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Urticaria (Hives)/Angioedema (Tissue Swelling)

Urticaria (Hives)/Angioedema (Tissue Swelling)

Most “hives” are caused by histamine and other mediators “released” in the upper layers of the skin.

Histamine can be released from special cells, mast cells and basophils, which are found in everyone’s skin.

Patients with hives release “too much” histamine when it is not needed and are classified as:

  • “Acute hivers” only when they take in an identifiable “trigger”, i.e., drug, food, etc. or if hives last less than 6 weeks.
  • “Chronic hivers” daily or almost daily without an identifiable “trigger” and lasting for greater than six weeks.

In “chronic” urticaria or persistent hives, a “trigger” is rarely found. A “complete” history is needed to look for identifiable “triggers”.

The etiology for chronic urticaria such as medication, heat, pressure or infection is found in less than 5% of patients.

For most cases of chronic urticaria the etiology will remain idiopathic (cause unknown) although an autoimmune etiology can sometimes be found.

  • Angioedema (tissue swelling), occurs in 90% of patients with chronic urticaria

For chronic urticaria laboratory evaluation can be performed: Thyroid auto-antibody profile, CU Index, complete metabolic profile, complete blood count and autoimmunity tests.

Fortunately, most chronic hives go away with or without treatment:

  • 50% of patients hives go away in 3-12 months
  • 20% of patients hives go away in 12-36 months
  • 20% of patients hives go away in 36-60 months
  • 1.5% of patients can have hives for up to 25 years

60% of “chronic” hivers have recurrences of the hives

Management is directed toward keeping patients “comfortable” with or without some hives being present. This can be achieved with “appropriate” antihistamine therapy, and occasionally with “other” medications. Prednisone (steroid) should be avoided if at all possible.

Remember the potency of:

  • Benadryl 50mg. is considered — a strength of 1
  • Clarinex, Claritin, Allegra — a strength of 2-3
  • Atarax (hydroxyzine 25mg.), Zyrtec, Xyzal — a strength of 88
  • Doxepin (Sinequan) 25mg — a strength of 779

 

Recent News

Very High Allergy Alert Issued for Tree Pollen 10-12-2026
Jake Strickbine
/ Categories: News

Very High Allergy Alert Issued for Tree Pollen 10-12-2026

Very High Tree Pollen Levels

ALLERGY ALERT - VERY HIGH LEVELS of Tree Pollen Detected for 10/12/2026

Oklahoma City has the HIGHEST TREE POLLEN LEVELS in the U.S. today

VERY HIGH RANGE: TREE POLLEN COUNTS ARE AT VERY HIGH LEVELS on Monday, October 12th, 2026

TREE POLLEN has risen into the VERY HIGH RANGE today. This is an extreme exposure situation. Severe symptoms may be expected in tree pollen sensitive individuals. More seriously allergic persons should be advised to stay indoors as much as possible. This is especially true if a person has tree pollen sensitivity or allergic bronchial asthma.

Elm Tree Pollen (Lacebark, or Chinese Elm and Cedar Elm) is detected and is the VERY HIGH RANGE. Additionally, WEED POLLEN (Ragweed) and MOLD levels are in the HIGH RANGE, at some of the highest levels in the U.S., according the to the National Allergy Bureau (NAB) data.

Central Oklahoma experiences a second elm pollen season from late August into October, thanks largely to fall-pollinating elm varieties including cedar elm and lacebark or Chinese elm, affecting thousands of people across the Oklahoma region, triggering allergic rhinitis, commonly known as “hay fever”, as fall tree species begin pollinating.  These pollen grains can be carried hundreds of miles due to windy conditions.

For More Information -

The best way to combat these allergens is to stay in filtered air. OAAC’s board-certified allergists recommend avoiding allergy triggers as the best way to reduce symptoms. These avoidance tactics include:

  • Limit outdoor activities during days with high pollen counts.
  • Keep windows closed (at home or in the car) to keep pollen out.
  • Don’t wear your outdoor work clothes in the house; they may have pollen on them.
  • Take a shower after coming indoors. Otherwise, pollen in your hair may bother you all night.
  • Leave shoes outside or just inside the door so that you don’t track pollen inside your home.
  • Wash your hands often. Pollen can stick to your hands when you touch something outside or a pet if it has been outside.
  • Wear a dust mask that people like carpenters use (found in hardware stores) when you need to do outdoor tasks such as raking leaves.
  • Clean and replace furnace and air conditioner filters often. Using HEPA (high efficiency particulate air) filters is recommended, which remove at least 99 percent of pollen, as well as animal dander, dust, and other particles.

Some other options include medications like nasal sprays and antihistamines, but it needs to be the correct medicine and should be used continuously throughout the season.

It is important to remember that seasonal allergies (allergic rhinitis, commonly known as “hay fever”) cannot be diagnosed by history alone. A board-certified allergist can diagnose allergies and determine the specific triggers that cause them through simple tests. The  board-certified allergists at OAAC evaluate and manage patients of all ages from throughout the southwest region of the United States. The  main clinic is on the Oklahoma University Health Sciences Center campus, south of the state capitol in Oklahoma City.  For patient convenience, satellite offices are also located in Edmond, Norman, and northwest Oklahoma City.

For more information about allergic rhinitis (“hay fever”), visit: https://oklahomaallergy.com/services/allergic-rhinitis/

For more information about Fall Allergies in Oklahoma, visit: https://oklahomaallergy.com/Blog/fall-allergies-in-oklahoma-whats-making-you-miserable-1

Daily Pollen Counts for Weed, Grass and Tree pollen, as well as Mold levels can be found at: https://oklahomaallergy.com/allergy-report/

Visit the OAAC website at www.oklahomaallergy.com to view the addresses for all Oklahoma Allergy and Asthma Clinic locations.  To make an initial appointment for an allergy, asthma, or immunology problem or to request more information, please call (405) 235-0040 or visit the website.

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