Understanding hives: Causes and prevention

July 26, 2024

Providence Health Team

[4 MIN READ]

Hives are red, itchy bumps that can appear on your skin. Hives can come and go, often without warning.
Hives can occur at any age. Roughly one in four Americans will experience hives during their lifetime.
An allergy and immunology specialist outlines common types of hives, their symptoms and treatments, including when it’s time to seek professional help.

Red itchy welts that appear on your skin and disappear without a trace soon afterward may be alarming, but in many cases, chances are good they’re not a serious health concern. They’re hives.

“Hives are a common problem that can affect roughly one in four people during their lifetime,” says Kevin Dooms, M.D., an allergy and immunology specialist at Providence Swedish Allergy and Immunology – Bellevue.

What are hives?

“Hives are red, itchy bumps that can appear anywhere on your skin, sometimes randomly and without warning,” says Dr. Dooms. “Hives may begin at any age, and can last for days, weeks, or even years.”

“Hives like to come and go,” adds Dr. Dooms. “One of the hallmarks of hives is that individual bumps will vanish after several minutes or hours. Unlike other rashes, hives don't stay in the same place. They move around like a game of Whac-A-Mole.”

Hives can be chronic or acute. They usually appear in three ways:

Urticaria – inflamed, itchy, red welts or patches that occur on your skin
Angioedema – swollen areas similar to hives that occur under your skin, most often on your lips, eyes, hands, or feet
Dermographia – temporary hives that form after your skin has been scratched or rubbed. Dermographia means “skin writing.”

Acute hives

Acute hives last for less than six weeks. They can be caused by viral infections (including the common cold), food allergy, medication allergy, environmental allergy or insect bites.

“If you have immediate hives or swelling after your first dose of amoxicillin, then it’s probably an allergic reaction to the medication,” says Dr. Dooms

Recent infections, such as cold viruses, are the most common hive trigger in infants and toddlers. Stress is a common trigger for adults.

Chronic hives

“We call hives ‘chronic’ when symptoms have lasted longer than six weeks,” says Dr. Dooms. “Chronic hives can be unpredictable and may appear without a clear pattern.”

The cause of chronic hives varies widely from person to person.

“Chronic hives can be triggered by any number of things, like it’s too hot or too cold outside,” explains Dr. Dooms. “Despite what you may have been told or read on the Internet, chronic hives are rarely due to an allergy. They can appear for many reasons.”

Causes of chronic hives include:

Unknown cause (aka “idiopathic” or “spontaneous”)
Autoimmune issues
Emotional stress
Extreme heat or cold
Exercise
Hormonal changes
Use of NSAIDs, such as aspirin, ibuprofen and naproxen

“Chronic hives can occur for multiple different reasons. Allergies are one reason, but there are many other common causes of hives that have nothing to do with allergies,” says Dr. Dooms. “Hives, swelling and dermographism are basically the body releasing histamine — a substance your skin produces to help your immune system respond to outside threats. Sometimes the skin gets mistaken and releases histamine at the wrong time and for the wrong reasons.”

There are no specific tests for hives. Experts recommend pausing before considering allergy tests, such as skin or blood tests. Testing for hives “may not be helpful, and could actually be misleading,” says Dr. Dooms. An allergist can help decide if testing is necessary for hives.

Treatment options for hives

Regardless of the type, most hives respond to the same treatment: inexpensive, over-the-counter antihistamines.

“All hive therapies are directed at stabilizing skin cells so they stop releasing histamine at the wrong time,” says Dr. Dooms. “The first line of therapy is an oral antihistamine, such as over-the-counter Zyrtec or cetirizine, its generic equivalent, and see if it helps. Antihistamines can be both diagnostic and therapeutic.”

If your initial treatment is not successful, you may need stronger medication that’s only available with a prescription from your health care provider.

The goal of hive medications is to improve quality of life: relief from itching, bumps, and swelling. However, antihistamines and other hive treatments won’t cure your condition. Your doctor will work with you to develop a treatment plan that addresses your unique health history.

“Recurrent hives and swelling can be miserable and are fundamentally a quality-of-life problem. Recurrent hives and swelling are seldom dangerous, and it is uncommon for there to be a serious underlying or life-threatening condition. Our goal is to find a medication regimen to make our patients comfortable so they can go on with their lives,” says Dr. Dooms.

When to see a doctor

In some cases, hives can be associated with more severe symptoms like anaphylaxis. Anaphylaxis can be a life-threatening medical emergency if not treated immediately.

Call 911 or go to your local emergency room immediately if you experience hives or swelling along with:

Cough, wheeze, or shortness of breath
Tightness in your throat
Swelling in your face or tongue
Difficulty speaking or change in voice quality
Nausea or vomiting
Dizziness or fainting

Contributing caregiver

Kevin Dooms, M.D., is an allergy and immunology specialist at Providence Swedish Allergy & Immunology – Bellevue.

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