Table of ContentsView AllTable of ContentsSymptomsCausesDiagnosisTreatment
Table of ContentsView All
View All
Table of Contents
Symptoms
Causes
Diagnosis
Treatment
Symptoms may come and go quickly or they can be long-lasting. The appearance may be enough for diagnosis, but chronic cases may require allergy testing, a physical challenge, or other tests. Antihistamines are typically used to treat urticaria, although H2 blockers, corticosteroids, antidepressants, and anti-asthma drugs may also be prescribed.
Verywell / Emily Roberts
Urticaria Symptoms
Urticaria can affect people of any age and may develop on any part of the body, including the palms and soles.
Thehives will appearas raised welts (wheals or weals) and will invariably be itchy—some more than others. They can vary in shape and size and will have a clearly defined border. When pressed, the center will “blanch” (turn white).
Symptoms are commonly confused with those of other conditions, but close attention to these defining factors can help distinguish urticaria.
Most hives are acute and self-limited, resolving on their own within 24 hours. Others may take days or weeks before they fully resolve. Hives that last longer are associated with more serious conditions, such as urticarial vasculitis.
This photo contains content that some people may find graphic or disturbing.See PhotoHives on leg.
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.
Broadly speaking, all forms of urticaria are a result of an abnormal immune response. While anallergyis the most common example, it isnot the only cause.
Allergy-Induced Urticaria
Allergy-induced urticaria occurs when the immune system responds abnormally to an otherwise harmless substance and releases a chemical known ashistamineinto the bloodstream.
Histamine causes vasodilation (widening of the blood vessels) and movement of fluid from the blood vessels into the tissues, producing hives or angioedema. This leads to the symptoms of allergy, affecting the respiratory system, gastrointestinal tract, and skin.
Common triggers of allergy-induced urticaria includefood(including shellfish, eggs, and nuts),drugs(including aspirin and antibiotics), andinsect bitesand stings (especially bees and fire ants).
Chronic Idiopathic Urticaria
Chronic urticaria is often idiopathic and may be worsened in times of stress.The exact pathway of the condition is unknown. In some patients, autoantibodies (immune proteins that target the body’s own cells) are found in blood, but these autoantibodies are not necessarily disease-causing. Testing for anti-thyroperoxidase antibodies may be performed for chronic urticaria.
While the instigating cause of chronic urticaria may be different from allergy-induced urticaria, the outcome will be the same (albeit longer-lasting). Women tend to be affected more than men.
In addition to stress, common physical triggers include exposure to cold, heat, sunlight, pressure, vibration, water, and friction. Certain types of exercise-induced urticaria occur only in tandem with a food allergy. In other words, exercise alone will not cause a reaction, and food alone will not cause a reaction, but in this form of allergy, eating a specific food (e.g. wheat) and then exercising may cause a reaction.
Other Causes
Infections and diseases like hepatitis, chronic kidney disease, lymphoma, and any number ofautoimmune disorders(including lupus, Hashimoto’s thyroiditis, and rheumatoid arthritis) may also manifest with acute or chronic hives.
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
All About Anxiety Rash
Urticaria can usually be diagnosed based on a review of your medical history and the characteristic appearance of the rash.Lab tests and imaging are generally not required unless an underlying cause is suspected, such as cancer.
The severity of an eruption can be classified based on an assessment tool called the urticaria activity score (UAS).For this, a patient subjectively rates the two primary symptoms—the wheals and the itchiness (pruritus)—on a scale of 0 (low disease activity) to 3 (severe disease activity). Having a maximum score of 6 often means that a patient requires further treatment, particularly if the symptoms are chronic.
If further testing is needed, it may involve one of the following:
How Urticaria Is Diagnosed
Most acute hives will resolve on their own within a few days and the itching and swelling may be eased with a wet, cool compress.
Treatment for hives that don’t resolve naturally depends on the cause and symptoms. Some cases may take up to several weeks and require oralantihistaminesto help alleviate the symptoms. Over-the-counter antihistamines such asAllegra (fexofenadine),Claritin (loratadine), and Zyrtec (cetirizine) usually provide ample relief.
If antihistamines are adequate for providing relief, other drugs may be added or substituted, particularly if the cause is non-allergic.
Among them:
How Urticaria Is Treated
A Word From Verywell
While hives can be unsightly and uncomfortable, they usually aren’t serious. However, if they start to interfere with your quality of life, ask your healthcare provider for a referral to anallergistwho can perform tests to pinpoint the cause.
