Overview

Urticaria, commonly known as hives, is a skin reaction that causes itchy, raised welts (also called wheals) to appear on your skin. These welts can vary in size and appear anywhere on your body. Hives are usually caused by your body's reaction to an allergen or another trigger, which causes cells to release histamine and other chemicals into your bloodstream.

Anyone can get hives, from babies to older adults, though they are quite common. Hives themselves are not contagious, so you can't catch them from someone else. Living with hives, especially if they are frequent or long-lasting, can be very frustrating and affect your sleep and daily activities due to the intense itch. We understand how disruptive this can be, and we're here to help you understand more about it.

Symptoms

You might experience several of these common signs if you have hives:

• Raised, red or skin-colored welts (wheals): These are the hallmark of hives and can look like mosquito bites, but often larger and in patches.
• Intense itching: This is often the most bothersome symptom and can be quite severe.
• Blanching: The welts may turn white or pale in the center when pressed.
• Changing appearance: Hives can change shape, move around, disappear, and reappear over short periods. Individual welts usually don't last more than 24 hours.
• Swelling under the skin (angioedema): This can occur with hives, often around the eyes, lips, hands, feet, or throat. Swelling in the throat can be serious.
• A burning or stinging sensation in the affected areas.
• Symptoms can sometimes be triggered or worsened by heat, stress, or exercise.

Diagnosis

Diagnosing hives is usually straightforward for a healthcare professional. They will typically look at your skin and ask questions about your symptoms, including how long you've had them and if you've noticed any potential triggers.

In most cases of acute (short-term) hives, specific tests aren't needed. If your hives last for more than six weeks (chronic hives) or if there's a suspicion of a specific allergy, your doctor might recommend further tests like blood tests or allergy skin tests to try and identify a cause. Keeping a diary of your symptoms and potential exposures can be very helpful.

Management & Treatment

We know how uncomfortable and disruptive hives can be, and finding relief is your top priority. The good news is that many cases of hives get better on their own, and there are excellent treatments available to manage symptoms and help you feel comfortable in your own skin again.

The main goal of treatment is to relieve the intense itch and calm the rash. The approach we recommend will depend on whether your hives are a one-time occurrence (acute) or a long-term issue (chronic).

Home Care and Self-Management

For mild to moderate hives, you can often find relief with these simple at-home strategies:

• Cool It Down: Apply a cool, damp cloth to the affected areas or take a comfortably cool bath. This can be incredibly soothing for itchy skin. Be careful not to use ice-cold water, as sudden temperature changes can sometimes trigger hives.
• Wear Loose, Soft Clothing: Avoid tight-fitting clothes that can rub against your skin and make the itching worse. Light, smooth fabrics are your best friend.
• Avoid Scratching: As hard as it may be, try not to scratch the hives. Scratching can irritate your skin further and may lead to a cycle of more itching and swelling.

Over-the-Counter (OTC) Options

The most common and effective treatment for hives is an antihistamine. These medications work by blocking the chemical (histamine) that your body releases during an allergic reaction, which is what causes the itching and swelling.

• Non-Drowsy Antihistamines: We usually recommend starting with newer, second-generation antihistamines that you can buy at any pharmacy. These are less likely to make you sleepy. Look for active ingredients like loratadine (Claritin), cetirizine (Zyrtec), or fexofenadine (Allegra).
• Topical Creams: Lotions like calamine can provide a cooling sensation and temporary relief from itching for small areas.

For many people, a standard dose of an OTC antihistamine is enough to control the hives until they disappear.

When Prescription Treatments Are Needed

If your hives are severe, don't improve with OTC options, or continue for more than six weeks (becoming chronic), it's time to partner with a healthcare provider. Living with constant hives can be frustrating, but we have many more tools to help.

Your doctor may recommend:

• Higher Doses of Antihistamines: Sometimes, a provider will advise taking a higher-than-standard dose of a non-drowsy antihistamine. This should only be done under a doctor's supervision.
• Combining Antihistamines: Your doctor might add a different type of antihistamine to your treatment plan.
• Oral Corticosteroids: For a severe flare-up, a short course of a strong anti-inflammatory pill like prednisone can quickly bring relief. This is typically used for only a short period due to potential side effects.
• Biologic Medications: For difficult-to-treat chronic hives, newer injectable medications like omalizumab (Xolair) or dupilumab (Dupixent) can be life-changing. These work by targeting specific parts of the immune system that cause hives.

What to Do If Treatments Aren't Working

It can take time to find the right treatment plan for you, especially with chronic hives. If your symptoms aren't under control, please don't feel discouraged. Talk to your dermatologist. They may need to adjust the dose, add another medication, or explore other causes.

