Urticaria in adults

Overview

Urticaria, also known as hives, is a skin condition that causes raised, itchy, red or skin-colored welts (wheals) on the skin. These welts can appear suddenly and usually fade within a few hours to days.

Yes, urticaria is very common. It affects people of all ages, and at least 1 in 5 adults will experience an episode at some point in their lives.

Urticaria can affect anyone, but it's most common in adults between 20 and 40 years old. Women are slightly more likely than men to develop chronic hives.

Symptoms

Common symptoms

• Raised, red or skin-colored welts (wheals) that can vary in size and shape
• Intense itching, sometimes burning or stinging
• Welts that come and go – usually lasting a few hours to a day, then fading without scarring
• Swelling of deeper skin layers (angioedema), often around the eyes, lips, hands, or feet

Symptoms in children

• Children often have widespread hives that can cover large areas of the body.
• They may also have a mild fever or feel generally unwell.
• Hives in children are commonly triggered by infections (like a cold) rather than allergies.

Symptoms in older adults

• Older adults may have more frequent or severe angioedema (deep swelling).
• Hives in this age group are sometimes linked to medications (such as some painkillers or blood pressure drugs).
• The skin may be more fragile, so scratching can lead to bruises or infection.

Causes

Main causes

• Allergic reactions to foods (e.g., nuts, shellfish, eggs, milk), medications (e.g., antibiotics, aspirin), or insect stings
• Infections – viral illnesses like colds or stomach bugs are a common cause, especially in children
• Physical triggers – pressure on the skin, cold, heat, sunlight, vibration, or water (physical urticaria)
• Stress or emotional upset can make hives worse or trigger an episode
• Sometimes the cause is unknown (idiopathic urticaria), especially in chronic cases lasting over 6 weeks

Risk factors

• Personal or family history of allergies (eczema, hay fever, asthma)
• History of previous hives or angioedema
• Autoimmune conditions, such as thyroid disease or lupus
• Certain medications, including nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen
• Frequent exposure to known triggers (e.g., pressure on skin from tight clothing)

When to see a doctor

See a doctor urgently if:

• If you have signs of anaphylaxis (see emergency symptoms), call emergency services immediately.
• If hives appear after taking a new medication or after an insect sting, seek care right away.
• If you have swelling of the face, tongue, or throat that is not life-threatening but concerning, see a doctor the same day.

Book a routine appointment if:

• If hives last longer than 2 days despite at-home care
• If hives keep coming back for more than 6 weeks (chronic urticaria)
• If the itching interferes with your sleep or daily life
• If you are worried or want to identify triggers

Diagnosis

A doctor can usually diagnose urticaria by looking at your skin and asking about your symptoms and possible triggers. They will want to know when the hives started, how long they last, and if you have any other symptoms like swelling or breathing trouble.

Tests that may be done

• Often no tests are needed for a first episode of acute hives.
• If hives are chronic or the cause is unclear, your doctor may recommend allergy tests (skin prick tests or blood tests for specific allergies).
• Blood tests can check for underlying conditions like thyroid problems or autoimmune diseases.
• In rare cases, a skin biopsy (taking a tiny sample of skin for analysis) may be done to rule out other conditions.

What to expect at your appointment

The diagnosis is usually quick and straightforward – your doctor will examine the welts and ask about your history. They may ask you to keep a diary of symptoms and triggers. Most people get a clear diagnosis and treatment plan in one visit.

Treatment

Treatment for urticaria focuses on relieving the itch and swelling and avoiding triggers. Most hives improve with simple measures, and for more persistent cases, doctors have several effective options.

Self-care at home

• Apply a cool, wet cloth or ice pack wrapped in a towel to the itchy areas.
• Wear loose, soft clothing to avoid irritating the skin.
• Avoid scratching – keep nails short and consider wearing light gloves at night.
• Take a lukewarm bath with baking soda or colloidal oatmeal to soothe the skin.
• Use a fragrance-free moisturizer to keep skin hydrated.

Medical treatments

If self-care isn't enough, doctors may recommend oral antihistamines (medicines that block histamine, a chemical that causes hives). These are taken regularly to prevent hives. For severe or chronic cases, other prescription medications may be used, such as certain corticosteroids (for short-term flare-ups) or biologic therapies that target the immune system. Always follow your doctor's advice about what to take and for how long.

When is surgery considered?

Surgery is not a treatment for urticaria.

Living with this condition

Most people with urticaria manage very well. For acute hives, you may have occasional flare-ups that clear within a day or two. For chronic hives, it can be more challenging, but with a good treatment plan and trigger avoidance, many people keep symptoms under control.

Lifestyle tips

• Identify and avoid your personal triggers – keep a diary of foods, activities, and situations that seem to bring on hives.
• Reduce stress through relaxation techniques like deep breathing, meditation, or gentle exercise.
• Avoid harsh soaps, detergents, and perfumes that can irritate your skin.
• If you have physical urticaria (triggered by pressure, cold, etc.), take steps to avoid those triggers – for example, wear padded gloves for pressure hives.

Diet and exercise

No special diet is needed unless you know a specific food triggers your hives. If you suspect a food allergy, your doctor may recommend an elimination diet. Exercise is generally fine, but if you have exercise-induced urticaria (hives from sweating or heat), you may need to exercise in cool conditions and stop if hives appear.

Mental health and emotional wellbeing

Chronic hives can be frustrating and embarrassing. The constant itching and unpredictable flare-ups may cause anxiety, sleep problems, or low mood. It's important to talk to your doctor if you are feeling stressed or depressed. They can offer support or refer you to a counselor.

Prevention

It's not always possible to prevent hives, especially if the cause is unknown. But you can lower your chances of flare-ups by avoiding known triggers, managing stress, and staying away from foods or medications you are allergic to.

Vaccines

Vaccines are not used to prevent urticaria, but they are important for preventing infections that could trigger hives. If you have a history of severe allergic reactions to vaccines, talk to your doctor before getting immunized.

Screening programmes

There is no routine screening for urticaria. If you have frequent or severe hives, your doctor may do tests to look for an underlying cause, but this is not screening in the usual sense.

Complications

If left untreated

• Intense itching can lead to skin damage, infection, or scarring from scratching.
• In rare cases, chronic untreated hives can cause sleep deprivation and affect quality of life.
• If angioedema (deep swelling) affects the throat or tongue, it can be life-threatening – this always needs emergency care.
• Underlying conditions (like thyroid disease) may go undiagnosed if hives are not investigated.

Long-term outlook

The outlook for urticaria is generally very good. Most acute hives resolve within hours to days. Even chronic hives, which can last for months or years, often improve over time and can be effectively managed with medical help. With the right treatment and support, most people live normal, active lives.

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