergy
• Eating food with too many salicylates
• Food additives

I believe that some food additives eg aspartame can increase hives so I try to avoid very processed foods, anything that contains sulphites such as alcohol and items containing dried fruit.

So, I have found a handful of aggravators but no real 'cause' so that left me wondering how best to treat my hives. Especially as everyone told me to 'stress less' and 'relax' and that would help. Yes maybe, but anyone who has suffered the depressing, itchy, ugliness that is an attack of hives will understand that is much easier said than done when you are in the throes of panic about whether you will be a red blob on your wedding day!

My history of Chronic Idiopathic Urticaria (hives)

I am not normally one to post on the internet however I hope that my experience with chronic idiopathic urticaria in the run up to my wedding might help other brides and those with a special event that are concerned about hives ruining their special day!

I am sure if you are reading this you or someone you know can relate to the information below.

I have had chronic idiopathic urticaria for nearly 10 years. It started when I was a student in my final year of uni and after what the doctor thinks was a virus brought on by a period of extreme stress.

Over the course of a few weeks I noticed my scalp was feeling itchy, so I tried changing my shampoo which helped a little and I didn't think anything of it. Then one day I noticed what looked like a mosquito bite on my forehead, no drama's, I just covered it with concealer and carried on with my day. Over the next night and day I developed a few more spots on my face, then the following afternoon, in a matter of hours and as if by magic a few spots turned into a rash that covered my entire body, leaving the doctors baffled as to what had caused this reaction and how to treat it.

At the time we treated with antihistamine and steriods which calmed it and I thought that would be the end of it. How wrong! This bout of urticaria lasted about 2 years and attacks came on with no warning, one day, one hour, one minute, I would be fine, then next a red, ugly, itchy mess. I am sure anyone reading this can relate.

My hives always began on my scalp and then spread across my face and head, neck, chest then my legs and torso, new wheals popping up as quickly as others went down. I knew that from the moment my head started to itch I would be covered within an hour. Frustrating, painful, depressing, I tried numerous treatments with limited success. And then after 2 years they disappeared. Just like that, one day they were gone. No changes to diet, environment or anything else, they literally just went.

A couple of years later I suffered another period of stress and again my hives returned with a vengeance. This time was worse. Again I would be covered with hives in a few hours. I had extensive allergy testing at this time from a very good UK clinic and discovered what I already knew to be true, I suffer allergic reactions to all air borne allergens, dust, fur, mould and so on, which make me sneeze and give me watery eyes but this was not the cause of my urticaria. No physical trigger was found for my hives. I had found that some things could make a reaction worse but it was not the root cause. The triggers I discovered included alcohol, especially anything containing sulphites like wine and cider, ibuprofen and eating a lot of shellfish in one go, so I knew to avoid them if possible, but they were just an aggravator, really stress seemed to be the cause.

At the time I was treated in the emergency department on several occasions for my extreme urticaria and angioedema reaction.  I was treated with antihistamine, steroids (prednisolone), intravenous hydrocortisone which calmed down the extreme burning, itching pain but left me exhausted and feeling hideous and of course didn't prevent the next attack.

I was prescribed additional medication in the form of the leukotriene receptor antagonist (LTRA) montelukast and Cimetidine (H2 antihistamine) by my Allergy specialist. None of these treatments worked against my hives and I continued to break out at random.

Some info on the drugs prescribed below:

http://en.wikipedia.org/wiki/Montelukast

http://en.wikipedia.org/wiki/H2_antagonist 

Again, after a couple of years my hives vanished as quickly as they had come and another happy few hive free years followed. I was so delighted, especially as they were unresponsive to treatment. Once again, no change of lifestyle, they just disappeared.

A couple of years ago I moved to Australia. I had been hive free for about 3 years but then I got engaged and that set me thinking 'what if my hives come back for my wedding?'.

I became very stressed out over wedding plans, but also about my hives returning. I couldn't think about anything else. Lo and behold my hives appeared again! Four months to go until my wedding and I have developed hives every single day, always on my legs, face, chest and torso, even a few on my hands and arms. This time the attacks are not as severe, I have only missed a couple of days of work, but as I have them every day I can predict that they will be there on my wedding day! I do not want hives on my wedding day!!

So, I decided that I was going to wage war upon my hives, they were not going to ruin my wedding. This is what this blog is about, how I am working on curing my hives for my wedding day in the hope that if you have a big event you too might be able to draw some ideas and comfort from this information.