Hives (Urticaria)

This information was reviewed and approved by Christine B. Cho, MD (3/31/2019).

What are hives?

Most of us have heard of hives. Many people develop hives at some point in their lives. The scientific name for hives is urticaria. A hive is a raised, extremely itchy "wheal" or bump on the skin with surrounding skin redness. Hives often last for less than a day and usually clear up within a few hours. They may be small bumps or large and irregularly shaped areas. Hives typically do not leave a mark or scar and are not painful. Hives can occur in any location, but if they occur in some areas, such as the eyelid or ear, they can appear to be very swollen. They can also be associated with other areas of swelling, also called angioedema.

Hives (urticaria) can be acute or chronic. Acute urticaria is when someone has hives for less than six weeks. If someone has hives for a longer period of time, he or she is diagnosed with chronic urticaria.

Transcript

Hives are an intensely itchy rash, generally raised and red, that comes and goes over time.

You can have acute hives where hives will come for a few hours and then go away and not come back or chronic hives which by definition are daily or almost daily for at least six weeks and sometimes up to years even.

How to Identify Hives

Hives are generally red, raised, itchy and they can be pinpoint or more commonly look like a welt, sort of more like a mosquito bite appearance.

And they should not leave behind a mark or a bruise.

If a hive is leaving behind a mark then that is something to mention to a physician.

How to Diagnose Hives

Acute hives which generally come and go within a day or days are most commonly a result of an allergic exposure.

And so generally the most important thing will be the clinical history, so the questions we ask and the clues that a patient gives us helps us to determine what might have caused the hives as part of an allergic reaction.

Chronic hives on the other hand which generally last for six weeks or longer don’t usually have a secondary cause and it’s very disconcerting and frustrating because we’re always looking for that secondary cause, but we will do some basic testing just to rule out anything serious as a secondary cause for the hives.

Treatment Options for Hives

The mainstay of hive treatment is going to be oral antihistamines, some of which are available over the counter and some of which are by prescription.

There are two different kinds of antihistamines, so there’s going to be the more short acting and more potent antihistamine which is oftentimes the one that makes you very drowsy, so it has more side effects, and then the longer acting antihistamine that stays in your system longer, may not be quite as potent, but can have more of an effect for longer.

If antihistamines are not enough, then generally I would talk to a physician about other options.

And we have many immunomodulators and immune suppressants that can calm the immune system so that revved up immune system causing the hives can be more calm.

In addition, if we find an acute cause for the hives, we’ll generally advise avoidance.

Visit njhealth.org/allergy to learn more about what causes hives.

Typical Hives (Urticaria)

Anyone at any age can get hives.
Hives are often extremely itchy and transient; hives last for hours, not days.
Hives are typically asymmetric in distribution (meaning that one half of the body does not mirror the other half of the body).
There are multiple causes of hives.

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