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Hives Skin Urticaria Causes Treatment Preventions & More

Hives is the term given to a skin reaction. The condition is medically known as urticaria. About 20% of people experience hives at some point during their lives. Hives present as itchy raised welts or bumps that appear on the skin. Most often, they are triggered by an allergen present in the environment or food.

Hives vary in size. They may be as small as a pencil dot or large as a dinner plate. Sometimes, smaller skin lesions merge to form an enormous welt.

Hives may be mildly irritant or severely itchy. Sometimes the condition is accompanied by swelling, which is called angioedema.

Hives may last for less than twenty-four hours and resolve. Sometimes the condition may become chronic, characterized by recurrence and relapse. A persistent skin lesion that lasts for more than six weeks and recurs within a year is termed chronic.

Hives Skin Urticaria Causes Treatment Preventions

What do Hives look like?

Hives do not have a specific shape or form. Appearing as welts on the skin surface, these can be red or the same color as your skin.

Hives tend to appear in batches on the affected part of the body. The welts can change shape, grow more extensively, and can spread too.

During an outbreak, urticaria changes its shape and color during the entire course of the attack. Upon pressing, the hives can turn white or pale. 

Seek medical attention immediately if hives involve your throat, tongue or if you are having trouble breathing. Signs like swollen eyelids, tongue and lips, dizziness, and difficult breathing call immediate medical help.

Causes of hives

The underlying cause of hives is an allergic response of our body to some irritant. The triggering stimuli may be encountered via inhalation or ingestion as a food ingredient.

When your body gets an allergic reaction, it releases histamine and other chemicals in the blood. These chemicals are responsible for causing the signs and symptoms signature of hives.

Some of the triggers that stimulate hives include;

  • A bacterial infection such as Urinary Tract Infection (UTI) and strep throat
  • Intestinal parasites
  • Pet dander from cats, dogs, horses, etc.
  • Latex
  • Pollen
  • Insect bites
  • Contact with chemicals
  • Allergy shots
  • Infections such as influenza, glandular
  • Cockroaches and their waste
  • Lupus
  • Exercise
  • Water on skin
  • Scratching
  • Hot or cold weather
  • Alcohol

 Other circumstances, rather than just allergies, can also cause hives.

Some people get hives due to tight clothes, stress, illness, or infections. Irritation from sweating can also cause hives.

The triggers for hives are numerous, and a specific cause may never be determined.

The acute cases and their causative factor may be identified. Yet, the chronic cases are the ones that are unlikely to be explicitly specified. Chronic cases are sometimes related to autoimmune disorders involving thyroid or some forms of cancers as well. 

The immune mechanism produces hives, so it is not contagious.

The chances of getting hives are higher if a person is known to have allergies or harbor a familial tendency to some allergies.

If the person is on some medication or unknowingly exposed to the stuff that triggers the allergies, such as pollen, pet dander, and pollen, they can get hives.

You are more vulnerable to getting hives if you are already ill with an infection or have an underlying health condition.

 Signs and Symptoms of skin hives

The primary and the earliest symptom of hives is that the skin gets flared up with wheals appearing on the skin.

The wheals can be round or oval-shaped. The color may vary according to the skin tone. It can be red, pink, or the same color of the skin. Their size range is from a few millimeters to a few inches.

Duration of the symptoms can last anywhere from a few minutes to months or sometimes even years. That is why hives development significantly disturbs one’s everyday routine.

Hives may resemble bug bites, but the former are itchier. The itch of a hive may be accompanied by swelling. It may go away within 24 hours only to reappear elsewhere.

The symptoms of chronic hives can last more than just six weeks.

Some of the symptoms are:

  • Welts appearing singly or in a group
  • Painful swelling of the lips, throat, and eyelids
  • Severe itching
  • Symptoms flaring up with triggers like exercise, sweating, and heat

Types of Skin Hives

Acute Hives

If hives last on your skin for less than six weeks, it is called acute hives.

The common reason for getting these are

  • A side effect of some medicine
  • Infections
  • Insect bites
  • Pet dander
  • Pollen
  • Dust mites
  • Food allergies (nuts, milk, eggs)

Trying certain foods for the first time is associated with a high risk of getting hives. Foods that cause hives are fresh berries, eggs, tomatoes, chocolate, nuts, and milk.

Similarly, some medicines may cause hives. These include;

  • Aspirin
  • Antibiotics
  • Ibuprofen (a nonsteroidal medication)
  • Codeine containing painkillers
  • Anti-hypertensive drugs (ACE inhibitors)

Chronic Hives

If you experience hives for more than six weeks, you are suffering from chronic hives.

The cause of this kind of hives is complicated to identify. In few cases, the reason may occur from hepatitis, infection, thyroid disease, or even cancer.

Lungs, gastrointestinal tract, and muscles can also get affected by chronic hives. Shortness of breath, diarrhea, vomiting and soreness of muscles are the symptoms of chronic urticaria.

Resistant to treatment, chronic hives can make life-debilitating.

Hives due to physical triggers

In some people, the skin reaction of hives gets triggered by cold or heat, sun exposure, sweating, vibrating exercise.

This is called physical urticaria. These kinds of hives appear within an hour of exposure to the triggering agent. The wheal formation is limited to the point of contact or where the skin is stimulated. It rarely appears on the non-stimulated area of the skin.


It is an acute physical hive that usually occurs because of excessive scratching or persistent pressure on the skin. Dermatographism can clear up on its own as it is short-lived. Usually, no treatment is required.

Infection-induced Hives

Bacterial and fungal infections cause these types of hives. Strep throat, mononucleosis, and cold are usually the causative infections for this type of urticaria.

