Hives or Urticaria is a common skin reaction that leads to itchy, red welts of varying sizes. These welts may repeatedly appear and fade as the condition runs its course. 

If the reaction keeps appearing and disappearing for more than six weeks and seem to recur frequently over months and years, it is considered chronic hives. The cause of this condition is not clear, even for medical professionals. 

Hives can be incredibly uncomfortable, and it may interfere with rest, sleep, and everyday activities. In most cases, anti-itch medication and antihistamine is the best way to find relief for hives. 


Chronic hives have the following signs and symptoms:

  • Groups of red or skin-colored welts that may appear in any parts of the body
  • Welts that vary in shape or size and repeatedly appear and fade during the reaction
  • Itching, which can be extreme
  • Painful swelling of the eyelids, lips, and insides of the mouth and throat
  • The tendency for signs and symptoms to flare up with triggers like stress, heat, and exercise
  • The tendency for these signs and symptoms to persist beyond six weeks and to recur frequently without predictability for months or years. 

Causes of Hives

Hives and its discomforting welts arise when specific cells release histamines and other chemicals into the bloodstream. Doctors still cannot pinpoint reasons for chronic hives or why severe hives become long-term health problems. In most cases, this skin condition and reaction is triggered by the following:

  • Insect bites or parasites
  • Medication for pain relief
  • Heat or cold
  • Infections
  • Scratching
  • Stress
  • Exercise
  • Food or Alcohol
  • Sunlight
  • Pressure on the skin like a tight waistband 

Likewise, chronic hives may also be due to an underlying health condition like thyroid diseases, and in some cases, cancers. 

Hives are commonly caused by an allergic reaction that a patient consumed or encountered. When a person has an allergic reaction, the body releases histamines into the blood. These are chemicals that the body produces as it tries to defend against infections and outside intruders. However, for some people, histamines can cause itching, swelling, and experiences hives symptoms. In such cases, hives may be caused by allergens such as insect bites, medication, pollen, animal dander, or food.  

Apart from allergies, hives may also be due to specific circumstances that patient experiences. It is not unusual for some people to experience hives due to tight clothing, illness, exercise, infections, or stress. Hives reaction may also develop due to excessive exposure to hot or cold temperatures or from irritation due to excessive sweat. Because of varying potential triggers, the actual hive cause is unknown. 

Diagnosis and Treatment

Before giving treatment, doctors have to determine whether you have hives. They may perform a physical exam to see if your skin is showing signs associated with hives like welts, redness, and itchiness.   

Other tests that may be recommended for evaluation of your condition. It includes blood tests, skin tests, complete blood count, and erythrocyte sedimentation rate or ESR. These are necessary for determining the actual cause of your hives, especially if it is a result of an allergen.

Most people who experience mild cases of hives may not need prescription medication. If you experience hives that are not related to allergies or other health conditions, doctors may suggest temporary relief through:

Taking a cool or lukewarm bath with baking soda or colloidal oatmeal

Avoiding hot water so as not to aggravate the area

Avoiding irritating the skin reaction

Taking of antihistamines like cetirizine and diphenhydramine

In rare cases, hives can lead to anaphylaxis. This medical emergency needs immediate medical attention. 

For chronic hives that lasts from months to years, doctors find it hard to evaluate the condition. There will be an allergy testing and other laboratory tests used for diagnosis. Patients are required to provide accurate information regarding their medical history, oral intake, and personal habits. 

It may be necessary for chronic hives patients to limit the intake of particular food or drugs with potential allergens for a period to observe its effect on your skin. Likewise, there are systemic infections and diseases such as parasitic infections that occasionally present skin reactions as hives.

If a cause can be determined, specific treatments for such conditions are effective. In case of allergies to food or drugs, avoidance of allergens is necessary. More so, there are rare cases of chronic hives that occur when a patient’s system creates antibodies against molecules on top of their mast cells. Several tests will help in diagnosis this kind of hives. 