Symptoms of Urticaria (Hives)
20 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.Deacock SJ.An approach to the patient with urticaria.Clin Exp Immunol. 2008;153(2):151–161. doi:10.1111/j.1365-2249.2008.03693.xKanani A, Betschel SD, Warrington R.Urticaria and angioedema.Allergy Asthma Clin Immunol. 2018;14(Suppl 2):59. doi:10.1186/s13223-018-0288-zKatelaris CH, Peake JE. 5.Allergy and the skin: eczema and chronic urticaria. Med J Aust. 2006;185(9):517-22.Goh CL, Tan KT.Chronic autoimmune urticaria: where we stand?.Indian J Dermatol. 2009;54(3):269–274. doi:10.4103/0019-5154.55640Greaves MW, Sabroe RA.ABC of allergies. Allergy and the skin. I–Urticaria.BMJ. 1998;316(7138):1147–1150. doi:10.1136/bmj.316.7138.1147Ograczyk-Piotrowska A, Gerlicz-Kowalczuk Z, Pietrzak A, Zalewska-Janowska AM.Stress, itch and quality of life in chronic urticaria females.Postepy Dermatol Alergol. 2018;35(2):156–160. doi:10.5114/ada.2018.75237Zuberbier 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.15090Justiz Vaillant AA, Zito PM.Immediate Hypersensitivity Reactions. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. Available from: https://www.ncbi.nlm.nih.gov/books/NBK513315/Schoepke N, Doumoulakis G, Maurer M.Diagnosis of urticaria.Indian J Dermatol. 2013;58(3):211–218. doi:10.4103/0019-5154.110831Hollis K, Proctor C, McBride D, et al.Comparison of Urticaria Activity Score Over 7 Days (UAS7) Values Obtained from Once-Daily and Twice-Daily Versions: Results from the ASSURE-CSU Study.Am J Clin Dermatol. 2018;19(2):267–274. doi:10.1007/s40257-017-0331-8Gleich GJ, Yunginger JW.The radioallergosorbent test: a method to measure IgE antibodies, IgG blocking antibodies, and the potency of allergy extracts.Bull N Y Acad Med. 1981;57(7):559–567.Komarow HD, Arceo S, Young M, Nelson C, Metcalfe DD.Dissociation between history and challenge in patients with physical urticaria.J Allergy Clin Immunol Pract. 2014;2(6):786–790. doi:10.1016/j.jaip.2014.07.008Ying S, Kikuchi Y, Meng Q, Kay AB, Kaplan AP.TH1/TH2 cytokines and inflammatory cells in skin biopsy specimens from patients with chronic idiopathic urticaria: comparison with the allergen-induced late-phase cutaneous reaction. J Allergy Clin Immunol. 2002;109(4):694-700.Lee EE, Maibach HI.Treatment of urticaria. An evidence-based evaluation of antihistamines. Am J Clin Dermatol. 2001;2(1):27-32.Fedorowicz Z, Van zuuren EJ, Hu N.Histamine H2-receptor antagonists for urticaria. Cochrane Database Syst Rev. 2012;(3):CD008596.Godse K, Bagadia A, Patil S, Nadkarni N, Gautam M.“Busting” urticaria with a “burst” of steroids.Indian J Dermatol. 2014;59(6):618–619. doi:10.4103/0019-5154.143546de Silva NL, Damayanthi H, Rajapakse AC, Rodrigo C, Rajapakse S.Leukotriene receptor antagonists for chronic urticaria: a systematic review.Allergy Asthma Clin Immunol. 2014;10(1):24. doi:10.1186/1710-1492-10-24Özkaya E, Babuna kobaner G, Yılmaz Z, Kutlay A.Doxepin in difficult-to-treat chronic urticaria: A retrospective, cross-sectional study from Turkey. Dermatol Ther. 2019;32(4):e12993.Naaman S, Sussman G.Chronic idiopathic urticaria: treatment with omalizumab. Skin Therapy Lett. 2014;19(6):1-4.Benelli E, Longo G, Barbi E, Berti I.Anaphylaxis in atypical cold urticaria: case report and review of literature.Ital J Pediatr. 2018;44(1):135. doi:10.1186/s13052-018-0578-6Additional ReadingFerrer, M.; Bastra, J.; Gimenez-Arnau, A. et al.Management of urticaria: not too complicated, not to simple.Clin Experimental Allergy.2014; 45(4):731-43. DOI: 10.1111/cea.12465.Schaefer, P.Acute and Chronic Urticaria: Evaluation and Treatment.Am Fam Physician.2017; 95(11):717-724.
