DermatologicalICD-10: L50Acute hives affect about 20% of people at some point
Hives
Also known as: Urticaria, Wheals, Welts
Hives are raised, itchy welts on the skin that appear suddenly, caused by the release of histamine from mast cells. They can be triggered by allergens, infections, or stress. Acute hives resolve within 6 weeks, while chronic urticaria persists longer and may have no identifiable trigger.
Symptoms
Raised, red or skin-colored welts that appear suddenly
Intense itching
Welts that change shape, move around, or disappear and reappear
Swelling of deeper skin layers (angioedema)
Burning or stinging sensation
Welts that blanch when pressed
Causes
- Allergic reactions to foods, medications, or insect stings
- Viral or bacterial infections
- Physical triggers (cold, heat, pressure, exercise, sunlight)
- Autoimmune mechanisms
- Stress and emotional factors
Risk Factors
- History of allergies
- Previous hives or angioedema episodes
- Family history of urticaria
- Autoimmune conditions
- Infections
Diagnosis
- Clinical examination of characteristic wheals
- Detailed history of potential triggers
- Allergy testing if a specific allergen is suspected
- Blood tests for chronic urticaria (CBC, ESR, thyroid function)
Treatment
- Second-generation antihistamines (cetirizine, loratadine, fexofenadine)
- Updosing antihistamines for refractory cases
- Omalizumab (anti-IgE) for chronic urticaria not responding to antihistamines
- Short courses of oral corticosteroids for severe acute episodes
- Epinephrine auto-injector for anaphylaxis-associated urticaria
- Avoidance of identified triggers
Prevention
- Identify and avoid known triggers
- Wear loose-fitting clothing
- Manage stress
- Keep a diary to identify patterns
When to See a Doctor
- Hives are accompanied by throat tightening, difficulty breathing, or dizziness (call 911)
- Hives persist despite antihistamines
- Episodes recur frequently without identifiable cause
- Significant facial swelling or angioedema develops
Frequently Asked Questions
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