Table of ContentsView AllTable of ContentsSymptomsAcute HivesChronic HivesDermatographismDiagnosisTreatment
Table of ContentsView All
View All
Table of Contents
Symptoms
Acute Hives
Chronic Hives
Dermatographism
Diagnosis
Treatment
Pictures of hives, also known asurticaria, can help you to identify these raised, red, itchy bumps or welts. Hives can affect people of any age on any part of the body. Causes include stress, infections, food or latex allergies,medications, and environmental effects of heat, cold, or exercise. Hives may also beidiopathic(meaning of no known cause).
Hives may come on in a sudden and severe episode, or be part of a chronic and recurring condition. They can also be generalized (widespread) or localized (limited to a certain area). Specific symptoms can help a healthcare provider to rule out possible causes and diagnose the reason.
SYMFONIA / Getty Images
The symptoms of hives will typically include:
Hives are not contagious, although sometimes the cause that led to emerging hives (such as infection) might be. In most cases, an episode is not serious.
However, a sudden, acute episode may be part of a severe allergic reaction calledanaphylaxis. This condition can be life-threatening, so seek immediate medical care if you experience problems breathing and other serious symptoms.
When to Call 911Call 911 or rush to your nearest emergency room if you develop signs and symptoms of anaphylaxis, including:A sudden, widespread outbreak of hives or rashTrouble breathingWheezingIrregular heartbeatDizziness or faintingSwelling of the face, tongue, or throatA feeling of impending doom
When to Call 911
Call 911 or rush to your nearest emergency room if you develop signs and symptoms of anaphylaxis, including:A sudden, widespread outbreak of hives or rashTrouble breathingWheezingIrregular heartbeatDizziness or faintingSwelling of the face, tongue, or throatA feeling of impending doom
Call 911 or rush to your nearest emergency room if you develop signs and symptoms of anaphylaxis, including:
What Causes Acute Hives?
Acute hives are common and tend to be harmless. Technically, acute hives can last up to six weeks before they are referred to as chronic, though they typically resolve within a few days and may be an isolated occurrence.
Common causes of acute hives include:
When your body comes into contact with an allergen it triggers an immune response in which an antibody calledimmunoglobulin E (IgE)is released into the bloodstream. This leads toallergy symptoms, with hives that can be:
There are also immune reactions that don’t involve IgE that can cause acute urticaria. These include certain infections and diseases.
IgE-Mediated CausesAirborne allergens, like pollenFood allergens, like peanutsContact allergens, like latexDrug allergiesInsect bitesParasitic infectionsNon-IgE-Mediated CausesBacterial infectionsFungal infectionsViral infectionsLymphoma (a type of blood cancer)Autoimmune diseases, like lupus
IgE-Mediated CausesAirborne allergens, like pollenFood allergens, like peanutsContact allergens, like latexDrug allergiesInsect bitesParasitic infections
Airborne allergens, like pollen
Food allergens, like peanuts
Contact allergens, like latex
Drug allergies
Insect bites
Parasitic infections
Non-IgE-Mediated CausesBacterial infectionsFungal infectionsViral infectionsLymphoma (a type of blood cancer)Autoimmune diseases, like lupus
Bacterial infections
Fungal infections
Viral infections
Lymphoma (a type of blood cancer)
Autoimmune diseases, like lupus
Jennifer Strong
What Causes Chronic Hives?
Chronic hives are those that persist for more than six weeks and/or recur frequently over months or years.They tend to be localized, although some cases may be generalized (particularly withcholinergicurticaria).
The hives commonly appear as splotchy welts with raised edges and well-defined borders. They tend to be less spongy than acute hives.
The cause of chronic hives is usually unknown. Studies suggest that between 80% and 90% of cases are idiopathic. Even with an extensive diagnosis, a cause may never be found.
anand purohit / Getty Images
Dermatographismis a form of pressure urticaria in which hives will form along the lines of trauma wherever the skin is scratched, rubbed, or roughly stroked. The term “dermatographism” literally means the ability to write on the skin.
Dermatographic hives—like many chronic hives—tend to:
Typically, treatment is not needed because symptoms are short-lasting. Instead, efforts may be focused on preventing scratching or abrasion.
R1carver/Wikimedia Commons/CC-BY-SA-3.0
Chronic urticaria is associated with theautoimmune response. This is when the immune system reacts to otherwise harmless stimuli and launches an attack against its own cells and tissues. Up to 30% of the time, chronic urticaria co-occurs with atopic (allergy-related) conditions like asthma,eczema, and allergic rhinitis (hay fever).
