Hives: What they are, why people get them and information about treatment options

Hives are itchy, red bumps that show up on the skin. They’re pretty common, with 1 out of 5 people getting hives at some point in their lives. People might see just a few spots in one area of their skin, or they might see hives all over their body. This article will explore why hives show up, whom they can effect and what you can do if you get them.

In this article:

What are hives?

Hives (also called urticaria) are raised red or skin-colored bumps that can pop up on the skin. They can show up anywhere and often itch, burn or feel warm. They are most common on the legs, stomach, back, buttocks, chest, arms and legs.

What do hives look and feel like?

Hives can appear anywhere on the body and may cover large patches of skin. They typically show up as raised spots that vary in shape and size. On lighter skin tones, hives often look pink, while on darker skin tones, they may blend in more and be harder to see. When pressed, the bumps usually turn white. Most people also experience hives that are itchy.

In some cases, hives are accompanied by deep swelling under the skin, known as angioedema. This can happen with or without visible hives and may affect areas like the eyes, hands, feet, mouth or throat. In more serious cases, it can lead to difficulty breathing or stomach cramps.

If someone is experiencing angioedema with hives, they should seek medical care urgently. It is also recommended that someone with hives lasting longer than six weeks or hives that cover a large area of the body should see a health care provider.

How long can hives last?

Hives usually show up suddenly and go away on their own. A normal hive should fade way in a day, but new hives may continue to form. This process may be short-lived, but it can continue for days to weeks. Most go away in a few weeks, but some can last longer. People shouldn’t be surprised if they disappear and then keep reappearing. That’s normal.

What causes hives?

Hives happen when the body releases histamine, usually from allergies or things like stress, infections or some illnesses. Whatever sets off an episode is called a trigger.

Non-allergy triggers (more common):

• Exercise
• Infections (like colds or urinary tract infection [UTIs])
• Pressure on the skin from rubbing, scratching or tight clothing
• Stress
• Sunlight or using tanning beds
• Temperatures that are too hot or too cold

Allergy triggers (less common):

• Animal dander
• Foods (e.g., eggs, peanuts, shellfish, tree nuts)
• Latex
• Medicine (e.g., aspirin, ibuprofen)
• Skin contact with plants (grass, weeds)
• Soaps, detergents or lotions

What are the different types of hives?

There are two types of hives:

• Short-term (acute) hives: Usually come from allergies or viral infections and often go away quickly.
• Long-term (chronic) hives: Lasts more than six weeks (less common)

How can hives be treated?

How hives are treated depends on whether they are short-term or chronic. Always work with a health care provider for the best treatment plan.

Short-term hives (acute) treatments:

• Cool compresses. Apply a cool, damp washcloth for 10 to 20 minutes.
• Anti-itch creams or lotions. A health care provider may recommend over-the-counter (OTC) creams or lotions like pramoxine, menthol or calamine.
• Oatmeal baths. Soak in warm water with colloidal oatmeal.
• Gentle skincare. Use fragrance-free products and wash skin gently.
• Warm baths and showers. Take warm (but not hot) baths and shower.
• Cotton clothing. Wear loose, 100 percent cotton clothing, which can help reduce skin irritation.
• Oral antihistamines. A health care provider may recommend an oral antihistamine to reduce itching and swelling.
• Avoid triggers. Identifying any potential triggers and avoiding them are key to preventing hives.

Chronic hives (lasting 6+ weeks):

Rarely, cases of hives last more than six weeks. This condition is known as chronic spontaneous or idiopathic urticaria. It can affect 1.4 percent of the general population and is seen in women twice as commonly as men. Contact a health care provider if someone is experiencing prolonged cases of hives to discuss treatment options.

These treatment options may include:

• Daily antihistamines. Non-drowsy options are the first line; dosages may be increased if needed.
• Prescription antihistamines. Options include desloratadine (common brand name: Clarinex) or hydroxyzine (common brand name: Vistaril).
• Additional medications. If antihistamines alone aren’t effective, a health care provider might prescribe:
  • H2 blockers, such as famotidine (common brand name: Pepcid)
  • Leukotriene inhibitors, such as montelukast (brand name: Singulair)
  • Biologics, such as omalizumab (brand name: Xolair) or dupilumab (brand name: Dupixent)
  • Immunosuppressants, such as cyclosporine (common brand name: Sandimmune)

How are hives diagnosed?

Hives are usually diagnosed based on physical exam findings and associated symptoms. Health care providers will sometimes order allergy tests to identify triggers, and a skin biopsy can help rule out other conditions.

When should someone see a health care provider about hives?

Anyone who experiences angioedema with hives should seek medical attention urgently. It is recommended that someone with hives lasting longer than six weeks or hives that cover a large area of the body should see a health care provider.

Key takeaways

Getting hives can be uncomfortable and a little alarming. They’re usually not serious and can be treated easily, but someone with hives should always consult a health care provider if they are unsure about their symptoms. It is important to call 911 immediately if they are showing signs of anaphylaxis. Whether it’s stress, food or something else, knowing the cause is the first step toward feeling better.