These types of hives can spread from person to person in susceptible people only. They are not contagious. However, when they do apply, they do so due to;

  • Poor hygiene
  • Direct contact with the saliva, stool or other body secretions of an infected person
  • Getting germs from sneezing and coughing
  • Sharing eating utensils

Some high-risk cases for this type of hive include;  

  • Pregnant women
  • Those having a suppressed or an undeveloped immune system
  • Having an underlying medical condition or immune system dysfunction
  • Older than 65 years old or younger than five years old

Temperature-induced Hives

If you have sensitive skin that cannot adjust to the changes in the temperature, you may become a victim of hives.

Such sensitive skin can get cold-induced hives from air exposure or cold water. On the other hand, tanning beds and sunlight exposure (sunbathing) can get you heat hives.

Hives and Stress

It is observed that people with high emotional stress levels are more likely to contract hives. Lack of family support, insomnia, and stressful life events lead to hives in 75 participants, according to a study of 2005.

Chronic stress can induce an inflammatory reaction in a susceptible person. This results in relapse and remissions, a hallmark of chronic hives.

Diagnosis of hives

A case of hives is usually apparent on physical examination. The history of the presenting complaints may suggest the underlying cause of acute hives. For diagnosing the causes of a chronic case, your doctor may ask you to keep track of

  • Your daily activities, including the places you visit
  • All the medications, herbal remedies, or dietary supplements you might be taking
  • Your nutritional habits including a record of foods and drinks

Skin tests and blood examination may indicate an underlying cause in case of chronic hives. A skin test often reveals the type of allergens that might be instigating a hives reaction.

Treatment for Acute Skin Hives Urticaria

OTC medications containing antihistamine ingredients are the first line of therapy for treating hives.

For some chronic cases, prescription medicine may be prescribed. Usually, a combination of drugs is advised to manage chronic hives. This helps to reduce the side effects of drugs since they are often suggested for long-term use.

Antihistamine medications are available as an over-the-counter remedy for hives. These medicines work by blocking the effect of histamine that contributes to the inflammatory response of hives.  

Antihistamines work effectively to reduce the itch and swelling associated with hives. These medicines work best if taken regularly for several days. Cetirizine, Loratadine, and diphenhydramine are some of the common antihistamine drugs.  

Your doctors will also suggest the following to achieve relief:

  • Avoid the substance that triggers your allergies
  • Avoid hot water
  • Taking a bath with lukewarm water with baking soda

Antihistamine comes in sedative and non-sedative formulas. The sedative ones make you drowsy, so they are best taken at night time.

The non-sedative ones are usually prescribed for daytime, pregnant women, and those whose work involves operating heavy machinery.

Treatment for Chronic skin Hives Urticaria

The treatment for chronic hives is quite different from acute hives because the course of the disease can cause long-term discomfort followed by many complications. 

If your symptoms do not get relieved by OTC medicine, then your doctor may prescribe you other options such as:

  • Immune Suppressants. These include Gengraf, Neoral, tacrolimus, mycophenolic, and methotrexate.
  • Short-term oral corticosteroids such as prednisone. This helps reduce the swelling of lips around the eyes and throat that is caused by hives.
  • H2 blockers. These drugs are significant in blocking the production of histamine; common types are famotidine and cimetidine.
  • Monoclonal antibodies. Xolair is a new but expensive drug that is very effective for chronic urticaria, injected once per month.
  • Antidepressants. Doxepin is a tricyclic antidepressant used as a topical cream form to alleviate itching.  
  • Asthma drugs alongside antihistamines. Anti-asthmatic medicines that interfere with the action of leukotriene modifiers may also be prescribed for resistant cases. This is done alongside antihistamine medication. For examples montelukast and zafirlukast.

Prevention of skin hives

Lifestyle modifications help you a lot in the prevention of hives. Here are some of the best ways you can add to avoid developing hives:

  • Manage stress

As mentioned earlier, chronic stress plays a leading role in contributing to getting hives.

This is particularly true in chronic hives when feelings of emotional distress, anxiety, and depression often accompany the condition.  

  • Alternative Therapy

Using alternative ways and self-therapy can provide you emotional release as well. These include remedies like deep breathing, yoga, meditation, etc. All of them can be an excellent way to reduce stress and helps in avoiding hives.

Some studies show that acupuncture helps reduce the symptoms of hives; however, more research is required.

Relax by taking a bath, placing a cool cloth, using a lotion or anti-itch cream on the affected area.

  • Wear loose and light clothes

As discussed, keeping pressure on the skin worsens the hives. Wearing light and breathable clothes helps relieve the symptoms. As hives can also appear on the sole of your foot, you should avoid wearing ill-fitting shoes.

  • Avoid the known Triggers.

The best way to manage hives is to remove any medication or food which you know triggers the skin lesion. Try to keep moderate room temperature. Do not get too much sun exposure, or stay in heat if it triggers your allergies. The application of sunscreens helps avoid hives if you are sensitive to heat.

Do not scratch your skin or use harsh soaps and skincare products.

Pet dander and pollen should also be avoided as much as possible. Get the treatment if you have any viral infection (Common flu, hepatitis) or bacterial infection (UTI).

  • Get your medications

Keep taking your medications according to your doctor’s prescription.  Antihistamine is usually the first-line treatment for chronic hives. The allergy shots are another option to remove the hives. If the medications are not working or the condition is getting worse, seek emergency help.

Abdur Rashid
Medically Reviewed By Abdur Rashid
MSC Public Health, MCSP, MHCPC
BSC (Hon) Physiotherapy
Consultant Neuro-spinal & Musculoskeletal Physiotherapist


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