Treatment for hiveswill depend on the diagnosis and type of urticaria. Acute hives are commonly treated with second-generation H1antihistaminesthat help relieve swelling and itching. Over-the-counter (OTC) options include:
First-generation H1 antihistamines, which tend to cause drowsiness, may be prescribed if symptoms are severe and interfering with your sleep. This includesBenadryl(diphenhydramine).
Chronic hive treatment usually begins with OTC antihistamines like Benadryl and Pepcid (famotidine). Severe cases may require oral corticosteroids like prednisone or an even stronger injectable prescription medication likeXolair(omalizumab).
Research into targeted therapies including dupilumab and remibrutinib shows promise in developing effective, personalized treatment for chronic urticaria.So do potential off-label uses of existing drugs, includingIL-17 inhibitors.
Heather L. Brannon, MD
Summary
Hives (urticaria) are a type of rash that causes raised, red, itchy bumps or welts. Hives may be acute, appearing quickly and usually resolving quickly on their own. Or, they may be chronic, lasting for more than six months and/or recurring frequently over months or years.
There are many possible causes of hives, including allergies, infections, stress, cold, vibration, exercise, and even scratching. Chronic hives are often idiopathic, meaning of unknown origin, and may develop spontaneously for no apparent reason.
9 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.Zuberbier T, Abdul Latiff AH, Abuzakouk M, et al.The international EAACI/GA²LEN/EuroGuiDerm/APAAACI guideline for the definition, classification, diagnosis, and management of urticaria.Allergy. 2022;77(3):734-766. doi:10.1111/all.15090American Academy of Dermatology Association.Hives: overview.Kocatürk E, Muñoz M, Elieh-Ali-Komi D, Criado PR, Peter J, Kolkhir P,et al.How Infection and Vaccination Are Linked to Acute and Chronic Urticaria: A Special Focus on COVID-19.Viruses. 2023 Jul 20;15(7):1585. doi:10.3390/v15071585Svendsen SV, Lange NG, Christensen MJ, Mørtz CG, Bindslev-Jensen C.Urticaria.Ugeskr Laeger.2023 Dec 4;185(49):V04230240. Danish. PMID: 38078471Schaefer P.Acute and chronic urticaria: Evaluation and treatment.Am Fam Physician. 2017;95(11):717-724.Branco ACCC, Yoshikawa FSY, Pietrobon AJ, Sato MN.Role of histamine in modulating the immune response and inflammation.Mediators Inflamm. 2018;2018:9524075. doi:10.1155/2018/9524075Zuberbier T, Ensina LF, Giménez-Arnau A, Grattan C, Kocatürk E, Kulthanan K,et al.Chronic urticaria: unmet needs, emerging drugs, and new perspectives on personalised treatment.Lancet. 2024 Jul 27;404(10450):393-404. doi: 10.1016/S0140-6736(24)00852-3Happel CS, Saini S.Biomarkers to diagnose, assess and treat chronic spontaneous urticaria: not there yet.Curr Treat Options Allergy.2017;4: 438–49. doi:10.1007/s40521-017-0147-zAmerican Osteopathic College of Dermatology.Dermatographism.
9 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.Zuberbier T, Abdul Latiff AH, Abuzakouk M, et al.The international EAACI/GA²LEN/EuroGuiDerm/APAAACI guideline for the definition, classification, diagnosis, and management of urticaria.Allergy. 2022;77(3):734-766. doi:10.1111/all.15090American Academy of Dermatology Association.Hives: overview.Kocatürk E, Muñoz M, Elieh-Ali-Komi D, Criado PR, Peter J, Kolkhir P,et al.How Infection and Vaccination Are Linked to Acute and Chronic Urticaria: A Special Focus on COVID-19.Viruses. 2023 Jul 20;15(7):1585. doi:10.3390/v15071585Svendsen SV, Lange NG, Christensen MJ, Mørtz CG, Bindslev-Jensen C.Urticaria.Ugeskr Laeger.2023 Dec 4;185(49):V04230240. Danish. PMID: 38078471Schaefer P.Acute and chronic urticaria: Evaluation and treatment.Am Fam Physician. 2017;95(11):717-724.Branco ACCC, Yoshikawa FSY, Pietrobon AJ, Sato MN.Role of histamine in modulating the immune response and inflammation.Mediators Inflamm. 2018;2018:9524075. doi:10.1155/2018/9524075Zuberbier T, Ensina LF, Giménez-Arnau A, Grattan C, Kocatürk E, Kulthanan K,et al.Chronic urticaria: unmet needs, emerging drugs, and new perspectives on personalised treatment.Lancet. 2024 Jul 27;404(10450):393-404. doi: 10.1016/S0140-6736(24)00852-3Happel CS, Saini S.Biomarkers to diagnose, assess and treat chronic spontaneous urticaria: not there yet.Curr Treat Options Allergy.2017;4: 438–49. doi:10.1007/s40521-017-0147-zAmerican Osteopathic College of Dermatology.Dermatographism.
