- 7 Tips to Help You Manage Chronic Hives
- What are hives?
- How do they occur?
- What are the symptoms?
- How is it diagnosed?
- How is it treated?
- How long will the effects of hives last?
- How can I take care of myself?
- What can I do to help prevent hives from recurring?
- Home Remedies: Having chronic hives
- Chronic Urticaria Treatment & Management
- Hives (Urticaria)
- What Is It?
- Hives and Swelling
7 Tips to Help You Manage Chronic Hives
Chronic hives, also known as chronic urticaria, is an uncomfortable skin condition marked by itchy red welts that can appear anywhere on your body. “About 85 percent of the time, we don’t know what causes it,” says Miriam Anand, MD, an allergist with Allergy Associates and Asthma in Tempe, Arizona. When the cause of hives can’t be determined, the condition is known as chronic idiopathic urticaria. This poses a challenge when it comes to treating chronic hives, which by definition last longer than six weeks, and can sometimes come and go for years.
Besides causing discomfort, chronic hives can interfere with daily activities, but there are many ways to manage the condition — even if you don’t know its cause. Start with these steps to soothe or prevent the symptoms associated with chronic hives:
1. Avoid known triggers
One of the best ways to control hives is to avoid known triggers, according to a report published in the June 2015 issue of the Journal of the European Academy of Dermatology and Venereology. To determine which triggers may be affecting you, the first step is to see your allergist. “We do allergy testing to see if your body is reacting to one of the many allergens that can cause hives,” says Dr. Anand. Some of these allergens are:
- Some foods, especially peanuts, eggs, nuts, shellfish, and some food additives
- Certain pain medications, such as aspirin and ibuprofen
- Physical stimuli such as pressure, temperature, exercise, and sun exposure
- Bacterial infections, including urinary tract infections
- Viral infections, such as the common cold and hepatitis
- Pet dander
If one or more of these allergens is found to be the cause of your hives, says Anand, your doctor will work with you to figure out ways to avoid exposure. “If a trigger isn’t found after testing, your doctor will look for other causes of chronic hives,” she adds. One of those could be an autoimmune condition — almost half of all cases of chronic hives are due to an overactive immune system, according to the American Osteopathic College of Dermatology. Treating an underlying medical condition, says Anand, can help rid you of the symptoms of chronic hives.
2. Take your medications
Antihistamines are usually the first line of treatment for chronic hives. “I usually prescribe a long-acting antihistamine once a day first,” says Anand, “and if that doesn’t work, I’ll add a second one.” If antihistamines don’t help, your doctor may prescribe another medication. According to a study published in March 2013 in the New England Journal of Medicine, omalizumab, an injectable medication commonly used to treat asthma, was found to be effective in treating most people who did not respond to antihistamines. Other treatments your doctor might prescribe include corticosteroids (for short-term use only) or epinephrine injections (if you experience swelling in your lips or throat). To help boost the effectiveness of your treatment, always follow your doctor’s instructions when it comes to taking your medications, and don’t skip any doses. Talk to your doctor if you have any questions or concerns about your medication.
3. Soothe your skin
The drier your skin is, the itchier it feels, tempting you to scratch. But scratching is one of the worst things you can do, says Anand, because it can aggravate your hives. To calm the itching, keep your skin moisturized, she says. Taking frequent baths can also help reduce itching and scratching, according to the American College of Allergy, Asthma & Immunology (ACAAI).
In addition, cooling the affected area can feel soothing to your skin (as long as cold temperature isn’t one of your hive triggers). There are many ways to cool your skin, including:
- Applying an anti-inflammatory medication or cream, as prescribed by your doctor
- Positioning yourself in front of a fan
- Applying a cold compress
4. Wear loose, light clothing
Constant friction and pressure on your skin can worsen your hives, according to the ACAAI. Avoid wearing constricting clothing, tight belts, and even ill-fitting shoes — hives can also appear on the soles of your feet. Choose loosely fitting clothing in soft fabrics instead.
