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This information was reviewed and approved by Christine B. Cho, MD (4/1/2019).

What causes hives (urticaria)?

  • No identifiable cause: In many cases, no cause is identified, and the hives are thought to occur spontaneously. This form of hives is often called Recurrent Spontaneous Urticaria or Chronic Idiopathic Urticaria. It has a good prognosis. Most cases resolve over time. The hives can recur more frequently or more severely with concurrent infection, stress, heat and NSAID or alcohol use.

  • Allergies: When hives are caused by allergies, they happen immediately (within minutes) of being exposed to the allergen.

    • Foods , such as milk, egg, wheat, soy, peanut, tree nuts, fish and shellfish.

      • Eating a particular food and then exercising can cause food-dependent, exercise-induced hives and/or anaphylaxis (a life-threatening reaction)

    • Medications, such as penicillin and other antibiotics, vaccines, sulfa drugs and aspirin. Aspirin may cause a delayed reaction hours later.

    • Insect stings from bees, wasps, yellow jackets or fire ants

    • Environmental allergies (typically through contact), such as cat or dog saliva

    • Occupational contact, such as cow dander, natural rubber latex, flour, grains, feeds, enzymes and a variety of plant and animal species

    • Contrary to popular belief, laundry detergents and lotions are not a common cause or trigger for urticaria.

  • Physical causes:

    • Pressure, friction, heat, sweat, cold, water, sunlight and vibration

    • Many of these triggers can be made worse by stress, alcohol and/or NSAID use.

  • Underlying autoimmune, infectious or inflammatory diseases:

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