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.
Zuberbier T, Abdul Latiff AH, Abuzakouk M, et al.The international EAACI/GA²LEN/EuroGuiDerm/APAAACI guideline for the definition, classification, diagnosis, and management of urticaria.Allergy. 2022;77(3):734-766. doi:10.1111/all.15090American Academy of Dermatology Association.Hives: overview.Kocatürk E, Muñoz M, Elieh-Ali-Komi D, Criado PR, Peter J, Kolkhir P,et al.How Infection and Vaccination Are Linked to Acute and Chronic Urticaria: A Special Focus on COVID-19.Viruses. 2023 Jul 20;15(7):1585. doi:10.3390/v15071585Svendsen SV, Lange NG, Christensen MJ, Mørtz CG, Bindslev-Jensen C.Urticaria.Ugeskr Laeger.2023 Dec 4;185(49):V04230240. Danish. PMID: 38078471Schaefer P.Acute and chronic urticaria: Evaluation and treatment.Am Fam Physician. 2017;95(11):717-724.Branco ACCC, Yoshikawa FSY, Pietrobon AJ, Sato MN.Role of histamine in modulating the immune response and inflammation.Mediators Inflamm. 2018;2018:9524075. doi:10.1155/2018/9524075Zuberbier T, Ensina LF, Giménez-Arnau A, Grattan C, Kocatürk E, Kulthanan K,et al.Chronic urticaria: unmet needs, emerging drugs, and new perspectives on personalised treatment.Lancet. 2024 Jul 27;404(10450):393-404. doi: 10.1016/S0140-6736(24)00852-3Happel CS, Saini S.Biomarkers to diagnose, assess and treat chronic spontaneous urticaria: not there yet.Curr Treat Options Allergy.2017;4: 438–49. doi:10.1007/s40521-017-0147-zAmerican Osteopathic College of Dermatology.Dermatographism.
Zuberbier T, Abdul Latiff AH, Abuzakouk M, et al.The international EAACI/GA²LEN/EuroGuiDerm/APAAACI guideline for the definition, classification, diagnosis, and management of urticaria.Allergy. 2022;77(3):734-766. doi:10.1111/all.15090
American Academy of Dermatology Association.Hives: overview.
Kocatürk E, Muñoz M, Elieh-Ali-Komi D, Criado PR, Peter J, Kolkhir P,et al.How Infection and Vaccination Are Linked to Acute and Chronic Urticaria: A Special Focus on COVID-19.Viruses. 2023 Jul 20;15(7):1585. doi:10.3390/v15071585
Svendsen SV, Lange NG, Christensen MJ, Mørtz CG, Bindslev-Jensen C.Urticaria.Ugeskr Laeger.2023 Dec 4;185(49):V04230240. Danish. PMID: 38078471
Schaefer P.Acute and chronic urticaria: Evaluation and treatment.Am Fam Physician. 2017;95(11):717-724.
Branco ACCC, Yoshikawa FSY, Pietrobon AJ, Sato MN.Role of histamine in modulating the immune response and inflammation.Mediators Inflamm. 2018;2018:9524075. doi:10.1155/2018/9524075
Zuberbier T, Ensina LF, Giménez-Arnau A, Grattan C, Kocatürk E, Kulthanan K,et al.Chronic urticaria: unmet needs, emerging drugs, and new perspectives on personalised treatment.Lancet. 2024 Jul 27;404(10450):393-404. doi: 10.1016/S0140-6736(24)00852-3
Happel CS, Saini S.Biomarkers to diagnose, assess and treat chronic spontaneous urticaria: not there yet.Curr Treat Options Allergy.2017;4: 438–49. doi:10.1007/s40521-017-0147-z
American Osteopathic College of Dermatology.Dermatographism.
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