Important Safety Warning

Hives can sometimes be part of a severe, life-threatening allergic reaction called anaphylaxis. If you experience hives along with any of the following symptoms, seek emergency medical care immediately:

• Swelling of the tongue, lips, or throat
• Difficulty breathing or wheezing
• Dizziness or feeling faint

If you have a known severe allergy, your doctor may prescribe an epinephrine auto-injector (like an EpiPen) for you to carry at all times.

Duration & Outlook

Hives can be either acute (short-term) or chronic (long-term). Acute hives usually last for less than six weeks, and often, an individual outbreak will clear up within hours to a couple of days. Many people experience only one episode of acute hives in their lifetime.

Chronic hives, on the other hand, last for more than six weeks, with welts appearing on most days. This form can sometimes persist for months or even years, which can be very challenging. The good news is that even chronic hives often eventually go away on their own, though it can take time.

A warning sign for a serious complication is swelling of your tongue or throat, or if you have trouble breathing or feel dizzy – this could be a sign of anaphylaxis and requires immediate emergency medical attention (call 911 or your local emergency number).

Prevention

If you know what triggers your hives, avoiding those triggers is the best way to prevent them. For example, if certain foods or medications cause your hives, you'll need to avoid them.

For many people, especially those with chronic hives, a specific trigger isn't always found. In these cases, managing stress and avoiding known irritants like harsh soaps or tight clothing might help reduce flare-ups. We know it's not always easy to pinpoint these triggers, but paying close attention to when your hives appear can sometimes offer clues.

Causes & Triggers

Hives occur when your body releases a chemical called histamine, along with other substances, into your skin. This causes small blood vessels to leak fluid, leading to the swelling and itchiness of welts.

Common triggers for acute hives include:

• Allergic reactions: To foods (like nuts, eggs, shellfish), medications (like penicillin or aspirin), insect stings or bites, latex, or pollen.
• Infections: Viral infections (like a cold or flu) are a common cause, especially in children. Bacterial infections can also trigger hives.
• Physical stimuli (less common for acute, more for chronic inducible urticaria): Pressure on the skin, changes in temperature (cold or heat), sunlight, water, vibration, or exercise.
• Stress: Emotional stress can sometimes trigger hives or make them worse.

Anyone can develop hives, but people with other allergies (like hay fever) or a family history of hives may be at a slightly higher risk. Sometimes, especially with chronic hives, the exact cause remains unknown, which can be understandably frustrating.

When to see a doctor

It’s a good idea to see a healthcare professional if:

• Your hives are severe or widespread.
• You experience swelling of your lips, tongue, or throat.
• You have difficulty breathing or swallowing, feel dizzy, or have a racing heart. These are signs of a severe allergic reaction (anaphylaxis) and require immediate emergency medical attention (call 911 or your local emergency number).
• Your hives last for more than a few days or keep coming back.
• The itching is unbearable and significantly impacts your daily life or sleep.
• You suspect a medication might be causing your hives.
• You have other symptoms like fever, joint pain, or weight loss along with the hives.

A dermatologist is a specialist in skin conditions and can be particularly helpful if your hives are chronic, severe, or if the cause isn't clear. They can help with diagnosis and discuss management strategies.

Frequently Asked Questions (FAQs):

• Q: Are hives contagious? A: No, hives are not contagious. You cannot catch them from someone else or spread them to others.
• Q: Do hives always mean I have an allergy? A: Not always. While allergies are a common cause, hives can also be triggered by infections, stress, physical factors, or sometimes the cause is unknown (especially in chronic cases).
• Q: Will my hives leave scars? A: Typically, hives do not leave scars. The welts usually disappear completely without a trace once the reaction subsides.
• Q: Can stress cause hives? A: Yes, stress can be a trigger for some people or can make existing hives worse. We understand that dealing with a skin condition can itself be stressful, creating a difficult cycle.
• Q: How long do individual hive welts last? A: Individual welts usually last less than 24 hours. New welts may appear as old ones fade, making it seem like they last longer. If individual spots last longer than 24 hours and leave a bruise, it might be a different condition, and you should see a doctor.

We hope this information helps you better understand urticaria. Remember, if you're concerned about your skin, seeking advice from a healthcare professional is always the best step. They are there to support you.

References

• American Academy of Dermatology. (n.d.). Hives: Diagnosis and treatment. Retrieved from https://www.aad.org/public/diseases/a-z/hives-treatment
• American College of Allergy, Asthma & Immunology. (2018, June 11). Hives (Urticaria). Retrieved from https://acaai.org/allergies/allergic-conditions/skin-allergy/hives/
• American Academy of Family Physicians. (2017, June 1). Acute and Chronic Urticaria: Evaluation and Treatment. Retrieved from https://www.aafp.org/pubs/afp/issues/2017/0601/p717.html
• Kayiran, M. A., & Akdeniz, N. (2019, February 14). Diagnosis and treatment of urticaria in primary care. North Clin Istanb. Retrieved from https://naturemed.org/natural-ways-to-treat-hives-quickly/