5. Talk to your doctor about a vitamin D supplement
Adding a vitamin D supplement to your treatment plan may help reduce the symptoms of chronic hives, according to a small study published in January 2014 in the Annals of Allergy, Asthma & Immunology. In the two-year study, people with chronic hives who took a daily supplement of vitamin D3 along with their regular allergy medications experienced a decrease of 33 percent in their symptoms within the first week. More research is needed to confirm the benefits of vitamin D supplementation for chronic hives. Talk to your doctor about possibly adding a supplement to your treatment.
6. Consider alternative therapies
Stress has been found to worsen hives, and techniques that promote relaxation, such as deep breathing, meditation, and yoga, can be good ways to reduce stress, says Anand. Some studies point to a potential link between acupuncture and a decrease in the symptoms of chronic hives, but more research is needed to confirm these findings.
7. Manage your emotions
When you have chronic hives, most of your efforts may naturally be directed toward managing visible symptoms. But don’t forget to address the condition’s invisible symptoms: Anxiety and depression often accompany chronic hives. “This stands to reason,” says Anand, “since living with a chronic condition can be challenging and uncomfortable.” Chronic hives has specifically been found to increase emotional distress, feelings of isolation, and fatigue. If these symptoms sound familiar, talking to a therapist may help you relieve some emotional pressure.
What are hives?
Hives are raised, red, itchy areas on the skin (also called wheals or welts) that can result from an allergic reaction.
The medical term for hives is urticaria.
How do they occur?
Clusters of hives may appear as a reaction to an allergen such as food, medicine, or an insect bite or sting. Hives may also occur as a reaction to infection or emotional stress. Histamine, a chemical your body makes, is released in response to the irritant that causes the hives to form. Histamine causes the redness, swelling, and itching. Often the cause of the hives cannot be determined.
What are the symptoms?
The raised, red, itchy areas may vary in size and shape. You may have one or many hives. The hives may appear on any part of the body. They are most common on the arms, legs, and trunk. You may have red blotches on your face. The rash may last for a few minutes or several days. Hives can be uncomfortable and they may recur.
In the case of a severe reaction–to a bee sting, for example–your face and throat may swell. Rarely, hives may cause problems with breathing, creating the danger of a severe asthma attack or a closing of the throat from swelling, which can be life-threatening.
How is it diagnosed?
Your healthcare provider will look at the hives and ask about your history of sensitivity to such things as:
- foods (especially eggs, shellfish, milk, nuts, berries, dyes or other additives)
- medicines (such as penicillin, aspirin, or sulfa drugs)
- plants (such as nettles) and pollens
- animals, such as an allergy to cats
- insect bites or stings
- exposure to heat, cold, or sunshine
To find the cause of your hives, the healthcare provider may suggest that you:
- Keep a detailed diary of everything you eat, drink, take as medicine, or are exposed to for 2 to 4 weeks.
- Avoid foods, one at a time, to which you may be allergic.
It is easiest to identify drugs, foods, or plants that may cause you to have hives because the response usually occurs within an hour. Identifying triggers such as emotional stress or multiple allergies may take more time. Identifying multiple allergies may require skin tests or other types of allergy tests.
How is it treated?
The treatment your healthcare provider recommends will depend on how serious your hives are. He or she may suggest that you do one or more of the following to relieve the itching and reduce the swelling:
- Soak in a lukewarm bath or use cool compresses.
- Avoid heat or rubbing, which releases more histamines.
- Take antihistamine medicine as directed by the label or your provider to reduce your allergic response.
If the rash is severe or not responding to the above treatments, your provider may prescribe an oral steroid medicine (for example, prednisone) to take for a few days.
Hives rarely cause emergencies. But sometimes they can cause throat swelling and trouble breathing. If your throat is swelling or you are having trouble breathing or are wheezing, call 911. Once you are getting medical care, you will be given a shot of epinephrine (adrenaline) to stop the reaction. When the emergency symptoms have been treated, you will probably be given steroid medicine–for example, prednisone–to take for the next several days to prevent the reaction from happening again.
Once the hives have gone and you are feeling better, you should see your healthcare provider to talk about whether you need tests to determine what caused the hives. If you are able to determine the cause, the best prevention is avoiding the cause, if that’s possible. Whether you are able to learn the cause or not, if hives are a frequent problem, you may need to take antihistamines every day to prevent the hives.
How long will the effects of hives last?
