Hives On Skin

The sweat itself doesn’t cause hives, but indicates your body heat rising. For some, excess warmth on the skin, from a workout or other body-heat inducing activity, is enough to produce hives. Hives is an itchy, sometimes lumpy rash that appears on the surface of a person’s skin. It is a condition also commonly known as weals, welts, or nettle rash. The medical term for hives is.

Medically reviewed by Drugs.com. Last updated on Mar 6, 2020.

• Health Guide

What Is It?

Hives, also called urticaria, are circumscribed swellings on the skin that often are itchy. Often they are pink or red, but they don't have to be. Hives happen when the cells in the skin called mast cells release histamine, a chemical that causes tiny blood vessels (capillaries) to leak fluid. When this leaking fluid accumulates in the skin, it forms the swellings that we recognize as hives.

Hives can be triggered by physical factors such as heat, cold, exercise, sunlight, stress, sustained pressure on a skin area (such as from a belt or shoulder strap), a sudden increase in body temperature (from a fever or a hot bath or shower) or from an irritating chemical, cosmetic or soap applied to the skin. Hives also can be one symptom of a whole-body (systemic) allergic reaction to something that was:

• Inhaled — Pollens, animal dander, molds

• Injected — Insect stings or bites, especially bee stings, or injected medication

• Ingested — Foods (tree nuts; fish and shellfish; dairy products; legumes, especially peanuts), food additives, medications such as penicillin or aspirin

Hives probably affect about 20% of people in the United States at some time in life, with the greatest number of episodes occurring in people aged 20 to 30. In rare cases, allergic reactions that trigger hives set off a chain reaction throughout the body, resulting in a life-threatening condition called anaphylaxis. Sometimes, hives last for six weeks or more, a condition called chronic (or idiopathic) urticaria. Often, no cause is found for this chronic condition, and it usually goes away on its own after several weeks.

Symptoms

Hives appear as 'wheals' (swellings) on the skin, sometimes pink or red and surrounded by a red blotch. Typically round or oval, hives often itch. Hives vary in size, and some may blend to form larger areas of swelling. Hives can affect skin on any area of the body, especially the trunk, thighs, upper arms and face. Most individual hives fade quickly, but new crops may appear every 24 to 72 hours if the person continues to be exposed to the environment or substance that triggered the hives.

If hives are an early sign of a whole-body reaction, other symptoms to look for include swelling of the tongue, lips or face; wheezing; dizziness; chest tightness; and breathing difficulties. If these symptoms occur, get immediate medical attention. You could be developing anaphylaxis, a life-threatening condition.

Diagnosis

Your doctor will ask about your history of allergic reactions, and about your recent exposure to pets, plants, insects or new foods or medications. During a physical examination, your doctor usually can distinguish between hives and other types of skin rashes. Also, he or she will check for other signs of a serious allergic reaction.

If the condition occurs frequently, your doctor may order blood tests or perform skin testing for allergies. If your doctor suspects that you are undergoing anaphylaxis, he or she will begin treatment immediately and closely monitor your blood pressure and breathing.

Expected Duration

Individual hives usually fade within eight to 12 hours, but recurrent hives can continue to reappear for weeks or months. In cases of chronic urticaria (hives), the condition may last for six months or more.

Prevention

You can prevent hives by identifying and avoiding the particular circumstance or substance that triggered your skin reaction. If your doctor determines that you are allergic to insect venom, you may be advised to keep an epinephrine kit for emergency injections to prevent anaphylaxis. Keep the medicine in a convenient place if you work outside or play a sport. Keep an antihistamine in your medicine cabinet and take it the first signs of hives or itching. Older adults and people with heart disease should double check with their doctor before buying or taking antihistamines.

Treatment

To relieve most uncomplicated episodes of hives, your doctor may suggest that you apply calamine lotion and/or take a nonprescription antihistamine medication, such as chlorpheniramine (Chlor-Trimeton), clemastine (Tavist) or diphenhydramine (Benadryl). It is critical to relieve the itching because scratching can stimulate more hives and itching.

If these medications are not effective, you may be given a prescription medication such as cyproheptadine (Periactin), azatadine (Optimine) or hydroxyzine (Atarax or Vistaril). For people who have significant side effects from those medications, non-sedating antihistamines can be used, including loratadine (Claritin), cetirizine (Zyrtec) and fexofenadine (Allegra). For cases that are even more resistant to treatment, H2 receptor blockers might be added. These include ranitidine (Zantac), nizatidine (Axid), famotidine (Pepcid) or cimetidine (Tagamet). Doxepin (Adapin, Sinequan) is particularly helpful for people having a hard time sleeping at night. When other options fail, corticosteroids may be used to suppress the immune system in chronic urticaria or for frequently recurring episodes.

