What are the Causes and Treatment Options for Hives?

Hives Treatment and Causes
Medically reviewed by Dr. Mavra Farrukh

Hives are itchy bumps on the skin. It is estimated that millions of people develop hives during their lifespan and never find out the cause. Some of these people will continue to have hives for six to seven weeks or longer. When this happens, the person has a medical condition known as chronic spontaneous Urticaria (CSU).

You should read this article till the end to learn more about hives’ symptoms, causes, prevention methods, and treatments.

What are Hives?

Hives, also known as Urticaria, are red or itchy bumps on the skin. It may appear on one part of your body or spread across large areas. The rash usually ranges from a few millimetres to the size of a hand. Acute hives can go away quickly, whereas chronic hives last long. They are a swelling on the skin surface that happens when your body has an allergic reaction. Allergic reactions usually happen when the immune system comes in contact with an allergen. Most people are not allergic to allergens, but those sensitive to them may experience an allergic reaction. Aside from itching, hives may also cause burning or stinging. Depending on their size, they can be as small as a fingertip or as large as a map. Sometimes, the welts from Urticaria join together to form larger areas known as plaques. They tend to fade within a day, although they can be noticeable for several days or longer.

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Types of Hives

There are two types of hives 

  • Acute Urticaria:

Acute Urticaria refers to hives that do not last for a long time. They last for less than six weeks. One in six adults or children gets acute Urticaria during their lifespan. It is more common in atopic individuals.

  • Chronic Urticaria:

Chronic, spontaneous Urticaria is known as chronic hives that do not have an obvious cause. It may occur when the body’s immune system attacks its tissues. Another name for this condition is chronic idiopathic Urticaria.

There is also a condition known as physical Urticaria or inducible Urticaria. These hives might pop up when you are in the cold, heat, or sun. They usually appear within an hour after exposure. This type of hive can also be chronic. They last for more than six weeks.

Symptoms of Hives

There may be some similarities and differences between the symptoms of active and chronic hives. It is important to make an appointment with your doctor as soon as you notice any of these symptoms.

Symptoms of Acute Hives

Each person’s hives appear differently depending on their condition. They can pop up anywhere on the body. Symptoms of acute hives include the following:

  • Itchy skin
  • Raised bumps or welts on the skin. The bumps may look reddish or brownish on lighter-colored skin.
  • Swelling and puffing
  • They can also appear with painful swelling of your lips, eyes, and inside your throat.
  • Hives blanch

Symptoms of Chronic Hives:

In many respects, chronic and acute hives may look similar, and they can be itchy, swollen, or raised welts that turn lighter in the center and with pressure. However, the symptoms of chronic hives are:

  • Shift sizes and shapes.
  • They appear, disappear, and then reappear periodically for months or years. 
  • Happen along with heat, exercise, or stress.
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What Causes Hives?

Causes of hives are divided into two categories acute and chronic.

Causes of Acute Hives:

You may experience acute hives from allergies caused by foods, drinks, medications, or something you touch. The skin has immune cells known as mast cells. When these mast cells act, they release chemicals, including one called histamine. Histamine is the reason that hives form.

You can also get hives for several other reasons. These reasons include infection, stress, or physical pressure on your skin. It is not uncommon for doctors to be unable to determine what caused your hives.

Causes of Chronic Hives:

Allergies more often bring on acute hives. Chronic hives, however, are rarely brought on by allergies. A bacterial or viral infection or a medical condition such as lupus can cause them. Sometimes, doctors cannot pinpoint the exact cause of your symptoms. In these cases, chronic hives are said to be idiopathic or spontaneous.

Chronic hives do last for long periods of time, but they are usually not permanent. They can be uncomfortable, but they are not life-threatening.

Medical Conditions Associated with Hives


Hives develop when cells in the body release chemicals and histamines into the bloodstream because of a perceived threat that causes allergies in your body.

Common allergens that trigger hives to pop up may include:

  • Food, especially fish, citrus fruits 
  • Pollen
  • Dander 
  • Insect bites 
  • Food additives and food preservatives 
  • Eggs and milk 

Anyone with a serious acute allergic reaction could have deadly swelling of the airways—your throat and lungs. This condition is called anaphylaxis. It can potentially close off the airways, resulting in death.

A serious allergic reaction to foods like eggs, peanuts, tree nuts, seafood, or a bee sting often triggers anaphylaxis. During anaphylaxis, you must get a quick shot of epinephrine, like the EpiPen or the AUVI-Q.

Epinephrine opens airways and raises blood pressure, which helps reduce hives and swelling. The first and foremost thing you should do if you take epinephrine outside of a medical setting is going to the emergency room so that you can be monitored. Symptoms of anaphylaxis can return as the epinephrine wears off.


Infections are the most common cause of hives. A viral infection alone can trigger hives. After your illness begins, your immune system often begins to purge the infection from your body by producing hives for a week or two.

Common bacterial and viral infections include the following:

Autoimmune Disease:

In addition to infections, you may also develop hives because of autoimmune diseases. These diseases make your immune system attack the tissues of your body because it perceives them as threats. 

The most common autoimmune disease includes the following:

  • Thyroid disease
  • Rheumatoid arthritis
  • Type 1 diabetes 

You may also experience the following:

  • Liver disease 
  • Lupus 
  • Vasculitis 


Lupus can cause hives. They sometimes go together, but only in about 15% of the cases. It is a chronic autoimmune disease with a large number of symptoms that affect the skin. It can cause hives, likely due to two common conditions: autoimmune and inflammatory. Some lupus treatments, such as Plaquenil and steroids, may help you get rid of hives. However, antihistamines are typically the most common treatment for hives. Always see your doctor for hives, especially if you do not know the cause. Lupus symptoms include several skin-related issues, such as:

  • Alopecia 
  • Malar rash
  • Photosensitivity 
  • Purpura
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How are Hives Diagnosed?

