Hives: Causes, Symptoms and Treatment


What are Hives?

arm covered in hives

Hives (urticaria) are a reaction that causes red, itchy, swollen welts on the skin.  Typically, hives develop as an allergic reaction to food, drugs, or other substances.  Also, physical urticaria can occur during viral infections.  Stress and sun exposure can be triggered as well.  They come suddenly and go away just as suddenly.

The rash is usually very itchy and ranges in size from a few millimeters to the size of a hand.  Although the affected area may change in appearance within 24 hours, the rash usually settles within a few days.  Doctors may refer to urticaria as either type of hives:

  • acute urticaria- if the rash clears completely within 6 weeks
  • chronic urticaria/chronic hives -in rarer cases of hives, where the rash persists or comes and goes for more than 6 weeks, often over many years A much rarer type of chronic idiopathic urticaria known as urticaria vasculitis, can cause blood vessels inside the skin to become inflamed.


Types of Hives


hives types


Although allergies can trigger hives, other things can also lead to hives. Understanding the cause can help to address ways to prevent this reaction and avoid the spread of hives.



1.Allergic Hives


Contact with an allergen is the most common cause of hives. Common allergens that can trigger hives are:

  • Pollen
  • Medications
  • Foods
  • Insect bites

   2.Physical Hives


Overexposure to the Sun, cold, or water can cause physical hives. Body heat from physical activity can also cause a reaction.


 3.Infected-induced Hives


Some bacterial and fungal infections can cause hives. Examples of these conditions include:


These infections can spread through:


  • Poor hygiene
  • Sharing eating utensils
  • Contact with stool
  • Airborne germs from sneezing and coughing


How to Identify Hives vs Rashes?


Hives characteristics 

Hives (urticaria) are raised, itchy bumps that can be large or small.  They may be red in color or the same color as your skin.  They may also come and go quickly or last a long time.  The breakout of hives can occur all over the body or only in one or two localized areas.

 Rash characteristics 

Rashes are earmarked by changes in the color or texture of the skin.  They may or may not have Itchy bumps.  They may also cause the skin to feel rough and look scaly or cracked.  Unlike hives, rashes don’t always itch.  Sometimes, they hurt or make your skin feel irritated, scratchy, or uncomfortable.  You may have a rash all over your body or in one or two areas.


How are Rashes Treated?


Rashes can be acute or chronic. If you have a mild rash, at-home treatments such as those used for hives may be effective.  When determining the best treatment for your rash, it is important to consider the cause.  Some possible treatments include:

soaking in a colloidal oatmeal bath

  • applying topical corticosteroids to the area
  • taking oral antihistamines applying topical retinoids to the area applying aloe vera to the area
  • taking oral or injected prescription medications


What Causes Hives

woman showing hives causes on skin



When you have an allergic reaction to a substance, your body releases histamine, and other chemicals into the blood.  This causes itching, swelling, and other symptoms. Hives are a common reaction.  People with other allergies, such as hay fever, often get hives. Angioedema is swelling of the deeper tissue that sometimes occurs with hives.  Like hives, angioedema can occur on any part of the body When it occurs around the mouth or throat, the symptoms can be severe, including airway blockage Many substances can trigger hives, including

  • Animal dander (especially cats).

Insect bites

  • Medicines
  • Pollen
  • Shellfish, fish nuts, eggs, milk, and other foods

Hives may also develop because of

  • Emotional stress
  • Extreme cold or sun exposure
  • Excessive perspiration
  • Illness, including lupus, other autoimmune diseases, and leukemia
  • Infections such as mononucleosis
  • Exercise


Symptoms of Hives

urticaria symptoms


Signs and Symptoms of Hives Include:


  • Itching, which may be severe
  • Welts that vary in size change shape and appear and repeatedly fade as the reaction runs its course.
  • Batches of red or skin-colored welts can appear anywhere on the body.
  • Skin swelling that subsides or goes away within 24 hours at one spot but may appear at another spot.
  • A tendency for signs and symptoms to flare with triggers such as heat, exercise, and stress.


Is It Hives or Angioedema?


Angioedema-swelling of tissue beneath the surface of the skin can be mistaken for, associated with hives. It can be caused by allergic reactions, medications, or a hereditary deficiency of some enzymes. The following symptoms may indicate angioedema:

  • Swelling of the hands, feet, or throat
  • Swelling in the eyes or mouth
  • Difficulty breathing, stomach cramps, or swelling of the lining of the eyes.