When To Call A Professional

Call your doctor immediately if hives appear after you have started taking a new medication or after you have been stung by an insect. Get emergency treatment if hives occur with wheezing, dizziness, chest tightness, breathing difficulties or swelling of the tongue, lips or face.

Prognosis

Most simple cases of hives fade quickly, and the affected skin returns to normal within hours. Even when you have episodes that recur over several weeks, without a known cause, they often stop coming back after a few months. Consult your doctor if hives persist for several days or if itching interferes with your ability to sleep or perform normal daily activities.

Learn more about Hives (Urticaria)

Associated drugs

IBM Watson Micromedex

External resources

American Academy of Allergy, Asthma, and Immunology (AAAAI)
611 East Wells St.
Milwaukee, WI 53202
Toll-Free: (800) 822-2762
http://www.aaaai.org/

American Academy of Dermatology
P.O. Box 4014
Schaumburg, IL 60168-4014
Phone: 847-330-0230
Toll-Free: 1-888-462-3376
Fax: 847-240-1859
http://www.aad.org/

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Hives is the common term for urticaria – the most common skin condition that brings people of all ages to the emergency room. (1) Approximately 15-20% of the population will have an acute, or short-term bout with hives at some point during their lifetime. (1)Hives usually appear without warning.

Although it can be scary looking, itchy and uncomfortable, in most cases it’s not serious and will resolve on its own.Here’s what you should know about the causes, how to deal with hives, and how to hopefully stop another outbreak before it starts. An outbreak of hives usually causes large or small red, raised areas, called wheals or welts, on your skin.The welts may have a white or lighter colored center. They can sting, but the most common complaint is that they itch – sometimes enough to interfere with your sleep or everyday activities.The welts can appear as individual spots, or you may notice them in groups that connect and cover large areas of your body. Some people who get hives repeatedly, get them in the same areas of their body. (2)Occasionally, hives can also cause a sudden and severe swelling below the surface of the skin, and in the fatty tissue in certain parts of the body.

The swelling is called angioedema.It often affects the face, especially the lips or eyelids. It can also occur in other places on your body, like your hands, feet, in your gastrointestinal tract, your tongue, or in your throat.Angioedema requires prompt medical attention. If the swelling affects your throat, it can affect your breathing and lead to anaphylaxis, which can be life-threatening. In most cases, the rash from hives usually disappears on its own in 30 minutes to less than 24 hours. (1)Occasionally, though, new welts may appear as the older ones clear up, so it may take a few days, or even a few weeks for a case of hives to completely resolve.Hives doesn’t cause any scarring, so once they rash is gone, your skin returns to normal. Angioedema from hives can take longer, up to 72 hours, to completely go away. (4)Most cases of hives are acute, which means they are not long-lasting.

Acute hives disappear completely within 6 weeks. Chronic hives last longer than 6 weeks. (3,4)In many chronic cases, they appear most every day. Chronic hive, is classified as either spontaneous (which doesn’t always have a known trigger), or inducible (which occurs in response to a known trigger). Sometimes there isn’t an identifiable cause of hives. In many cases, however, hives are caused by an allergic reaction to something that your body doesn’t like because it thinks it’s harmful, but is usually harmless.On exposure, your body releases histamine, as part of an inflammatory response.Histamine can cause different types of reactions in the body, such as itchy eyes, sneezing, or gastrointestinal problems. It can also cause the capillaries in your skin to swell and leak fluid into the surrounding tissue, and this causes the welts or wheals known as hives.

Foods: especially citrus fruits, berries, tomatoes, cheese, chocolate, shellfish, eggs, wheat, nuts, and soy. Medications such as NSAIDS (aspirin or ibuprofen), penicillins, codeine, or sulfonamides. Insect stings, as well as exposure to caterpillars or moths.

Latex exposure. Environmental factors like dust, mold, detergents, soaps, lotions, shampoos, plants, or animal dander.

A viral infection somewhere in your body. Stress.