The itching, swelling, and redness of hives can last hours to several weeks or months. In most cases the hives eventually go away without treatment, but taking drugs such as antihistamines or corticosteroids help the hives go away faster. The medicines also treat the itching and prevent new hives.
Chronic hives last a longer time. Most often (more than 50% of the time) it is not possible to determine their cause. Antihistamines are usually very helpful. The hives go away spontaneously after weeks or months but they may come back repeatedly.
How can I take care of myself?
- Call 911 right away for emergency medical care if you have an allergic reaction that affects your breathing, your throat feels tight, or your face begins to swell around the eyes, lips, or tongue.
- Take antihistamines or other medicines to help relieve your symptoms. Be sure to ask your healthcare provider or pharmacist about possible side effects or drug interactions.
- Avoid foods that seem to cause you to break out in hives.
- See your healthcare provider if you continue to have outbreaks of hives.
- If you have a known severe allergy, such as to bee stings or to a food such as peanuts, ask your provider about carrying EpiPen. EpiPen is a single-dose injection kit of epinephrine. You can use it to give yourself a shot if you have a severe allergic reaction. It will counteract or slow the allergic reaction until medical help arrives.
- Wear a medical ID bracelet or necklace that indicates your allergies and risk of a severe reaction. This can help ensure prompt and proper treatment during an emergency.
What can I do to help prevent hives from recurring?
If you know the cause of your hives, you should take steps to avoid the cause. You may need to take frequent, even daily, doses of antihistamine to prevent recurrences.
Developed by RelayHealth.
Published by RelayHealth.
This content is reviewed periodically and is subject to change as new health information becomes available. The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional.
© 2018 RelayHealth and/or its affiliates. All Rights Reserved.
Home Remedies: Having chronic hives
Hives, also known as urticaria (ur-tih-KAR-e-uh), are reddened, itchy welts that may be triggered by exposure to certain foods, medications or other substances. The welts vary in size and appear and fade repeatedly as the reaction runs its course.
Chronic hives are a condition in which the welts last more than six weeks or recur over months or years. Chronic hives usually aren’t life-threatening, but the condition can be very uncomfortable and interfere with sleep and daily activities. Often, the cause is not clear and in some cases, chronic hives are a sign of an underlying health problem, such as thyroid disease or lupus.
You can try various treatments to relieve your symptoms. For many people, antihistamine and anti-itch medications provide relief from chronic hives.
Chronic hives signs and symptoms include:
- Batches of red or white welts (wheals), usually on the face, trunk, arms or legs.
- Welts that vary in size, change shape, and appear and fade repeatedly as the reaction runs its course.
- Itching, which may be severe.
- Swelling that causes pain or burning (angioedema), especially inside the throat and around the eyes, cheeks, lips, hands, feet and genitals.
- A tendency for signs and symptoms to flare with triggers such as heat, exercise and stress.
- A tendency for symptoms to recur frequently and unpredictably, sometimes for months or years.
These precautions may help prevent or soothe recurring skin reactions of chronic hives:
- Wear loose, light clothing.
- Avoid scratching or using harsh soaps.
- Cool the affected area with a shower, fan, cool cloth or soothing lotion.
- Keep a diary of when and where hives occur, what you were doing, what you were eating, and so on. This may help you and your doctor identify triggers.
- Avoid known triggers, such as certain foods or additives, alcohol, pain relievers, heat, cold, exertion, and stress.
Related article: Mayo Clinic Q and A: Chronic Hives Come and Go With No Clear Pattern
More study is needed, but some evidence supports the following alternative medicine approaches for providing relief of symptoms:
- Diet restrictions, such as eliminating yeast, food additives and other things that may cause the skin reaction (allergens)
- Supplements, such as vitamins B-12, C and D, fish oil, and quercetin
- Relaxation techniques
- Acupuncture, sometimes with an herbal wash of burdock
When to see a doctor
See your doctor if you have:
- Severe hives
- Hives that don’t respond to treatment
- Hives that continue to appear for several days
Seek emergency care if you:
- Feel dizzy
- Have severe chest tightness or trouble breathing
- Feel your tongue or throat swelling
Chronic Urticaria Treatment & Management
The mainstay of pharmacotherapy for chronic urticaria is the administration of low-sedation anti-H1 antihistamines (eg, loratadine, cetirizine, levocetirizine, and fexofenadine), which have a low incidence of adverse effects. Quality of life appears to be improved more by daily therapy than by therapy administered on an “as needed” basis.