Your doctor can diagnose hives by looking at your skin. However, allergy tests can help identify what triggers a reaction, but this is true mainly for acute hives. Hives can be avoided by knowing their cause and avoiding the allergens that cause them. Allergy tests to diagnose hives include:

  • Skin tests: Doctors test different allergens on your skin during this test. You are allergic to the substance if the skin turns red or swells. This allergy test is also known as a skin prick or scratch test. Skin testing usually is not done for chronic hives.
  • Blood tests: A blood test is done to check for specific antibodies in the blood. In order to fight off allergens, your body produces antibodies. You can develop hives and swelling if the body makes too many antibodies. Hence, a blood test helps identify those antibodies.

Treatment of Hives

Mostly, hives go away without any treatment. For faster recovery and to lower your chances of recurrence of hives, your doctor might recommend some medications and at-home care. Treatments include:

  • Allergy medications: Medicines known as antihistamines block histamine’s effects. You can take them orally by swallowing pills or topically (by applying them to the affected area of your skin). Antihistamines relieve itching from hives and prevent allergic reactions or reduce their severity. Some antihistamines react quickly, such as diphenhydramine (Benadryl). Depending on the severity, your doctor may recommend daily allergy medications, like loratadine (Claritin), fexofenadine (Allegra), cetirizine (Zyrtec), or levocetirizine (Xyzal).
  • Allergy shots: For chronic hives that are hard to treat, your doctor may recommend you take monthly injections of drugs that block allergic reactions. People with severe allergies make too much IgE (linear gingival erythema). These injections block your immune system from making IgE.
  • At-home treatments: You can take a cool bath or shower to relieve hives, wear loose-fitting clothes and apply cold compresses. An over-the-counter (OTC) hydrocortisone or antihistamine cream can relieve itching and swelling.
  • Oral steroids: Corticosteroids, such as prednisone, can mitigate hive symptoms that do not respond to antihistamines or topical steroids.
  • Epinephrine: Some serious acute allergic reactions can lead to a dangerous condition known as anaphylaxis. Symptoms may include hives, swelling of your face and mouth, sore throat, shortness of breath, wheezing, vomiting, and low blood pressure. Anaphylaxis is life-threatening, and anyone having this kind of reaction needs an immediate epinephrine injection (EpiPen®) to open a swollen airway.

If you develop hives in response to medications, you should contact your healthcare provider as soon as possible. 

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How to Get Rid of Hives?

Ways to Get Rid of Acute Hives

Your doctor can use the results of allergy tests to help you figure out which substances cause acute hives. Once you know the triggers, you can avoid them. You may also:

  • Cut certain food products out of your diet.
  • Reduce exposure to airborne allergens.
  • Switch to detergents and soaps without scents or dyes.
  • Avoid extreme temperature changes.
  • Relax and take a break when you’re stressed or overworked.
  • Wear loose-fitting, lightweight clothes.

Some of these tips can also help you with chronic hives.

Ways to Get Rid of Chronic Hives

It may not be possible to prevent chronic hives. Also, your doctor may not need help finding out what causes them. They may also be a part of a bigger and more serious medical condition that affects your immune system. But a few self-care tips can help you manage your condition.

  • Use an anti-itching drug.
  • Track your symptoms
  • Protect your skin from sun
  • Avoid triggers

How Are Hives and Rashes Different?

A rash is a skin condition characterized by small bumps of skin that are itchy and look red. Blisters may form in some rashes. Some rashes may develop suddenly, whereas others form over several days. Treatments may vary, depending upon what caused the rash in the first place but can include moisturizers, lotions, corticosteroid creams (which relieve redness and swelling), and antihistamines.

On the other hand, hives are an outbreak of swollen, pale red bumps that suddenly appear on your skin. These bumps are sometimes known as wheals or welts, and they can be circular or irregular in shape and range in size from a pin-size dot to large dinner plate-like patches.

You may experience them anywhere on your body, including your face, lips, tongue, throat, and ears. A hive’s edges are distinct, and its affected area is smooth and elevated above its surrounding area (reflecting the fluid below the skin’s surface). Itching is common with both hives and rashes.

Can Hives be a Sign of Something Serious?

Rashes are caused by environmental allergens such as food, weather, sunlight, physical pressure on your skin, and even stress. It can be treated effectively with over-the-counter medications. But sometimes, the skin may tell you you have a more serious condition. A minor rash is easily treatable with antihistamines, but if there is bruising and swelling around it, it can signify something serious.

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When to Consult a Doctor with Hives?

Hives can get better without treatment. Call your doctor if you have the following:

  • Hives or swelling that lasts more than 7-8 days.
  • Infected-looking bumps (red, swollen, or pus-filled).
  • Recurring hives (they reappear every few months).
  • Severe itching that might even disturb you while sleeping.
  • Signs of anaphylaxis include wheezing, shortness of breath, or vomiting.
  • Swollen lips or face.

Your doctors online team has team office expert doctors that can diagnose you even if you have early signs of disease. If you have any symptoms, you can get help from our doctors and the treatment you need.

FAQs About Hives Answered By Your Doctors Online Team

Do you know what hives look like on the arms and legs?

Depending on the type of red spot, the skin may have a raised or flat appearance. The neck, arms, and legs are more commonly affected than any other body part. Itching or pain is not usually associated with petechial red spots. If you press on them, they should remain red.

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