20 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.Deacock SJ.An approach to the patient with urticaria.Clin Exp Immunol. 2008;153(2):151–161. doi:10.1111/j.1365-2249.2008.03693.xKanani A, Betschel SD, Warrington R.Urticaria and angioedema.Allergy Asthma Clin Immunol. 2018;14(Suppl 2):59. doi:10.1186/s13223-018-0288-zKatelaris CH, Peake JE. 5.Allergy and the skin: eczema and chronic urticaria. Med J Aust. 2006;185(9):517-22.Goh CL, Tan KT.Chronic autoimmune urticaria: where we stand?.Indian J Dermatol. 2009;54(3):269–274. doi:10.4103/0019-5154.55640Greaves MW, Sabroe RA.ABC of allergies. Allergy and the skin. I–Urticaria.BMJ. 1998;316(7138):1147–1150. doi:10.1136/bmj.316.7138.1147Ograczyk-Piotrowska A, Gerlicz-Kowalczuk Z, Pietrzak A, Zalewska-Janowska AM.Stress, itch and quality of life in chronic urticaria females.Postepy Dermatol Alergol. 2018;35(2):156–160. doi:10.5114/ada.2018.75237Zuberbier 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.15090Justiz Vaillant AA, Zito PM.Immediate Hypersensitivity Reactions. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. Available from: https://www.ncbi.nlm.nih.gov/books/NBK513315/Schoepke N, Doumoulakis G, Maurer M.Diagnosis of urticaria.Indian J Dermatol. 2013;58(3):211–218. doi:10.4103/0019-5154.110831Hollis K, Proctor C, McBride D, et al.Comparison of Urticaria Activity Score Over 7 Days (UAS7) Values Obtained from Once-Daily and Twice-Daily Versions: Results from the ASSURE-CSU Study.Am J Clin Dermatol. 2018;19(2):267–274. doi:10.1007/s40257-017-0331-8Gleich GJ, Yunginger JW.The radioallergosorbent test: a method to measure IgE antibodies, IgG blocking antibodies, and the potency of allergy extracts.Bull N Y Acad Med. 1981;57(7):559–567.Komarow HD, Arceo S, Young M, Nelson C, Metcalfe DD.Dissociation between history and challenge in patients with physical urticaria.J Allergy Clin Immunol Pract. 2014;2(6):786–790. doi:10.1016/j.jaip.2014.07.008Ying S, Kikuchi Y, Meng Q, Kay AB, Kaplan AP.TH1/TH2 cytokines and inflammatory cells in skin biopsy specimens from patients with chronic idiopathic urticaria: comparison with the allergen-induced late-phase cutaneous reaction. J Allergy Clin Immunol. 2002;109(4):694-700.Lee EE, Maibach HI.Treatment of urticaria. An evidence-based evaluation of antihistamines. Am J Clin Dermatol. 2001;2(1):27-32.Fedorowicz Z, Van zuuren EJ, Hu N.Histamine H2-receptor antagonists for urticaria. Cochrane Database Syst Rev. 2012;(3):CD008596.Godse K, Bagadia A, Patil S, Nadkarni N, Gautam M.“Busting” urticaria with a “burst” of steroids.Indian J Dermatol. 2014;59(6):618–619. doi:10.4103/0019-5154.143546de Silva NL, Damayanthi H, Rajapakse AC, Rodrigo C, Rajapakse S.Leukotriene receptor antagonists for chronic urticaria: a systematic review.Allergy Asthma Clin Immunol. 2014;10(1):24. doi:10.1186/1710-1492-10-24Özkaya E, Babuna kobaner G, Yılmaz Z, Kutlay A.Doxepin in difficult-to-treat chronic urticaria: A retrospective, cross-sectional study from Turkey. Dermatol Ther. 2019;32(4):e12993.Naaman S, Sussman G.Chronic idiopathic urticaria: treatment with omalizumab. Skin Therapy Lett. 2014;19(6):1-4.Benelli E, Longo G, Barbi E, Berti I.Anaphylaxis in atypical cold urticaria: case report and review of literature.Ital J Pediatr. 2018;44(1):135. doi:10.1186/s13052-018-0578-6Additional ReadingFerrer, M.; Bastra, J.; Gimenez-Arnau, A. et al.Management of urticaria: not too complicated, not to simple.Clin Experimental Allergy.2014; 45(4):731-43. DOI: 10.1111/cea.12465.Schaefer, P.Acute and Chronic Urticaria: Evaluation and Treatment.Am Fam Physician.2017; 95(11):717-724.
