The other night, my friend called me regarding her daughter who had a strange rash, hives we determined. What she didn’t understand was, though her daughter had the rash the night before, it had cleared up during the day, but was back that evening. I did tell her that it’s not unusual for rashes and hives, even insect bites to be fine during the day, but resurface or flare up at night. Though I knew that, I had no idea why, and curiosity got the best of me.
Hives are raised skin irritations that resemble mosquito bites, but can be much larger. They usually appear in groups, most frequently on arms, legs, back and torso, and can disappear as quickly as they come on. For some, however, they become chronic (lasting months or more) and as we’ve said, are usually worse at night. Obviously, this can become a very uncomfortable and frustrating situation; it’s important to understand why they are worse at night.
The body actually produces its own anti-itch chemicals which help us out with relieving all types of rashes, stings and hives. Often, this chemical provides enough relief for us; sometimes we need to help it along with an antihistamine like Benadryl or Chlortrimeton. As the sun goes down and our body prepares for sleep, however, this chemical in our body decreases. It is very common, like my friend’s daughter, for the rash to worsen at night and then disappear completely during the day. This is also why your insect bites itch more at night.
So we have the why, but what to do? Trying to sleep with a body full of itchy hives is not only hard to do, but while sleeping, many people scratch the rash unknowingly, making it worse. There are several recommendations of treatment worth trying.
Taking an oral antihistamine will not only relieve some of the itchiness, but also help with sleep. Benadryl and Chlortrimeton are the most often recommended (Benadryl is my particular drug of choice). Another non-medicative option to try is a cool shower or bath before bed, but not hot because that will exacerbate the hives. You can also add an oatmeal bath to your water, like Aveeno. Oatmeal baths are also a good option for babies and young children if you are opposed to medicating at a young age; it’s also a relaxing alternative.
Another suggestion is increasing your water intake throughout the day to help your body flush out the hive causing toxin. You can also try rooibos tea as it contains quercetin, a natural antihistamine, and it will simultaneously aid in the cleansing of your body.
Hives are not only uncomfortable, but also frustrating due to their mysterious nature. If you can’t find the cause, at least perhaps you can alleviate some of the nighttime itchiness.
We know winter is a bad time for those with dry, itchy skin and we try our best to combat it. My nine year old daughter wakes up almost every night with itchy flare ups, even though we slather her with lotion before she goes to bed and have cut her showers back to no more than every other night. So why does it flare up at night? She can go all day with barely an itch and then her eczema wakes her up at night. I recently have had three or four friends tell me the same thing, one is even going through it herself.
Eczema runs in cycles, we know that, too. It goes from clear skin to signs and symptoms to flare ups. Then it starts over. Certain things can flare it up and yes, the itch does tend to get worse at night. And in turn, those with eczema scratch it, making it flare even more.
Not only is the itch itself bothersome, but waking up throughout the night is disruptive to the sleep cycle and daily well being. The best thing to do is note when a symptom is showing itself and try to catch it becomes uncontrollably itchy. I’ve seen my daughter during a flare up and she literally can’t stop scratching, though she makes her legs red and even worse.
Many people with eczema have other allergies, and often it runs in families. For us, the one with the worse skin is the one without the food allergies or animal dander allergies, but that’s just the way it is. We try to manage by keeping her hydrated from the inside and out in the winter months. Spring and fall she is fine, but in the summer, she does tend to get heat induced eczema which is different for her than in the winter months.
There are lots of lotions and creams on the market for itchy skin. Find the one that works best for you or your child. Many people recommend Vanicream, it is said to be great for dry, sensitive skin. Another good one is Cetaphil cream; I love the big pot that you can just scoop handfuls of cream out of. Cerave is another one that our dermatologist recommended an does sink right in. I think any of these would be good to keep by the bed so you or your child can reach it instead of scratching. As soon as lotion hits my daughter’s legs, she feels better and is calmer. Much better than frantic night time scratching.
Hives – Unknown Causes and Known Treatment
This weekend we were with some friends and one of them had a terrible outbreak of hives. The worst part – she had no idea why they were there. Of course, all of us were asking her about everything she had eaten and come in contact with, and nobody could figure out anything.
She said for the past few years she has had mystery outbreaks. For her, they start at her hairline and work their way down her body and end up on her feet. We watched the progression of the breakout of hives around her face and hairline and by the next day, those had gone but her feet were swollen and red. She wasn’t concerned with anything more than the hives, and they didn’t even really itch that bad; she was mostly frustrated with the unknown cause.
As I did a bit of research when we got home, I did find that on her feet it could be something a little different than hives, called angioedema. According to webmd.com, this is “similar to hives but the swelling occurs beneath the skin instead of on the surface.” The article mentions a common place for this is the hands and feet (as well as eyes and lips), and it can last longer than hives but usually not more than 24 hours. It can also, though rarely, occur in the airways blocking air flow, similar to anaphylaxis.
Angiodema forms in response to histamine (like hives) and blood plasma leaks out of small blood vessels in the skin, therefore causing the swelling. I’m sure our friend would like to know (or not) that it is common to have the reactions with no idea why, though allergic reactions can occur from anything from foods (meaning anything from a food itself to preservatives and additives), insect stings, sunlight exposure or medicine.
As far as treatment goes, everyone tends to go to the antihistamines first which is recommended. Benadryl can usually be effective, but it is important to take the right dosage. Once Benadryl (or similar form) is taken, there are some other things to do, but it is smart to take medication at onset to try to control the outbreak. To relieve the itching, cool compresses usually help. Because heat can be a trigger, too, cooling down the body can help, either with a cold shower or bath in addition to cool compresses. Relaxing is helpful as well, though sometimes easier said than done. Hives can get worse with stress (which adds heat to the body) so trying to sit and relax during an outbreak is a good idea. Some of the treatments and drugs usually used for hives.
Of course, if the hives are getting to air passages and turning into swelling of the lips, face and/or mouth, emergency medical attention may be necessary in case breathing is at risk.
Often, like our friend, people never learn the cause of their hives or angioedema. This is classified as idiopathic hives. According to the World Allergy Organization, if no cause is found, even with blood tests, it’s not considered a true allergy because no IgE antibody is involved.
“Research suggests that in 35-45% of patients with idiopathic hives the cause may be autoimmunity – that is, the patient’s immune system working against itself. These autoimmune types of hives are not serious and usually respond to treatment with antihistamines.”
Because there can be so many causes, or none at all, for hives and angioedema, the hardest part may be the unknown and the fact that they can’t even be controlled with avoidance, as you don’t even know what to avoid.
– Heather Legg