Exposure to heat, cold, sunlight, or in rare cases, water. Exercise. Pregnancy. Chronic hives can also be spontaneous, without an identifiable trigger, or they may be caused by any of the above triggers.Interestingly, researchers have found that about 40-50% of those with unidentifiable triggers have chronic autoimmune urticaria (6) – or chronic hives due to an overactive immune system.Autoimmune diseases often occur when a combination of stressors from environmental factors, diet, stress, and genetics come together at the right time and wreak havoc on your immune system. Your body reacts as though there’s an infection or foreign invader, but it ends up attacking healthy cells or tissues.In the case of chronic autoimmune urticaria, it’s the mast cells in your skin that are affected. Autoimmune diseases often travel together, and this is true for chronic autoimmune hives.As many as 23% of those with this form of chronic hives also have autoimmune thyroid diseases. Most of the time, a dermatologist or primary doctor can diagnose acute hives by examining your skin and taking a medical history that includes any history of recent illnesses, where you were, what you were doing, and what you ate just before the hives appeared.In some cases, they may need to exclude other skin conditions which cause similar symptoms.Diagnosing acute hives usually doesn’t require any lab testing.

However, if the cause of hives is unclear, your doctor may wish to do allergy testing to see how you react to the most common triggers. (1)For chronic hives, your doctor may run blood tests to rule out other skin conditions, and allergy tests to help identify the cause.If autoimmune urticaria is suspected, they’ll do further blood tests for inflammatory markers, and they may test for related autoimmune diseases, such as thyroid antibodies.Also be aware that infections can also trigger hives. One of the most notable infections that can cause chronic hives is the gut infection blastocystis hominis. If you have a mild to moderate case of the hives, anti-histamine medications usually work well to control any symptoms. That said, ongoing use of anti-histamines (like Benedryl) can negatively impact other biochemical systems in your body since they may not be appropriate for long-term use.There are supplements such as quercetin and stinging nettles which may be worth investigating for their anti-histamine properties.Glucocorticoids, such as prednisone, are also sometimes used to control the inflammatory response.In more severe cases, an injectable medication called an IgE blocker can help reduce your sensitivity to allergens. (1,2,4)Oftentimes, chronic autoimmune urticaria doesn’t respond well to these medications, and patients may require immunosuppressant or immune modulating medications. (7)Sudden and severe hives, especially with angioedema and shortness of breath, need to be treated with an epinephrine injection.

It’s important to seek medical attention quickly because of the risk of life-threatening anaphylaxis. While medications can treat the symptoms, the challenge with hives is more about identifying the cause, and eliminating it.

Usually that happens with repeated exposure (intentionally or unintentionally) to see if you have the same reaction.If you’re not sure about your trigger, or if you think there are many things causing your hives, keeping a journal of your symptoms and possible triggers is very helpful. Once you identify your trigger(s), avoiding them will usually fix the problem.Food triggers can be a bit tricky, so it’s helpful to to identify them.

Sometimes, it’s not a specific food, but rather, an ingredient or additive that’s used in many foods, that’s causing your reaction. If you have chronic hives without a clear cause, you should also consider the autoimmune connection.Chronic autoimmune urticaria may be a possibility If you’ve been under extreme stress recently; if you’ve had a long-term illness or other autoimmune disease; if you eat a diet full of processed foods; or if your gut health isn’t as good as it can be.In that case, your immune system may need a support.This often requires looking at your body and health from that spans several different body systems. It may include an elimination diet, stress reduction, and supplements to support a healthy gut, immune system, and stress response.Most of the time, a case of hives goes away just as quickly as it came on. However, if hives are bothersome enough to affect your quality of life, if they’re severe, or if they never seem to go away, you should seek medical advice.Especially with chronic hives, it can be very helpful to work with your medical team to determine the root causes and try to improve them, rather than taking the Band-Aid approach and fixing your symptoms. K., Hives (Urticaria). Updated June 13, 2018.

Accessed December 11, 2018.2) Hives. American Academy of Dermatology. Accessed December 11, 20183) Hives (urticarial) and angiodedema. American Academy of Allergy Asthma and Immunology. Accessed December 11, 2018.4) Zuberbier T, Aberer W, Asero R, Abdul Latiff AH, Baker D, Ballmer‐Weber B, Bernstein JA, Bindslev‐Jensen C, Brzoza Z, Buense Bedrikow R, Canonica GW. The EAACI/GA²LEN/EDF/WAO guideline for the definition, classification, diagnosis and management of urticaria.

2018 Jul;73(7):1393-414.5) Moolani, Y., Lynde, C., & Sussman, G. Advances in Understanding and Managing Chronic Urticaria. F1000Research, 5, F1000 Faculty Rev-177.

Doi:10.12688/f1000research.7246.16) Kaplan AP. Chronic urticaria: pathogenesis and treatment. Journal of Allergy and Clinical Immunology. 2004 Sep 1;114(3):465-74.7) Goh, C. L., & Tan, K. Bs hacker replay full game. Chronic autoimmune urticaria: where we stand? Indian journal of dermatology, 54(3), 269-74. Skinterrupt offers health, wellness, fitness and nutritional information which is designed for educational purposes only.

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