Table of ContentsView AllTable of ContentsAllergic ReactionEnvironmental ExposureStressExerciseInfections and DiseasesDiagnosisNext in Urticaria Guide20 Effective Ways to Treat Hives
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Allergic Reaction
Environmental Exposure
Stress
Exercise
Infections and Diseases
Diagnosis
Next in Urticaria Guide
The cause and severity of hives can vary from one person to the next. Urticaria can affect people of any age, gender, and race. It is estimated that between 15% and 23% of adults will experience at least one bout of urticaria in their lifetime.
© Verywell, 2018
Allergy is a common cause ofurticaria. The red welts, itchy rash, and other symptoms are caused when the immune system responds abnormally to an otherwise harmless substance and floods the body with inflammatory chemicals includinghistamine.
Other symptoms include swelling (edema) and trouble breathing, which can become life-threatening in severe cases.
When to Call 911 for an Allergic ReactionHives can occur with a severe and potentially life-threatening allergic reaction calledanaphylaxis. Seek immediate medical attention if you experience hives with symptoms that include:Trouble breathing or wheezingFeeling as though your throat is closingSwelling (edema) of the lips or tongueHot, flushed skinItchy skin, including the palms or soles of the feetFast pulseLow blood pressureChange in (or loss of) consciousnessAnaphylaxis is life-threatening. Call 911 at the first sign of anaphylaxis. Do not wait to see if symptoms get better.
When to Call 911 for an Allergic Reaction
Hives can occur with a severe and potentially life-threatening allergic reaction calledanaphylaxis. Seek immediate medical attention if you experience hives with symptoms that include:Trouble breathing or wheezingFeeling as though your throat is closingSwelling (edema) of the lips or tongueHot, flushed skinItchy skin, including the palms or soles of the feetFast pulseLow blood pressureChange in (or loss of) consciousnessAnaphylaxis is life-threatening. Call 911 at the first sign of anaphylaxis. Do not wait to see if symptoms get better.
Hives can occur with a severe and potentially life-threatening allergic reaction calledanaphylaxis. Seek immediate medical attention if you experience hives with symptoms that include:
Anaphylaxis is life-threatening. Call 911 at the first sign of anaphylaxis. Do not wait to see if symptoms get better.
There are two types of allergies frequently associated with urticaria:
Common allergens such as pollen, pet dander, insect bites, and latex also can cause allergy-related hives. Most of these allergy-induced hives will resolve on their own when the allergy trigger (allergen) is removed.
2:24Click Play to Learn About the Symptoms of Urticaria or Hives
2:24
Click Play to Learn About the Symptoms of Urticaria or Hives
The same inflammatory response seen with allergic hives is at work with physical urticaria but the rash and welts may look different. They may form only at the site of contact or exposure, or they may cause a systemic response that includes symptoms such as headaches, low blood pressure, flushing, and fainting. These types are more likely to be a chronic condition that recurs.
This photo contains content that some people may find graphic or disturbing.See PhotoReproduced with permission from © DermNet and © Te Whatu Ora Waikatowww.dermnetnz.org2023.
This photo contains content that some people may find graphic or disturbing.See Photo
This photo contains content that some people may find graphic or disturbing.
Reproduced with permission from © DermNet and © Te Whatu Ora Waikatowww.dermnetnz.org2023.
Stressis commonly associated with the development or worsening of chronic hives. There’s a significant number of people with chronic urticaria (35% to 60%) who have a co-occurring mental health condition, including anxiety and depression.
It’s not entirely clear why there is a relationship between mental health and urticaria. In some cases, it may be a physical exposure like stress-related perspiration that leads to a heat rash.
It’s also important to consider that having a chronic urticaria diagnosis and living with its symptoms can be the reason for why people are stressed or depressed, too.
What causes facial hives?Facial hives may be due to contact urticaria, in which you have an allergic reaction to something that has either touched or been applied to your face.Facial hives may coexist withangioedema, in which there is swelling of the lips, cheeks, and eyes. Like urticaria, angioedema has both allergic and non-allergic triggers.
What causes facial hives?
Facial hives may be due to contact urticaria, in which you have an allergic reaction to something that has either touched or been applied to your face.Facial hives may coexist withangioedema, in which there is swelling of the lips, cheeks, and eyes. Like urticaria, angioedema has both allergic and non-allergic triggers.
Physical activity can cause urticaria to appear in some people. The cause remains unknown, although it’s common for another co-occurring food allergy to be present.
Symptoms typically occur within 30 minutes of starting to exercise. In food-dependent cases, symptoms occur only when both eating a particular food (like wheat) and then exercising shortly after. In some cases, this can lead to a potentially life-threatening exercise-induced anaphylaxis.
