Dear Alice,

What about hives?


 Dear Itchy,

Hives, or urticaria, are a common condition that results in raised, red, and usually itchy patches of skin ("wheals") that appear suddenly and then later disappear without a trace. They can appear all over the body, but usually appear first on the trunk and upper arms and legs, and most of the time they last anywhere from 24 hours to a couple of days. They can range in size from small dots the size of pencil tip to patches covering large areas of the body. Hives typically cause itching, stinging, or pain.

Hives are one of the body's responses to the presence of histamine or other chemicals in the blood. They are often, but not always, caused by allergies. During an allergic reaction, the body recognizes a substance (e.g., foods, medications, new soaps, lotions, and perfumes, pollen, or animal hair) or a trigger as a dangerous intruder and mounts an immune response to it. Hives usually form within minutes of exposure or but might also occur several hours later. Other triggers that may cause hives include:

  • Sunlight
  • Heat
  • Cold
  • Constricting clothing
  • Anxiety or stress
  • Exercise
  • Insect stings/bites
  • Recent (viral) infections
  • Contact with chemicals
  • Scratching your skin

As with other allergic reactions, it's possible to recognize and then avoid triggers that can cause hives. At times, the exact cause of hives can be obvious, but other situations may require more in-depth detective work. Sometimes, an allergic reaction may begin with hives and quickly progress to become more serious, even life-threatening. Symptoms of an anaphylactic reaction include difficulty breathing or swallowing, lightheadedness, rapid or irregular heartbeat, and/or loss of consciousness. The person may need to go to a hospital for immediate care.

Someone experiencing hives lasting longer than six weeks, or hives that reoccur frequently, may have chronic hives. Though in many cases the cause is difficult to determine, some cases of chronic hives are caused by an underlying autoimmune disorder, including thyroid disease or lupus. Around 40 percent of those with chronic hives may also have a condition called angioedema, which commonly results in welts or swelling on your eyes, lips, hands, feet, genitals, or throat. Angioedema typically itches less than hives, but may cause pain and a burning sensation. If you think you might have chronic hives, consider making an appointment with your health care provider.  

Working with a health care provider or allergist can serve as a stepping stone to identifying the triggers for hives, whether it’s chronic or not. S/he can perform blood or allergy tests to determine the cause of your hives, test for underlying conditions, and recommend medications to help relieve your symptoms.

Aside from over-the-counter and prescription medications, how does one find relief from itching? The following suggestions might help soothe or prevent itchiness:

  • Cold packs or baths (rather than hot baths or showers)
  • Wear loose-fitting clothing
  • Minimize exposure to sunlight or using sunscreen when outdoors
  • Minimize strenuous activities
  • Use an over-the-counter antihistamine cream

Here’s hoping you’ve now scratched the itch for knowledge!


Last updated Jul 13, 2015
Originally published Nov 30, 1993

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