Urticaria (Hives)
Sources consulted
This article is original patient-education content.
- WHO—Health topics A–Z(2024)
- NHS—Health A to Z(2024)
- CDC—Health topics(2024)
Based on international clinical guidelines
Overview
Urticaria, commonly called hives, is a skin reaction that causes raised, itchy welts (also called weals) to appear on the skin. These welts can be red or skin-coloured, and they often come and go quickly — each one usually fades within a few hours.
Key facts
- Hives are very common and can affect anyone.
- Most cases of hives go away on their own within a few days.
- Hives are not contagious — you cannot catch them from someone else.
Yes, hives are extremely common. Around 1 in 5 people will have hives at some point in their life.
Anyone can get hives, but they are more common in children and young adults. People with allergies, asthma, or a family history of hives are more likely to have them.
Symptoms
- Difficulty breathing or wheezing
- Swelling of the lips, tongue, or throat
- Dizziness, fainting, or a rapid heartbeat
- Feeling of doom or severe anxiety with hives
- ⚠Hives that spread rapidly or cover a large area of the body
- ⚠Hives along with fever, joint pain, or feeling generally unwell
- ⚠Hives that appear after taking a new medication or after an insect sting
Common symptoms
- Raised, red or skin-coloured welts that can vary in size and shape
- Intense itching, sometimes with a stinging or burning feeling
- Welts that appear suddenly and may disappear within hours
- New welts forming as old ones fade
- Swelling of the skin around the eyes, lips, hands, or feet (called angioedema)
Symptoms in children
- Welts may be fewer in number but can cause significant itching
- Sometimes accompanied by a mild fever, especially if triggered by an infection
- Children may scratch a lot, which can lead to skin irritation
Symptoms in older adults
- Hives may last longer and be more persistent
- Often linked to medications (such as certain painkillers or antibiotics)
- May have underlying health conditions like thyroid disease or autoimmune disorders
Causes
Main causes
- Allergic reactions to foods (e.g., nuts, shellfish, eggs), medications (e.g., antibiotics, aspirin), or insect stings
- Physical triggers such as pressure on the skin, cold or hot temperatures, sunlight, or exercise
- Infections, especially viral infections like the common cold
- Stress or emotional upset
- Autoimmune conditions where the body's immune system attacks healthy skin cells
Risk factors
- Personal or family history of allergies, eczema, or asthma
- Autoimmune diseases such as lupus or thyroiditis
- Recent infections or illness
- Taking certain medications regularly
When to see a doctor
See a doctor urgently if:
- If hives come with any of the emergency symptoms listed above, call your local emergency number immediately.
- If hives appear after starting a new medication or after an insect sting, seek same-day medical care.
Book a routine appointment if:
- If hives last longer than 6 weeks (this is called chronic urticaria)
- If hives keep coming back and affect your sleep, work, or daily life
- If you cannot identify a trigger and want help finding the cause
Diagnosis
A doctor will ask about your symptoms, when they started, what you were doing or eating before they appeared, and whether you have any allergies or medical conditions. They will also examine your skin.
Tests that may be done
- Allergy tests (skin prick test or blood test) to look for specific triggers
- Blood tests to check for underlying conditions like autoimmune disease or thyroid problems
- In rare cases, a skin biopsy (taking a small sample of skin) if the diagnosis is uncertain
What to expect at your appointment
Most people with hives do not need tests. Your doctor may ask you to keep a diary of your symptoms and possible triggers. For chronic hives, you may be referred to a dermatologist (skin specialist) or allergy specialist. The process is usually straightforward and not painful.
Treatment
The main goal of treatment is to relieve itching and prevent new hives from forming. Treatment depends on whether hives are acute (short-term) or chronic (long-term). Most cases can be managed with simple measures and over-the-counter medications. For severe or persistent hives, a doctor may prescribe stronger medicines.
Self-care at home
- Apply cool compresses or ice packs to itchy areas
- Wear loose, soft clothing to avoid rubbing the skin
- Take a lukewarm bath with baking soda or colloidal oatmeal
- Avoid scratching — keep nails short and consider wearing gloves at night
- Identify and avoid triggers such as certain foods, medications, or physical factors
- Manage stress with relaxation techniques like deep breathing or gentle exercise
Medical treatments
For mild hives, doctors often recommend a type of medicine called an antihistamine (taken by mouth) to reduce itching and swelling. For more severe hives, a short course of corticosteroid tablets may be used. For chronic hives that do not respond to other treatments, there are injectable medications called biologics that target the immune system — these are prescribed by specialists. Always follow your doctor's advice about any treatment.
When is surgery considered?
Surgery is not a treatment for hives.
Living with this condition
Living with hives can be uncomfortable, but most people manage well with simple strategies. When hives appear, try to stay calm and avoid things that make it worse, like hot showers or tight clothing. Keep a diary to track what triggers your hives — this can help you avoid them in the future.
Lifestyle tips
- Identify and avoid personal triggers
- Keep cool — avoid overheating from exercise or hot weather
- Manage stress, as it can be a trigger
- Use gentle, fragrance-free skin products
- Wear a medical alert bracelet if you have severe allergic reactions
Diet and exercise
There is no special diet for hives unless you know a specific food triggers them. If you suspect a food trigger, speak with your doctor about an elimination diet. Exercise can be helpful for stress relief, but if exercise itself triggers hives (called exercise-induced urticaria), talk to your doctor about ways to manage it.
Mental health and emotional wellbeing
Chronic hives can be frustrating and affect your confidence and mood. It is normal to feel anxious or upset. If hives are affecting your mental well-being, talk to your doctor or consider speaking with a counsellor. You are not alone — many people manage hives and live full, active lives.
Prevention
It is not always possible to prevent hives, but avoiding known triggers is the best strategy. If you have a known allergy, steer clear of that food, medicine, or trigger. For physical hives, you can take steps like protecting your skin from cold or sun. Keeping a symptom diary can help you spot patterns and avoid flare-ups.
Complications
If left untreated
- Rarely, hives can be a sign of a severe allergic reaction (anaphylaxis) that needs emergency treatment.
- Chronic hives can interfere with sleep, work, and daily activities if not managed.
- Scratching too much can break the skin and lead to infection.
Long-term outlook
The outlook for hives is excellent. Most acute hives clear up in a few days without any lasting effects. For chronic hives, while they can last for months or even years, treatments are very effective at controlling symptoms. Most people with chronic hives find that their condition improves over time.
Find support
International organisations
Local organisations
- NHS (UK) — Urticaria ↗ · United Kingdom
- HealthLink BC (Canada) ↗ · Canada
- Healthdirect (Australia) ↗ · Australia
Helplines
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Always verify with your doctor
Health guidelines vary by country and region. The information in this article is based on international clinical guidelines but may not reflect the specific guidelines, medications, or practices in your country. Always discuss your health concerns with your own doctor or healthcare provider, and refer to your local national health guidelines where available.
Important notice This information is for educational purposes only. It does not replace professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider about your specific situation. If you are experiencing a medical emergency, call your local emergency services immediately.