There are certain infections and diseases for which urticaria is common.
Other illnesses are commonly associated with hives, many of which are autoimmune and others of which are related to an infection or malignancy. They include:
Hives associated with these diseases can be chronic (long-lasting) or acute (sudden and for a limited time).
Why do hives seem worse at night?Hives often seem worse at night because of a condition called nocturnalpruritus, thought to be related to thecircadian rhythmand changes in the level of the stress hormone cortisol. Cortisol levels drop at night, reducing inflammation but increasing the itch. Changes in body temperature and water in the skin may also contribute.
Why do hives seem worse at night?
Hives often seem worse at night because of a condition called nocturnalpruritus, thought to be related to thecircadian rhythmand changes in the level of the stress hormone cortisol. Cortisol levels drop at night, reducing inflammation but increasing the itch. Changes in body temperature and water in the skin may also contribute.
With urticaria, diagnosis is focused on identifying the cause. This can involve assessing an allergy to food, medication, or environmental exposures through skin prick or other testing.
In some cases, over-the-counter medications like Claritin (loratadine) can help to treat symptoms. Prescription drugs or additional therapies may be needed.
If an autoimmune disorder or other medical cause is at work, your healthcare provider will consider additional testing and treatment options.
Summary
Hives are a common allergy response to foods, medication, or environmental exposure. The itchy rash and red welts also can occur with chronic autoimmune conditions, infections, and other medical causes.
Treatment will vary depending on the cause. Be sure to seek immediate medical care if you also experience swelling that closes the airway, problems breathing, heart rate changes, or other symptoms associated with a severe allergic response known as anaphylaxis.
17 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Lee SJ, Ha EK, Jee HM, et al.Prevalence and Risk Factors of Urticaria With a Focus on Chronic Urticaria in Children. Allergy Asthma Immunol Res. 2017;9(3):212-219.Ben-Shoshan M, Kanani A, Kalicinsky C, Watson W.Urticaria.Allergy Asthma Clin Immunol. 2024 Dec 9;20(Suppl 3):64. doi:10.1186/s13223-024-00931-6Johns Hopkins Medicine.Food allergies.Wood RA, Togias A, Sicherer SH, Shreffler WG, Kim EH, Jones SM,et al.Omalizumab for the Treatment of Multiple Food Allergies.N Engl J Med. 2024 Mar 7;390(10):889-899. doi:10.1056/NEJMoa2312382American College of Allergy, Asthma & Immunology.Drug Allergies.Schaefer, P.Acute and Chronic Urticaria: Evaluation and Treatment.Am Fam Physician.2017; 95(11):717-724.Pozderac I, Lugović-Mihić L, Artuković M, Stipić-Marković A, Kuna M, Ferček I.Chronic inducible urticaria: classification and prominent features of physical and non-physical types.Acta Dermatovenerol Alp Pannonica Adriat. 2020 Sep;29(3):141-148. PMID:32975301Rani S, Singh S, Kumar D, Dabas S, Ritu K.Assessment of depression, anxiety, and stress in chronic urticaria and its correlation with disease severity.Ann Allergy Asthma Immunol. 2022 Mar;128(3):330-331. doi:10.1016/j.anai.2021.11.009.Konstantinou GN, Konstantinou GN.Psychiatric comorbidities in children and adolescents with chronic urticaria.World J Pediatr. 2023 Apr;19(4):315-322. doi:10.1007/s12519-022-00641-2Uter W, Werfel T, White IR, Johansen JD.Contact allergy: a review of current problems from a clinical perspective.Int J Environ Res Public Health. 2018;15(6). doi:29844295Tarbox JA, Bansal A, Peiris AN.Angioedema.JAMA. 2018;319(19):2054. doi:10.1001/jama.2018.4860Sijapati N, Sciturro M, Le M, Lanza J, Mercado E, Seferovic A.Exercise-Induced Urticaria: A Rare Case Report.Cureus. 2022 Mar 11;14(3):e23062. doi:10.7759/cureus.23062Shin M, Lee S.Prevalence and Causes of Childhood Urticaria. Allergy Asthma Immunol Res. 2017;9(3):189-190.Shalom G, Magen E, Babaev M, Tiosano S, Vardy DA, Linder D,et al.Chronic urticaria and the metabolic syndrome: a cross-sectional community-based study of 11 261 patients.J Eur Acad Dermatol Venereol. 2018 Feb;32(2):276-281. doi:10.1111/jdv.14548DermNet.Urticaria – an overview.Lavery M, Stull C, Kinney M, Yosipovitch G.Nocturnal pruritus: the battle for a peaceful night’s sleep.IJMS. 2016;17(3):425. doi:10.3390/ijms17030425Harvard Health Publishing.Hives (Urticaria).