Your doctor will do a physical exam. He or she will look at the hives and ask for allergy tests. Your doctor may also do a blood, skin, or urine test. If a specific food is a suspected trigger, your doctor may do a skin-prick test to confirm the diagnosis. In rare instances, your doctor may recommend an oral food challenge- a carefully monitored test in which you will eat a measured amount of the suspected trigger to see if hives develop.

In cases where vasculitis (inflammation of the blood cells) may be the cause, your allergist may conduct a skin biopsy and send it to the specialist to examine it under the microscope.



If your symptoms are mild, you may not need treatment. Hives and angioedema often clear up on their own. But treatment can offer relief for intense itching, serious discomfort, or symptoms that persist. Following are the things you can do to lessen the discomfort:


  • Avoid scratching the hives
  • Apply an anti-itch cream
  • Avoid alcohol, tobacco, and exercise
  • Wear loose clothing
  • Cover the area with a cold cloth




ointment for hives

Treatments for hives and angioedema may include prescription drugs, including:


  • Anti-inflammatory drugs


For severe hives or angioedema, doctors may sometimes prescribe an oral corticosteroid drug- such as prednisone to reduce swelling, redness, or itching.


  • Anti-itch drugs


The standard treatment for hives and angioedema are antihistamines that do not make you drowsy. These medications reduce itching, swelling, and other allergy symptoms.


  • Drugs that suppress the immune system


If antihistamines and corticosteroids are ineffective, your doctor might prescribe a drug capable of calming an overactive immune system.


Treatment for Chronic Hives


Treatment for chronic hives to treat a type of chronic hives called CIU, which can last for six weeks or longer and sometimes months and years, the Food and Drug Administration has approved two medications- antihistamines and omalizumab.  Research shows that up to 50% of people with chronic hives CIU continue to have hives after treatment with antihistamines.  Omalizumab, which is injected under the skin, has been shown to relieve the itch and clear hives in some people with CIU in one research study, 36% of patients treated with omalizumab reported no itch and no hives after treatment.


Can hives be prevented?


Simple changes to your lifestyle may be able to help you prevent hives from reoccurring in the future. If You have allergies and you know which substances are likely to cause an allergic reaction your doctor will suggest that you avoid any possible exposure to these factors. Allergy shots are another option that may help you reduce the risk of experiencing hives again. Avoid being in high-humidity areas or wearing tight clothing if you have recently had a hives outbreak.


If you have a known allergy, you can do the following to prevent hives:

  •  Avoid foods you are allergic to.
  • Carry an EpiPen in case of allergic emergencies.
  • Find alternatives to medication for thyroid disease or blood pressure prescriptions that contain allergens.
  • Be wary of any side effects such as welts on skin

Here are a few tips you can try to prevent becoming infected with this bacterium:

  • Wash your hands regularly.
  • Practice good hygiene.
  • Get vaccinated for preventable infections.
  • Limit contact with people who are sick or are exhibiting hives.
  • Avoid harsh soaps that could irritate.
  • Avoiding tight clothing.


Lifestyle and Home Remedies

home remedies

If you are experiencing mild hives or angioedema, these tips may help highlight your symptoms:

  • Avoid triggers.  These can include foods, medications, pollen, pet dander, latex, and insect stings.  If you think a medication causes your rash, stop using it, and contact your primary care provider.
  • Apply cold washcloth.  Covering the affected area with a cold water washcloth can help soothe the skin and prevent scratching.
  • Take a comfortably cool bath.  Find relief from itching in a cool shower or bath.  Some people may also benefit from bathing in cool water sprinkled with baking soda or oatmeal powder (Aveeno, others), but this is not a solution for long term control of chronic itching.
  • Wear loose, smooth-textured cotton clothing.  Avoid wearing clothing that is rough, tight, scratchy, or made from wool.  This will help you avoid skin irritation.
  • Avoid the sun.  When outdoors, seek shade to help relieve discomfort.


 Hives and Stress

hives and stress



One cause of hives, or a factor that can make symptoms worse, is emotional stress.  A study in 2005 linked stressful life events, low family support, insomnia, and hives in 75 participants.  Other scientists have explained how “chronic stress can lead to dysregulation of the mediators and exacerbate underlying inflammatory disease pathophysiology.”  In other words, when a person is stressed, any inflammatory reactions are likely to be more severe in a person who is susceptible to a reaction.  In this way, hives, or urticaria, can be linked to stress.


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