Physical stimuli produce physical hives like heat or cold urticaria. Hives can appear after exposure to environmental provocations like sunlight, heat, water, exercise, cold, and pressure. Additionally, dermatographism or skin writing is a common cause of physical hives. 

This condition happens when the skin is rubbed or scratched. A red welt appears in the area that is rubbed. This itchy, raised, red welt comes with flares whenever the skin is scratched or wherever belts and other types of clothing rub against the skin and cause mast cells to release histamine.

Another common type of physical hives is the cholinergic urticaria. It usually occurs within a few minutes after physical exertion or exercise. It comes out in hundreds of itchy and small bumps, which soon fades away. This type of hive is common in younger people. 

How to Stop Hives

Stopping most cases of ordinary hives focus on relieving the symptoms while the condition goes away on its own. The most common oral treatment used is antihistamines. It helps fight the effects of histamines released by mast cells. Most people experience drowsiness as a side effect of antihistamines.

You can purchase antihistamines without prescription like chlorpheniramine and diphenhydramine. They are mostly taken during bedtime because of its side effects. Those who take this medication should be extra cautious and ensure that they are fit for driving or joining activities that need mental concentration.

On the other hand, there are also available over the counter antihistamines like Loratadine, Cetirizine, and Fexofenadine, which are non-sedating and are less likely to cause drowsiness. 

Antihistamine, which needs a prescription, includes cyproheptadine, which causes drowsiness. Levocetirizine is also a prescription medication that causes low sedation. Some doctors would combine antihistamines called H2 blockers. These medications are not exhaustive, and physicians individualize treatment plans according to the clinical response of the patient. 

In severe cases of hives, oral steroids may be used for short term relief. But they are not recommended for chronic hives because they are not safe for long term use. 

Other treatments for hives include montelukast, antifungal antibiotics, ultraviolet radiation, a tricyclic antidepressant, and agents that suppress the immune system. These types of treatment are rarely needed, and evidence of their benefits is still sparse. 

Additionally, there are also topical therapies for hives, but they are not that effective. Some of these creams and lotions only numb nerve endings to lessen itching. These topical preparations do not require prescriptions except for cortisone-containing creams and lotions.

Changes to your lifestyle may also help prevent hives from recurring in the future. If you know your allergens, it is best to avoid exposure to these substances. Allergy shots may also be an option for those with chronic hives. Additionally, avoid wearing tight clothes and high-humidity areas if you had a recent hives reaction.  

What are Normal Conditions?

Signs and symptoms of common hives flare up suddenly and, in most cases, for no specific reasons. Red or skin-colored welts appear in several areas, and they itch, flare, and cause swelling. The bumps disappear in a few minutes or hours and appear in another area. This condition can go on for days or weeks. Normal hives conditions last less than six weeks, if it goes beyond this, the condition is called chronic hives. 

Risks of Having Hives 

In most cases of the common hives, the real cause is unknown. They may be due to an allergic reaction or a viral infection. It may also be caused by a reaction to medications, especially when taken for the first time. When a drug is the cause of hives, it should be stopped since testing is rarely available to confirm hives causes. Usually, drug-induced hives fade in a matter of days. If the drug is stopped the hives yet do not disappear, it indicates that it is not the cause of hives. 

Medications like aspirin, codeine, and other nonsteroidal anti-inflammatory medicines such as ibuprofen can cause the body to leak histamines and produce hives. People with such reactions should avoid these types of medications.

Hives are reputed to be a typical “allergic” condition, but there is no apparent connection to substances that provokes it. Random testing might not be helpful, thus knowing what causes hives should be avoided.   

When to Seek Medical Attention?

Hives may not put you at risk of a severe allergic reaction. If you experience hives as part of a severe condition, seek immediate medical care. Anaphylaxis signs and symptoms include trouble breathing, dizziness, and swelling of the eyelids, lips, and tongue. Likewise, if you experience severe hives that go on for several days, consult with your doctor.