17 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Lee SJ, Ha EK, Jee HM, et al.Prevalence and Risk Factors of Urticaria With a Focus on Chronic Urticaria in Children. Allergy Asthma Immunol Res. 2017;9(3):212-219.Ben-Shoshan M, Kanani A, Kalicinsky C, Watson W.Urticaria.Allergy Asthma Clin Immunol. 2024 Dec 9;20(Suppl 3):64. doi:10.1186/s13223-024-00931-6Johns Hopkins Medicine.Food allergies.Wood RA, Togias A, Sicherer SH, Shreffler WG, Kim EH, Jones SM,et al.Omalizumab for the Treatment of Multiple Food Allergies.N Engl J Med. 2024 Mar 7;390(10):889-899. doi:10.1056/NEJMoa2312382American College of Allergy, Asthma & Immunology.Drug Allergies.Schaefer, P.Acute and Chronic Urticaria: Evaluation and Treatment.Am Fam Physician.2017; 95(11):717-724.Pozderac I, Lugović-Mihić L, Artuković M, Stipić-Marković A, Kuna M, Ferček I.Chronic inducible urticaria: classification and prominent features of physical and non-physical types.Acta Dermatovenerol Alp Pannonica Adriat. 2020 Sep;29(3):141-148. PMID:32975301Rani S, Singh S, Kumar D, Dabas S, Ritu K.Assessment of depression, anxiety, and stress in chronic urticaria and its correlation with disease severity.Ann Allergy Asthma Immunol. 2022 Mar;128(3):330-331. doi:10.1016/j.anai.2021.11.009.Konstantinou GN, Konstantinou GN.Psychiatric comorbidities in children and adolescents with chronic urticaria.World J Pediatr. 2023 Apr;19(4):315-322. doi:10.1007/s12519-022-00641-2Uter W, Werfel T, White IR, Johansen JD.Contact allergy: a review of current problems from a clinical perspective.Int J Environ Res Public Health. 2018;15(6). doi:29844295Tarbox JA, Bansal A, Peiris AN.Angioedema.JAMA. 2018;319(19):2054. doi:10.1001/jama.2018.4860Sijapati N, Sciturro M, Le M, Lanza J, Mercado E, Seferovic A.Exercise-Induced Urticaria: A Rare Case Report.Cureus. 2022 Mar 11;14(3):e23062. doi:10.7759/cureus.23062Shin M, Lee S.Prevalence and Causes of Childhood Urticaria. Allergy Asthma Immunol Res. 2017;9(3):189-190.Shalom G, Magen E, Babaev M, Tiosano S, Vardy DA, Linder D,et al.Chronic urticaria and the metabolic syndrome: a cross-sectional community-based study of 11 261 patients.J Eur Acad Dermatol Venereol. 2018 Feb;32(2):276-281. doi:10.1111/jdv.14548DermNet.Urticaria – an overview.Lavery M, Stull C, Kinney M, Yosipovitch G.Nocturnal pruritus: the battle for a peaceful night’s sleep.IJMS. 2016;17(3):425. doi:10.3390/ijms17030425Harvard Health Publishing.Hives (Urticaria).
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Lee SJ, Ha EK, Jee HM, et al.Prevalence and Risk Factors of Urticaria With a Focus on Chronic Urticaria in Children. Allergy Asthma Immunol Res. 2017;9(3):212-219.Ben-Shoshan M, Kanani A, Kalicinsky C, Watson W.Urticaria.Allergy Asthma Clin Immunol. 2024 Dec 9;20(Suppl 3):64. doi:10.1186/s13223-024-00931-6Johns Hopkins Medicine.Food allergies.Wood RA, Togias A, Sicherer SH, Shreffler WG, Kim EH, Jones SM,et al.Omalizumab for the Treatment of Multiple Food Allergies.N Engl J Med. 2024 Mar 7;390(10):889-899. doi:10.1056/NEJMoa2312382American College of Allergy, Asthma & Immunology.Drug Allergies.Schaefer, P.Acute and Chronic Urticaria: Evaluation and Treatment.Am Fam Physician.2017; 95(11):717-724.Pozderac I, Lugović-Mihić L, Artuković M, Stipić-Marković A, Kuna M, Ferček I.Chronic inducible urticaria: classification and prominent features of physical and non-physical types.Acta Dermatovenerol Alp Pannonica Adriat. 2020 Sep;29(3):141-148. PMID:32975301Rani S, Singh S, Kumar D, Dabas S, Ritu K.Assessment of depression, anxiety, and stress in chronic urticaria and its correlation with disease severity.Ann Allergy Asthma Immunol. 