Low-sedation antihistamines decrease the intensity of hives and pruritus in patients with mild chronic urticaria and are considered first-line therapy. Crossover studies comparing the suppression of skin papule and erythema formation induced by intradermal histamine injection after a single antihistamine dose suggest the following order of inhibitory effect: (1) levocetirizine, (2) cetirizine, (3) terfenadine, (4) fexofenadine, and (5) loratadine.
The potency of an antihistamine in inhibiting wheal and erythema formation response to intradermal histamine injection is correlated with the skin concentration of the drug rather than the plasma concentration. Sedation and impairment of performance are concerns when sedating antihistamines are used, but these adverse effects may diminish after 1-2 weeks of therapy.
Many patients find that pruritus is less troublesome during the day but is maximized at night, when there are fewer distractions. An additional nocturnal dose of a sedative antihistamine such as hydroxyzine or doxepin may be added to the morning dose of a low-sedation anti-H1 antihistamine. Doxepin should not be used in patients with glaucoma and should be used with extreme caution in elderly patients or those with heart disease.
Doubling the labeled dose of low-sedation antihistamines may benefit some patients, and increasing the dose of these antihistamines is often the safest therapeutic approach for patients who do not have an adequate response to the conventional doses of these medications. Increasing the dosage up to 4-fold is recommended by expert groups such as the European Academy of Allergy and Clinical Immunology (EAACI).
As many as 75% of patients with chronic urticaria referred to tertiary care centers may require higher than conventional antihistamine doses. These higher nonsedating antihistamine doses improved quality of life but did not increase somnolence.
If high-dose nonsedating antihistamine therapy is not effective, switching to a different nonsedating antihistamine or adding a leukotriene antagonist (see below) to the antihistamine regimen may be considered. Patients who do not respond to 20 mg of desloratadine may benefit from 20 mg of levocetirizine.
Use in pregnant women
Cetirizine and loratadine are category B agents; nevertheless, a first-generation antihistamine such as chlorpheniramine may be considered the drug of choice in pregnant women because the cumulative experience with use of such agents in this population is greater.
Use in patients with kidney or liver impairment
For cetirizine, 60% of an administered dose is eliminated via the kidneys; for levocetirizine, the figure is 85%. Most H1 or H2 antihistamines undergo presystemic metabolism in the liver via cytochrome P-450. Accordingly, reduction of low-sedation antihistamine doses is advised in patients with liver or renal failure.
Use in children
Cetirizine and fexofenadine are approved by the US Food and Drug Administration (FDA) for chronic urticaria in children aged 6 months and older. Desloratadine is approved for chronic urticaria in children aged 1 year and older. Loratadine is approved for chronic urticaria in children aged 2 years and older. Levocetirizine is approved for chronic urticaria in children aged 6 years and older.
Hydroxyzine has been used to alleviate pruritus in children with atopic dermatitis and is an appropriate second-line agent in children with chronic urticaria that is refractory to nonsedating antihistamines.
Leukotriene antagonists have been shown to be superior to placebo in the treatment of patients with chronic urticaria but are considered less effective than nonsedating antihistamines ; however, the two classes of agents can be combined. Montelukast 10 mg/day may be particularly helpful for patients experiencing flare-ups due to aspirin or other NSAIDs. Montelukast is approved for treatment of perennial allergic rhinitis in children aged 6 months and older.
Colchicine and dapsone
Patients who respond poorly to antihistamine therapy or who are known to have urticaria in which the inflammatory infiltrate is neutrophil-predominant (except those with glucose-6-phosphate dehydrogenase deficiency) may require the addition of colchicine (0.6 mg twice daily) or dapsone (50-150 mg once daily) to the treatment regimen.
