As I was indexing the forthcoming 2nd edition of Bring Your Own Bandages, working through the section on rashes, I noticed several references to hives. And I realized that nothing had been posted on that topic. Having never experienced or seen it, I wasn’t sure that I could even differentiate between a normal rash and hives. Part of the problem lies in the fact that people sometimes use the terms hives and rash interchangeably.
A rash is a general term for any abnormal change in the skin. Rashes can be flat, raised, or blistering. Scaly, purple, red, white, or no color at all. They may be itchy.
Gathering my references around me, I found that one of the major off-grid texts doesn’t provide any direction. Three others do cover it, including the Ship’s Medicine Chest, so we’ll start there.
Hives (Urticaria, Welts, Angio Edema)
Hives are a common problem that result from allergy to a large number of agents. These agents may be either internal or external. Examples of internal causes include infections as hepatitis and mononucleosis; dental abscess; drugs as aspirin, barbituates [sic], antibiotics, and narcotics; foods as shellfish, eggs, strawberries, and nuts; and anxiety states. External agents include insects, jellyfish, and rarely certain chemicals.
Individual lesions of hives usually last for several hours, but new lesions may come and go for a week or longer after a single exposure to the causative agent. Occasionally, hives may persist for months or years if the cause cannot be found.
Hives can occur anywhere on the body and are typically itchy. They show suddenly as pink or white slightly raised bumps, varying in size from a matchhead to large areas of the body. The lesions have a smooth surface and do not develop scales, crusts, or blisters. (See Fig. 5-2.)
In addition to typical hives, swelling may occur on certain body areas, as the hands, feet, lips, or face. Swelling that occurs inside the mouth may obstruct breathing so emergency medical care will be required.
Treatment
A diligent search for the offending agent is necessary, or continued exposure may result in persistent hives. Diphenhydramine hydrochloride, 25-75 mg depending on severity and patient response, should be given by mouth every four to six hours to help suppress the itching and shorten the course of illness. Drowsiness may result as a side effect of diphenhydramine hydrochloride, so the patient should be excused from standing watch, or doing precision work or potentially hazardous work while receiving the medication.
Severe reactions or oral involvement may require 0.3 to 0.5 ml epinephrine hydrochloride injection 1:1000 to be administered subcutaneously. (See Anaphylactic Reaction, p. 221.)[1]
While that is helpful, other sources provide a bit more info to better describe and treat this condition.
Appearance
Hives are usually 1 cm or larger and form red, swollen, raised “welts” with sharp edges. There may appear a pink “halo” around the edges, and the center may turn white from swelling.[2] They look quite similar to mosquito bites, but the size varies from 1/8” to several inches wide.[3] Small hives are round; the larger ones melt together into irregular shapes. They’re usually symmetrically distributed on the body.
Treatment
Conventional
Administer full doses of an antihistamine.[4]
- Allegra
- Benadryl
- Chlorpheniramine
- Claritin
- Zyrtec
- Histamine-2 (H-2) blockers used for acid reflux[5]
Do not use Prilosec or Prevacid[10]
Prescription strength options
- Clarinex[11]
- Hydroxyzine[12]
- Tricyclic antidepressants like Elavil and Sinequan[13]
- Prescription strengths of the H-2 blockers above[14]
If the patient develops difficulty breathing, seek licensed medical care immediately.
Steroids, are only used if accompanied by difficulty breathing[15]
Other medications
- Epinephrine Primatene Mist or injectable[16]
- Albuterol and Benadryl, followed by steroids[17]
- 40-60 mg prednisone, 5-7 days[18]
Taper the medication if possible, decreasing by 10-20 mg every 2-3 days.[19]
A physical exam may reveal shock (weak, fast pulse, low BP), severe swelling, wheezing, or shortness of breath. If so, treat for shock.[20]
Alternative
- Bearberry
- Chickweed
- Isatis
- Parsley
- Bathe in cool water or use cool compresses
- Oatmeal water compresses
Causes
Allergic reactions to
- Foods
- Seafood
- Berries
- Wine
- All of the above may be dose-dependent. And you might never figure it out. Avoid any suspected food or chemical.
- Plants, inhaled chemicals, drug reactions, insect bites/stings,
[1] Ship’s Medicine Chest and Medical Aid at Sea, 1978, 240.
[2] Robert D. Burgess, Community Health Aide/Practitioner Manual, 1987, 318.
[3] Cynthia Koelker, Armageddon Medicine, 2012, 232-34.
[4] Koelker.
[5] Koelker.
[6] Koelker.
[7] Koelker.
[8] Koelker.
[9] Koelker.
[10] Koelker.
[11] Koelker.
[12] Koelker.
[13] Koelker.
[14] Koelker.
[15] Koelker.
[16] Koelker.
[17] Koelker.
[18] Koelker.
[19] Koelker.
[20] Burgess.
[21] Burgess.
[22] Koelker.
[23] Koelker.
[24] Koelker.
[25] Koelker.
[26] Koelker.
[27] Koelker.
[28] Koelker.
[29] Koelker.
[30] Koelker.
[31] Koelker.
[32] Koelker.
[33] Koelker.
[34] Koelker.