2022 Mar;128(3):330-331. doi:10.1016/j.anai.2021.11.009.Konstantinou GN, Konstantinou GN.Psychiatric comorbidities in children and adolescents with chronic urticaria.World J Pediatr. 2023 Apr;19(4):315-322. doi:10.1007/s12519-022-00641-2Uter W, Werfel T, White IR, Johansen JD.Contact allergy: a review of current problems from a clinical perspective.Int J Environ Res Public Health. 2018;15(6). doi:29844295Tarbox JA, Bansal A, Peiris AN.Angioedema.JAMA. 2018;319(19):2054. doi:10.1001/jama.2018.4860Sijapati N, Sciturro M, Le M, Lanza J, Mercado E, Seferovic A.Exercise-Induced Urticaria: A Rare Case Report.Cureus. 2022 Mar 11;14(3):e23062. doi:10.7759/cureus.23062Shin M, Lee S.Prevalence and Causes of Childhood Urticaria. Allergy Asthma Immunol Res. 2017;9(3):189-190.Shalom G, Magen E, Babaev M, Tiosano S, Vardy DA, Linder D,et al.Chronic urticaria and the metabolic syndrome: a cross-sectional community-based study of 11 261 patients.J Eur Acad Dermatol Venereol. 2018 Feb;32(2):276-281. doi:10.1111/jdv.14548DermNet.Urticaria – an overview.Lavery M, Stull C, Kinney M, Yosipovitch G.Nocturnal pruritus: the battle for a peaceful night’s sleep.IJMS. 2016;17(3):425. doi:10.3390/ijms17030425Harvard Health Publishing.Hives (Urticaria).
Lee SJ, Ha EK, Jee HM, et al.Prevalence and Risk Factors of Urticaria With a Focus on Chronic Urticaria in Children. Allergy Asthma Immunol Res. 2017;9(3):212-219.
Ben-Shoshan M, Kanani A, Kalicinsky C, Watson W.Urticaria.Allergy Asthma Clin Immunol. 2024 Dec 9;20(Suppl 3):64. doi:10.1186/s13223-024-00931-6
Johns Hopkins Medicine.Food allergies.
Wood RA, Togias A, Sicherer SH, Shreffler WG, Kim EH, Jones SM,et al.Omalizumab for the Treatment of Multiple Food Allergies.N Engl J Med. 2024 Mar 7;390(10):889-899. doi:10.1056/NEJMoa2312382
American College of Allergy, Asthma & Immunology.Drug Allergies.
Schaefer, P.Acute and Chronic Urticaria: Evaluation and Treatment.Am Fam Physician.2017; 95(11):717-724.
Pozderac I, Lugović-Mihić L, Artuković M, Stipić-Marković A, Kuna M, Ferček I.Chronic inducible urticaria: classification and prominent features of physical and non-physical types.Acta Dermatovenerol Alp Pannonica Adriat. 2020 Sep;29(3):141-148. PMID:32975301
Rani S, Singh S, Kumar D, Dabas S, Ritu K.Assessment of depression, anxiety, and stress in chronic urticaria and its correlation with disease severity.Ann Allergy Asthma Immunol. 2022 Mar;128(3):330-331. doi:10.1016/j.anai.2021.11.009.
Konstantinou GN, Konstantinou GN.Psychiatric comorbidities in children and adolescents with chronic urticaria.World J Pediatr. 2023 Apr;19(4):315-322. doi:10.1007/s12519-022-00641-2
Uter W, Werfel T, White IR, Johansen JD.Contact allergy: a review of current problems from a clinical perspective.Int J Environ Res Public Health. 2018;15(6). doi:29844295
Tarbox JA, Bansal A, Peiris AN.Angioedema.JAMA. 2018;319(19):2054. doi:10.1001/jama.2018.4860
Sijapati N, Sciturro M, Le M, Lanza J, Mercado E, Seferovic A.Exercise-Induced Urticaria: A Rare Case Report.Cureus. 2022 Mar 11;14(3):e23062. doi:10.7759/cureus.23062
Shin M, Lee S.Prevalence and Causes of Childhood Urticaria. Allergy Asthma Immunol Res. 2017;9(3):189-190.
Shalom G, Magen E, Babaev M, Tiosano S, Vardy DA, Linder D,et al.Chronic urticaria and the metabolic syndrome: a cross-sectional community-based study of 11 261 patients.J Eur Acad Dermatol Venereol. 2018 Feb;32(2):276-281. doi:10.1111/jdv.14548
DermNet.Urticaria – an overview.
Lavery M, Stull C, Kinney M, Yosipovitch G.Nocturnal pruritus: the battle for a peaceful night’s sleep.IJMS. 2016;17(3):425. doi:10.3390/ijms17030425
Harvard Health Publishing.Hives (Urticaria).
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