Overview of Hives

Urticaria, commonly known as hives, is a disorder that affects up to 20% 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.

Urticaria rash (hives) on legs due to exam stress Creative RM By:
Dr. P. Marazzi / Science Photo Library / Getty Images

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 they 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) is a viral infection (such as the common cold), and the most common cause of chronic hives (those lasting greater than 6 weeks) is chronic spontaneous urticaria (also known as chronic idiopathic urticaria). In this form of urticaria, there is no one specific trigger that causes the hives but rather internal mediators (typically benign) that lead to recurrent hives.

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% of people with hives. Each one of these forms of physical hives has unique features that warrant special consideration:

  • Dermatographism (developing raised, red skin after skin has been scratched)
  • Cholinergic urticaria (hives caused by heat and sweating)
  • Delayed pressure urticaria - Pressure
  • Cold urticaria - Cold
  • Aquagenic urticaria - Water exposure
  • Solar urticaria - Sun exposure
  • Vibratory urticaria - Vibration

Treatment of Hives

In many cases, an external trigger for hives may not be found. In these instances, medications are used to control symptoms. Non-sedating antihistamines, taken by mouth, are the medications of choice for the treatment and prevention of hives. While oral corticosteroids are sometimes used for a few days to reduce symptoms, these should not be used long-term and other therapies should be started.

Xolair (omalizumab), a monoclonal antibody against IgE significantly improves hives in more than half of patients with chronic spontaneous urticaria. This is the only currently FDA-approved systemic therapy for chronic hives refractory to antihistamines. Some oral medications that are much cheaper than Xolair are also used off-label to treat chronic hives including cyclosporine, sulfasalazine, and dapsone among others; these can cause side effects and would require monitoring. If hives are not improving with antihistamine therapies, it is recommended to discuss possible therapies with your allergist/immunologist.

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 healthcare provider if you experience hives and especially a specialist, like an allergist, if your hives persist for more than a month or recur over time. 

2 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  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

Additional Reading

By Daniel More, MD
Daniel More, MD, is a board-certified allergist and clinical immunologist. He is an assistant clinical professor at the University of California, San Francisco School of Medicine and currently practices at Central Coast Allergy and Asthma in Salinas, California.