Systemic corticosteroids are usually effective when antihistamines are not adequate. In the rare situation where systemic corticosteroid treatment is needed to treat chronic urticaria, a low daily dose or alternate-day dosing is advised, and the dose should be titrated to the lowest effective level. In general, long-term systemic corticosteroids are not recommended. Patients receiving long-term corticosteroid therapy should be routinely monitored for bone density changes and adverse ocular effects.
Cyclosporine and methotrexate
Patients with autoimmune urticaria may benefit from administration of methotrexate or cyclosporine. Cyclosporine 4-6 mg/kg/day has been shown in randomized double-blind studies to be effective for chronic urticaria. Cyclosporine has a better risk-to-benefit ratio than systemic corticosteroids.
Cyclosporine is recommended only for patients with severe disease refractory to high doses of oral antihistamines. Cyclosporine therapy for chronic urticaria should be limited to 3 months or less. A sustained remission is observed in approximately one third of patients treated with this medication.
Some patients with chronic urticaria and antithyroid antibodies benefit from levothyroxine treatment, perhaps because of suppression of thyroid activity and, possibly, the autoimmune process. The goal of treatment is to suppress thyrotropin maximally without rendering the patient clinically hyperthyroid. The urticaria may respond within 2 weeks of initiation of adequate treatment. Some patients may maintain a sustained remission after 3-6 months of treatment, at which point the levothyroxine can be tapered and then discontinued.
Omalizumab (Xolair) was approved by the US Food and Drug Administration (FDA) in March 2014 for chronic idiopathic urticaria in adults and children aged 12 years or older who remain symptomatic despite anti-H1 antihistamine treatment. It is a monoclonal antibody that selectively binds to immunoglobulin E (IgE) and inhibits binding to IgE receptors on the surface of mast cells and basophils. The efficacy and safety of omalizumab for chronic idiopathic urticaria was demonstrated in 2 clinical studies that showed omalizumab significantly improved the mean weekly itch severity score (ISS) from baseline by 9.4-9.6 in the 300-mg treatment arm, by 6.4-6.7 in the 150-mg treatment arm, and by 5.9-6.5 in the 75-mg treatment arm, compared with an improvement of 3.6-5.1 in patients on placebo.
High-dose vitamin D add-on therapy may provide relief in some patients with chronic urticaria. In a 12-week prospective study of 42 patients with chronic therapy receiving standard triple-drug therapy (cetirizine, ranitidine, and montelukast), those randomized to supplementation with high-dose vitamin D3 (4,000 IU/d) had a trend toward lower total symptom severity scores at the end of the trial (significant reduction in hive body distribution and duration, improved pruritus, and improved sleep quality) compared with patients randomized to low-dose vitamin D3 supplements.
Although baseline total Urticaria Symptom Severity (USS) scores were similar between the 2 groups, and each group had a 33% reduction in total USS scores on triple-drug therapy at 1 week follow-up, by 12 week follow-up, the high-dose vitamin D3 group showed an additional 40% decrease in total USS scores that was not seen in the low-dose group. Despite an increase in levels of serum 25-hydroxyvitamin D with high-dose vitamin D3 supplementation, there was no corresponding association between 25-hydroxyvitamin D levels and USS scores. No adverse events were reported, and medication use in both groups remained similar.
Autologous whole blood injection (AWBI)
AWBI may be an alternative to treat adults with refractory chronic urticaria. In a study of 19 patients in which AWBI was performed on a weekly basis for 8 weeks, a significant improvement was seen in urticaria symptoms and quality-of-life scores.
Acute urticaria and/or angioedema are hives or swelling lasting less than 6 weeks. The most common causes are foods, medicines, latex, and infections. Insect bites or a disease may also be responsible.
The most common foods that cause hives are nuts, chocolate, fish, tomatoes, eggs, fresh berries, soy, wheat, and milk. Fresh foods cause hives more often than cooked foods. Certain food additives and preservatives may also be to blame.
Drugs that can cause hives and angioedema include aspirin and other NSAIDs (such as ibuprofen), high blood pressure medications (such as ACE inhibitors), and painkillers such as codeine.
Chronic urticaria and/or angioedema are hives or swelling that lasts more than 6 weeks. The cause is usually harder to find than in acute cases. The causes can be similar to those of acute urticaria but can also include your immune system, chronic infections, hormonal disorders, and tumors.
