Hives (Chronic Urticaria) Program

Michael Wilson, MD, PhD, of the Allergy and Immunology Unit, discusses hives.

Individualized Care

Treatment Plans Tailored to the Individual

Hives can be triggered by a variety of substances, illnesses and other factors. No two cases are the same (although certain patterns emerge), and symptoms often are fleeting or intermittent. As a result, diagnosing the condition — especially when it persists more than two weeks — can be challenging.

When obvious causes have been ruled out (e.g. change in medication or introduction of a new food), we discuss next steps with patients. We analyze each case meticulously, seeking to uncover any potential alternative root cause for the hives. Patients frequently are surprised to learn that many cases of chronic hives are not caused by underlying allergy.

Our expertise in hives, achieved through a collaborative approach, has earned us recognition as a referral center for this problem. Allergists and dermatologists throughout the Northeast regularly refer patients with particularly complicated cases to our program.

What to Expect

At your first appointment, you can expect an in-depth evaluation by one of our specialists. To diagnose your symptoms, we conduct a physical examination and may perform:

• A thorough review of your medical history including medications you are taking, recent changes in lifestyle or habits, and exposures in your home, workplace and elsewhere
• Allergy skin testing to determine whether allergies may be triggering your symptoms, although this is often not performed in this condition
• Additional laboratory testing to determine whether your hives are associated with a systemic underlying medical problem, including possible autoimmune disorders, if concern arises during the history, as this is not always performed
• Photos of your hives can be very helpful to help confirm the diagnosis

After diagnosing your condition, we develop a customized care plan based on your medical history, symptoms and goals for treatment, and we introduce it in a highly structured manner. This typically involves closely monitoring your progress during follow-up appointments and adjusting your course of treatment as needed. Treatment may include prescribing clinically proven medications and explaining how to avoid or minimize exposure to substances or agents that result in hives.

Comprehensive, Multidisciplinary Care

Whether our patients visit our downtown Boston campus or Mass General Brigham Healthcare Center (Waltham), they receive state-of-the-art care from some of the foremost experts in allergy medicine and related specialties. Patients who have other allergies in addition to hives have access to our allergists who specialize in conditions such as asthma and allergic rhinitis.

Advancing Our Understanding of Hives

Senior members of our physician staff have worked and studied with some of the pioneers in the field of hives and manage care for hundreds of patients annually. Together with other leading researchers, our clinicians and scientists have advanced the understanding of the behaviors and causes of hives and developed breakthrough treatments.

We treat all types of hives, including those associated with:

• Food, drug and environmental allergies
• Non-immunological sources, in which patients come in contact with certain foods, food preservatives or chemicals, resulting in contact dermatitis
• Systemic autoimmune illnesses (e.g. lupus, Sjögren's syndrome, rheumatoid arthritis, diabetes)
• Viral infections (e.g. hepatitis, measles, mononucleosis)
• Hormonal aberrations

Additionally, we treat patients with chronic hives conditions, such as urticarial vasculitis, and those who experience hives in conjunction with other allergies, such as asthma and angioedema.

Physicians Specializing in the Treatment of Hives

Because they have treated so many varieties of hives and studied the condition extensively, our physicians excel at evaluating patients and assessing their symptoms quickly. As a result, patients can expect an expert diagnosis and a fast pathway to treatment, helping them to resume a healthy and comfortable lifestyle as soon as possible.

Although some cases of hives have no known cause, our allergy specialists are skilled in tailoring treatment plans for patients who experience such hives-related conditions. Additionally, we diagnose and manage care for patients when hives appear together with other problems (e.g. joint pain or weight loss) that may signal an underlying and potentially serious autoimmune disorder.

When patients experience symptoms that prove extremely difficult to diagnose, our physicians collaborate with other leading hives authorities in the national and international medical communities.

State-of-the-Art Resources in Boston & Waltham

A full range of hives and allergy-related services are available at Mass General's downtown campus and at Mass General Brigham Healthcare Center (Waltham), including:

• Expert evaluation and diagnosis by allergy specialists
• Comprehensive testing and analysis at our Clinical Immunology Laboratory
• A staff physician and fellow on call 24/7 for patients with urgent conditions