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.
Deacock SJ.An approach to the patient with urticaria.Clin Exp Immunol. 2008;153(2):151–161. doi:10.1111/j.1365-2249.2008.03693.xKanani A, Betschel SD, Warrington R.Urticaria and angioedema.Allergy Asthma Clin Immunol. 2018;14(Suppl 2):59. doi:10.1186/s13223-018-0288-zKatelaris CH, Peake JE. 5.Allergy and the skin: eczema and chronic urticaria. Med J Aust. 2006;185(9):517-22.Goh CL, Tan KT.Chronic autoimmune urticaria: where we stand?.Indian J Dermatol. 2009;54(3):269–274. doi:10.4103/0019-5154.55640Greaves MW, Sabroe RA.ABC of allergies. Allergy and the skin. I–Urticaria.BMJ. 1998;316(7138):1147–1150. doi:10.1136/bmj.316.7138.1147Ograczyk-Piotrowska A, Gerlicz-Kowalczuk Z, Pietrzak A, Zalewska-Janowska AM.Stress, itch and quality of life in chronic urticaria females.Postepy Dermatol Alergol. 2018;35(2):156–160. doi:10.5114/ada.2018.75237Zuberbier 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.15090Justiz Vaillant AA, Zito PM.Immediate Hypersensitivity Reactions. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. Available from: https://www.ncbi.nlm.nih.gov/books/NBK513315/Schoepke N, Doumoulakis G, Maurer M.Diagnosis of urticaria.Indian J Dermatol. 2013;58(3):211–218. doi:10.4103/0019-5154.110831Hollis K, Proctor C, McBride D, et al.Comparison of Urticaria Activity Score Over 7 Days (UAS7) Values Obtained from Once-Daily and Twice-Daily Versions: Results from the ASSURE-CSU Study.Am J Clin Dermatol. 2018;19(2):267–274. doi:10.1007/s40257-017-0331-8Gleich GJ, Yunginger JW.The radioallergosorbent test: a method to measure IgE antibodies, IgG blocking antibodies, and the potency of allergy extracts.Bull N Y Acad Med. 1981;57(7):559–567.Komarow HD, Arceo S, Young M, Nelson C, Metcalfe DD.Dissociation between history and challenge in patients with physical urticaria.J Allergy Clin Immunol Pract. 2014;2(6):786–790. doi:10.1016/j.jaip.2014.07.008Ying S, Kikuchi Y, Meng Q, Kay AB, Kaplan AP.TH1/TH2 cytokines and inflammatory cells in skin biopsy specimens from patients with chronic idiopathic urticaria: comparison with the allergen-induced late-phase cutaneous reaction. J Allergy Clin Immunol. 2002;109(4):694-700.Lee EE, Maibach HI.Treatment of urticaria. An evidence-based evaluation of antihistamines. Am J Clin Dermatol. 2001;2(1):27-32.Fedorowicz Z, Van zuuren EJ, Hu N.Histamine H2-receptor antagonists for urticaria. Cochrane Database Syst Rev. 2012;(3):CD008596.Godse K, Bagadia A, Patil S, Nadkarni N, Gautam M.“Busting” urticaria with a “burst” of steroids.Indian J Dermatol. 2014;59(6):618–619. doi:10.4103/0019-5154.143546de Silva NL, Damayanthi H, Rajapakse AC, Rodrigo C, Rajapakse S.Leukotriene receptor antagonists for chronic urticaria: a systematic review.Allergy Asthma Clin Immunol. 2014;10(1):24. doi:10.1186/1710-1492-10-24Özkaya E, Babuna kobaner G, Yılmaz Z, Kutlay A.Doxepin in difficult-to-treat chronic urticaria: A retrospective, cross-sectional study from Turkey. Dermatol Ther. 2019;32(4):e12993.Naaman S, Sussman G.Chronic idiopathic urticaria: treatment with omalizumab. Skin Therapy Lett. 2014;19(6):1-4.Benelli E, Longo G, Barbi E, Berti I.Anaphylaxis in atypical cold urticaria: case report and review of literature.Ital J Pediatr. 2018;44(1):135. doi:10.1186/s13052-018-0578-6
Deacock SJ.An approach to the patient with urticaria.Clin Exp Immunol. 2008;153(2):151–161. doi:10.1111/j.1365-2249.2008.03693.x
Kanani A, Betschel SD, Warrington R.Urticaria and angioedema.Allergy Asthma Clin Immunol. 2018;14(Suppl 2):59. doi:10.1186/s13223-018-0288-z
Katelaris CH, Peake JE. 5.Allergy and the skin: eczema and chronic urticaria. Med J Aust. 2006;185(9):517-22.