Physical urticaria are hives caused by direct physical stimulation of the skin — for example, cold, heat, sunlight, vibration, pressure, sweating, and exercise. They usually happen right where the skin was affected and rarely appear anywhere else. Most appear within 1 hour after exposure.
Dermatographism are hives that form after firmly stroking or scratching the skin. You may also have other forms of hives.
Hereditary angioedema is painful swelling under the skin. It runs in families.
Ever had an itch you just can’t seem to scratch?
Scientists have long studied itch and why it happens. While some itches are due to problems like dry skin or eczema rashes, in some cases these irritations could be a sign of an allergic reaction. One of these types of allergic reactions are hives.
Hives, or urticaria, are a collection of red, swollen “whelps” that can appear on the skin in response to an allergic reaction. The condition is actually quite common overall. Almost 40.8 million Americans are stricken with hives every year and there’s a 10-20 percent chance that a person will experience hives at least once in their lifetime.
What are the Symptoms?
The most noticeable external symptom is the appearance of raised red swollen bumps that resemble mosquito bites on the skin. Itching, redness, and a stinging sensation are also common symptoms. Hives can last for hours, minutes, or days before they start to fade away.
What Causes Hives?
Hives are caused by an allergic reaction taking place on the skin. Some of the most common things that can trigger reactions are:
● Allergic reactions to a known substance: common causes of this would include
○ Foods, such as eggs, shellfish, cheese, nuts, and fruits
○ Medications, such as Penicillin or codeine
○ Chemicals such as latex rubber
○ Insect bites and stings
● Physical urticaria: in some cases, hives can be triggered by physical stimuli such as scratching or rubbing the skin, water exposure, heat or cold, or sun exposure
● Infections such as strep throat, urinary tract infections, or the “common cold”
While these are all possible triggers that could cause hives, sometimes individuals get the rash for no apparent reason. Studies show that up to 60 percent of people that deal with hives aren’t able to trace them back to a cause. This particularly true in cases where the hives persist for many weeks, or longer. These are called “chronic urticarial,” and in a significant percentage of these cases, no clear cause can be identified. This percentage may be 50% or higher.
How do I get treated?
One of the best ways to get treatment for hives is to seek out a dermatologist. While most of these doctors can diagnose the condition by examining the skin’s appearance, it’s sometimes difficult to find the exact cause, especially for individuals with chronic hives. A careful history and physical are the most important parts of the evaluation, looking for an underlying cause. To help get rid of the hives, dermatologists rely typically on antihistamines, which block the effects of histamine on the skin. Sometimes, stubborn cases require additional medications such as H-2 blockers or steroids. The type of medication you receive will depend on the results your dermatologist pulls from the tests and the severity of your condition.
Are you struggling to deal with hives? Schedule an appointment with one of our elite dermatologists at Avail Dermatology by calling us at (770) 251-5111 today!
What are hives?
Hives are red, itchy, raised areas on the skin that often result from an allergic reaction. Hives are very common and may change size rapidly and spread all over the body, often in a matter of hours. Hives may appear due to a reaction to allergens such as food, medications, or insect bites. Stress also causes hives.
What are the symptoms of hives?
Histamine, a chemical produced by your body, is released and causes the redness, swelling, and itching that causes hives which vary in size and shape. The hives may appear on any part of the body, but are most common on the arms, legs, and trunk. The skin rash may last for a few minutes or up to several days. Hives may appear as a reaction to an allergen: including food, medicine or an insect bite. Hives may also occur as a reaction to emotional stress.
How are hives diagnosed?
An Our Urgent Care professional will take a look at your hives and discuss your history of sensitivity to the following:
- Foods (milk, peanuts, and eggs)
- Heat exposure
How are hives treated?
The treatment for your hives will depend on the seriousness of your situation. Your Our Urgent Care provider may suggest using a cool compress, avoiding heat, or taking an antihistamine medicine. Antihistamines are the most common treatment for hives.
Hives are rarely considered an emergency, but sometimes they cause throat swelling and trouble breathing. Walk into any of the five Our Urgent Care locations to treat your hives.
What Is It?
