Overview of Hives

Urticaria rash (hives) on legs due to exam stress Creative RM By:
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Urticaria, commonly known as hives, is a disorder that affects up to 20 percent of the population at some point in their lives.

Hives usually feel very itchy and burning or cause a tingling sensation—and these symptoms often make people miserable. The swelling that sometimes accompanies hives—called angioedema—can lead to swelling of the face, hands, and feet and is often painful.

In my allergy clinic, I see people every day who suffer from hives. Some people have had symptoms for a few days whereas others have had symptoms for decades—yet, each and every one of them is extremely bothered by them.

The good news is that through a proper evaluation and treatment plan, almost all people who suffer from hives can achieve good control of their symptoms—although, may not be able to be cured.

What Causes Hives?

Most people have a suspicion of what could be causing their hives, and these suspicions range from concern over a food allergy, a medication or environmental trigger (such as an odor or chemical), or a physical trigger, such as heat or cold.

While any of the above triggers are possible, the most common cause of acute hives (those lasting less than 6 weeks) are viral infections (such as the common cold), and the most common cause of chronic hives (those lasting greater than 6 weeks) are autoimmune conditions.

In addition, stress can cause hives, whether or not the stress is good stress (going on vacation) or bad stress (death in the family).

Physical Hives

Physical causes for hives occur in up to 15 percent of people with hives. Each one of these forms of physical hives has unique features that warrant special consideration:

  • Dermatographism (hives caused by pressure)
  • Cholinergic Urticaria (hives caused by heat and sweating)
  • Delayed pressure urticaria - Pressure
  • Cold urticaria - Cold
  • Aquagenic urticaria - Water exposure
  • Cholinergic urticaria - Heat, exercise, or stress
  • Solar urticaria - Sun exposure
  • Vibratory urticaria - Vibration

Treatment of Hives

You may be surprised to learn that in many cases, a cause of hives cannot be found. In these instances, medications are used to control symptoms. Antihistamines, taken by mouth, are the medications of choice for the treatment and prevention of hives. Corticosteroids are often given to people with hives as well, but caution should be used if these medications are to be used long term, given their side effects.

Xolair, approved for the treatment of chronic hives in March 2014, is a monoclonal antibody against IgE that can significantly reduce the number of hives a person experiences. 

A Word From Verywell

Hives can literally turn a person’s life upside down, as they are uncomfortable and often affect a person's sleep and daily functioning, whether at home or at work. While people who suffer from hives are not alone, this isn’t much of a comfort to them when their lives are consumed with not knowing why they have their symptoms—and all of this can lead to emotional distress.

Yet, be assured that hives are often easily treated with medications. Please seek out guidance from your doctor if you experience hives and especially a specialist, like an allergist, if your hives persist for more than a month or recur over time. 

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  1. Fine LM, Bernstein JA. Guideline of chronic urticaria beyondAllergy Asthma Immunol Res. 2016;8(5):396–403. doi:10.4168/aair.2016.8.5.396

  2. Sachdeva S, Gupta V, Amin SS, Tahseen M. Chronic urticariaIndian J Dermatol. 2011;56(6):622–628. doi:10.4103/0019-5154.91817

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