Hives (urticaria) – how to spot and ease symptoms

Hives can be really uncomfortable and even stop you from sleeping properly, but they can be treated.

What are the symptoms?

What are the causes and who’s affected?

Self-care tips

When to see a doctor

How are hives diagnosed?

What is the treatment?

An uncomfortably itchy rash that seems to pop up at random, or when you eat or touch something specific, is known as hives. Here’s how to soothe skin and when to see a doctor.


Have you noticed raised bumps or patches on your skin? Are they pink or red and really itchy too? This could be due to hives – also known as urticaria or nettle rash.

It’s a common skin rash that happens when your body releases a chemical called histamine into your bloodstream, as a result of your body overreacting to something you’ve touched or eaten. Hives may come and go quickly, or last for a long time.

While they usually aren’t a sign of anything serious, hives can be uncomfortable and make it hard to sleep.

## What are the symptoms?

Hives can be split into 2 different categories, depending on how long they last for. These include:

- __acute hives__ – lasting less than 6 weeks 
- __chronic hives__ – happen at least twice a week for more than 6 weeks.

Signs of hives vary depending on the type you have and the color of your skin. But symptoms can include:

- raised bumps or patches in different shapes and sizes on the skin
- pink or red bumps or patches on white skin – it can be hard to spot this on darker skin
- itching, burning, or stinging in the affected area
- a rash anywhere on the body
- blanching (the center of the hive goes pale when pressed)
- appearing on 1 area of your skin, or across your body.

Chronic hives look similar to acute hives, but they also tend to:

- appear, go away, and then return every few days over a long period of time
- shift in size and shape
- be triggered by heat, exercise, or stress.

Hives are not contagious, meaning they cannot spread from person to person.

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## What are the causes and who’s affected?

Acute hives happen when the skin’s army of immune cells kicks into action to protect the body from an allergen. These cells release the chemical histamine, causing hives.

Allergens are known as triggers and can include:

- specific foods, such as spicy foods, shrimp, or peanuts
- certain medication
- a reaction to an insect bite or sting
- touching or wearing objects with latex in them, such as latex gloves
- pet dander
- pollen.

Chronic hives aren't usually caused by an allergy, but histamine is still the main culprit. The triggers include:

- heat or cold
- sunlight
- stress
- medical conditions, such as [thyroid disease](https://www.livehealthily.com/self-care/thyroid-disease), infections from bacteria or viruses, or problems with your immune system, like [lupus](https://www.livehealthily.com/health-library/conditions/lupus) 
- vibration, such as that caused by jogging
- pressure on the skin, from something like a tight waistband.

Sometimes, there’s no obvious cause for hives, and this is known as idiopathic hives.

Anyone can get hives. In fact, they’re pretty common. But you might be more likely to develop them if:

- you have multiple allergies
- you have a condition like [asthma](https://www.livehealthily.com/health-library/conditions/asthma), [allergic rhinitis](https://www.livehealthily.com/health-library/conditions/rhinitis-allergic), or [atopic dermatitis (eczema)](https://www.livehealthily.com/health-library/conditions/eczema-atopic)
- you’re often very stressed.

## Self-care tips

Hives can often be treated without needing to see a doctor, and many cases clear up in a few days. 

If you’re unsure about your rash you can check with a pharmacist, who may be able to help ease your symptoms by recommending an antihistamine. As the name suggests, these treatments block the effect of histamine. Let them know if you have an underlying condition.

You can also soothe symptoms by:

- __putting a cold washcloth on your skin__ – to soothe it
- __taking a cool shower or bath__ – to soothe irritated skin
- __protecting your skin from the sun__ – use a high-factor sunscreen.

If you keep getting hives, it’s a good idea to keep a diary of your symptoms, including when they happen, to help identify your triggers and take steps to avoid them.

## When to see a doctor

Get an appointment with a doctor as soon as you can if:

- your symptoms don’t get better after 2 days
- your hives are severe
- your hives keep coming back
- your rash is spreading
- you also have a high temperature and don’t feel well
- medicine from a pharmacist hasn’t helped
- you also have swelling under your skin ([angioedema](https://www.livehealthily.com/health-library/conditions/angioedema)).

Get emergency medical care if:

- you feel dizzy, drowsy, or confused
- you’re finding it hard to swallow
- you have trouble breathing, or you’re breathing very fast
- your throat feels tight
- your tongue, lips, mouth, or throat is suddenly swollen, or has turned blue or pale – on
- black and brown skin this might be clearer to see on your palms or the soles of your feet.

## How are hives diagnosed?

A doctor will take a look at your skin and ask you about your symptoms. This will include asking about your medical history to check whether an underlying condition, such as lupus, is causing your hives.

Keep a diary of your triggers if you can – it can be really helpful in pinpointing a cause. For instance, if you’ve noticed your hives seem to come and go at random, rather than being triggered by an allergen, it’s more likely you have chronic hives.

If your doctor isn’t sure about a cause, or they want to confirm a specific trigger, they might send you for further checks, including:

- __allergy tests__ – to find out if you’re allergic to a substance
- __skin tests__ – such as a skin prick or scratch test. This can reveal what allergen is causing the reaction by placing it on your skin
- __blood tests__ – to check for specific antibodies in your blood that might point to an allergen
- __a biopsy__ – a skin sample taken to examine under a microscope.

## What is the treatment?

If [self-care](https://www.livehealthily.com/health-library/conditions/nettle-rash#selfcare-tips) measures don’t improve your hives, you might need medical treatment from a doctor. 

This may include:

- prescription antihistamines (taken as pills or creams applied to the skin)
- menthol cream
- steroid tablets
- allergy shots.

If these measures don’t help, your doctor may refer you to a dermatologist or allergy specialist.

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References

Amelia Glean

Jo Wheatley

Dr Ewan O'Farrell

Article information

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