Published: April, 2019
Hives, also called urticaria, are circumscribed swellings on the skin that often are itchy. Often they are pink or red, but they don’t have to be. Hives happen when the cells in the skin called mast cells release histamine, a chemical that causes tiny blood vessels (capillaries) to leak fluid. When this leaking fluid accumulates in the skin, it forms the swellings that we recognize as hives.
Hives can be triggered by physical factors such as heat, cold, exercise, sunlight, stress, sustained pressure on a skin area (such as from a belt or shoulder strap), a sudden increase in body temperature (from a fever or a hot bath or shower) or from an irritating chemical, cosmetic or soap applied to the skin. Hives also can be one symptom of a whole-body (systemic) allergic reaction to something that was:
To continue reading this article, you must login.
Subscribe to Harvard Health Online for immediate access to health news and information from Harvard Medical School.
- Research health conditions
- Check your symptoms
- Prepare for a doctor’s visit or test
- Find the best treatments and procedures for you
- Explore options for better nutrition and exercise
Learn more about the many benefits and features of joining Harvard Health Online “
Hives and Swelling
Nearly one in four people have experienced itchy, red or white bumps, welts or patches on the skin called hives. The medical name for this condition is urticaria (ur-tih-CAR-ee-uh). Some hives are classified as acute hives and other cases are chronic. The difference depends on how long the symptoms last. They can happen because of an allergy or other causes. In most cases, hives come and go within a few hours. But they can show up again and again in some people.
Angioedema (an-gee-oh-eh-dee-ma) is a swelling reaction that affects deep layers of tissues underneath the skin. Angioedema usually causes puffiness of the face, eyelids, ears, mouth, hands, feet, and genitals. It is basically a hive that forms in a deeper layer of skin.
Hives are not contagious, but they can move from one location on the body to another.
Both children and adults can suffer from hives.
Some people who get hives or angioedema are having a dangerous allergic reaction. Call 911 or see a doctor or nurse right away if you suddenly get hives or get puffy and also have any of these symptoms:
- Trouble breathing
- Tightness in the throat
- Nausea and vomiting
- Cramps or stomach pain
- Passing out
Why did I get hives?
If you just got hives for the first time, you might have a new allergy to something. People can get hives because of allergies to:
- Medicines, such as antibiotics or aspirin
- Something they touched, such as a plant, animal saliva, or latex
- Insect stings
- Foods, such as eggs, nuts, fish, or shellfish
- If your hives are caused by an allergy, you may need to avoid whatever you are allergic to.
Hives can also be caused by:
- Having cold air or water on the skin
- Having something press or vibrate against the skin
- Changes in body temperature (such as when you cool down after a hot shower or a work out)
- Occasionally stress and anxiety (this is often related to body temperature, as well).
The word “acute” refers to a short period of time. Acute hives can last less than a day, or up to six weeks. Acute hives can be a reaction triggered by coming in contact with an allergen such as a food, animal dander, insect bite, latex or pollen. Identifying and avoiding the trigger can help prevent this allergic reaction from reoccurring.
Medications can potentially trigger hives. Reactions to medications can happen anytime throughout the life cycle of taking the medication. Hives can also occur from non-allergic causes. These include heat, stress, exercise or exposure to certain chemicals. One of the most common causes of acute hives in children is a viral infection.
If you have had hives on most days for more than six weeks, you probably do not have an allergy. Allergy as the cause of the hives is found in less than 5% of people with the condition. Hives that last this long are called “chronic hives.” In most cases, doctors do not know what causes chronic hives.
Rarely, chronic hives can be caused by an underlying illness (such as low thyroid, etc..). We may do some basic blood work to rule-out underlying disease if the hives are present over six weeks.
If you have chronic hives, you will probably need to take medicines every day to control them. Luckily, chronic hives do usually go away with time.
Whether acute or chronic, hives are often very itchy. This is because the swelling occurs in the layer of skin that has many nerve endings.
While most cases of hives get better on their own, here are some tips to reduce the itching and swelling:
- Avoid hot baths or showers.
- Wear loose-fitting clothing.
- Take antihistamines or other medicines as for the hives as directed.
- Severe flare-ups may require taking corticosteroids to reduce inflammation.
Swelling without hives can also be caused by a condition called hereditary angioedema, or HAE.