Goh CL, Tan KT.Chronic autoimmune urticaria: where we stand?.Indian J Dermatol. 2009;54(3):269–274. doi:10.4103/0019-5154.55640
Greaves MW, Sabroe RA.ABC of allergies. Allergy and the skin. I–Urticaria.BMJ. 1998;316(7138):1147–1150. doi:10.1136/bmj.316.7138.1147
Ograczyk-Piotrowska A, Gerlicz-Kowalczuk Z, Pietrzak A, Zalewska-Janowska AM.Stress, itch and quality of life in chronic urticaria females.Postepy Dermatol Alergol. 2018;35(2):156–160. doi:10.5114/ada.2018.75237
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
Justiz Vaillant AA, Zito PM.Immediate Hypersensitivity Reactions. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. Available from: https://www.ncbi.nlm.nih.gov/books/NBK513315/
Schoepke N, Doumoulakis G, Maurer M.Diagnosis of urticaria.Indian J Dermatol. 2013;58(3):211–218. doi:10.4103/0019-5154.110831
Hollis K, Proctor C, McBride D, et al.Comparison of Urticaria Activity Score Over 7 Days (UAS7) Values Obtained from Once-Daily and Twice-Daily Versions: Results from the ASSURE-CSU Study.Am J Clin Dermatol. 2018;19(2):267–274. doi:10.1007/s40257-017-0331-8
Gleich GJ, Yunginger JW.The radioallergosorbent test: a method to measure IgE antibodies, IgG blocking antibodies, and the potency of allergy extracts.Bull N Y Acad Med. 1981;57(7):559–567.
Komarow HD, Arceo S, Young M, Nelson C, Metcalfe DD.Dissociation between history and challenge in patients with physical urticaria.J Allergy Clin Immunol Pract. 2014;2(6):786–790. doi:10.1016/j.jaip.2014.07.008
Ying S, Kikuchi Y, Meng Q, Kay AB, Kaplan AP.TH1/TH2 cytokines and inflammatory cells in skin biopsy specimens from patients with chronic idiopathic urticaria: comparison with the allergen-induced late-phase cutaneous reaction. J Allergy Clin Immunol. 2002;109(4):694-700.
Lee EE, Maibach HI.Treatment of urticaria. An evidence-based evaluation of antihistamines. Am J Clin Dermatol. 2001;2(1):27-32.
Fedorowicz Z, Van zuuren EJ, Hu N.Histamine H2-receptor antagonists for urticaria. Cochrane Database Syst Rev. 2012;(3):CD008596.
Godse K, Bagadia A, Patil S, Nadkarni N, Gautam M.“Busting” urticaria with a “burst” of steroids.Indian J Dermatol. 2014;59(6):618–619. doi:10.4103/0019-5154.143546
de Silva NL, Damayanthi H, Rajapakse AC, Rodrigo C, Rajapakse S.Leukotriene receptor antagonists for chronic urticaria: a systematic review.Allergy Asthma Clin Immunol. 2014;10(1):24. doi:10.1186/1710-1492-10-24
Özkaya E, Babuna kobaner G, Yılmaz Z, Kutlay A.Doxepin in difficult-to-treat chronic urticaria: A retrospective, cross-sectional study from Turkey. Dermatol Ther. 2019;32(4):e12993.
Naaman S, Sussman G.Chronic idiopathic urticaria: treatment with omalizumab. Skin Therapy Lett. 2014;19(6):1-4.
Benelli E, Longo G, Barbi E, Berti I.Anaphylaxis in atypical cold urticaria: case report and review of literature.Ital J Pediatr. 2018;44(1):135. doi:10.1186/s13052-018-0578-6
Ferrer, M.; Bastra, J.; Gimenez-Arnau, A. et al.Management of urticaria: not too complicated, not to simple.Clin Experimental Allergy.2014; 45(4):731-43. DOI: 10.1111/cea.12465.Schaefer, P.Acute and Chronic Urticaria: Evaluation and Treatment.Am Fam Physician.2017; 95(11):717-724.
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