About Hives

What Are Hives?

Hives are an outbreak of swollen, pale red bumps or rounded breakouts known as “Wheals” on the skin that usually appear rather suddenly. This is usually as a result of the body’s reaction to certain allergens, or for a myriad of other reasons.  Hives usually cause itching, but may also burn or sting. They can appear anywhere on the body, including the face, lips, throat, ears, or even the tongue!

Skin Condition:  Hives - Urticaria

Urticaria Hives

Hives can vary in size from a small as a pencil eraser to as large as the size of a plate! The hive rashes can also “join together” to form larger areas known as “Plaques.”  Hives can last for hours or even as long as a couple of days before fading, depending on the severity of the eruption.

There is a type of outbreak known as an “Angioedema,” which causes swelling to occur under the skin instead of on the surface. Angioedema is similar to hives, but different. These eruptions are characterized by deep swelling around the eyes and lips, and sometimes around the hands, feet and even the genitals. Angioedema can generally last longer than hives, but the swelling usually goes away within less than 24 hours.

In rare cases, Angioedema can be quite serious and can erupt inside the throat, tongue, or even inside the lungs, which can block the airways and cause difficulty breathing. This may become life threatening, so seeking a doctor in this case is urgent.

What Causes Hives and Angioedema?

Allergic hives and angioedema form when blood plasma leaks out of small blood vessels in the skin. This is referred to as a “Histamine” reaction. A Histamine is a chemical released from specific cells known as “mast cells” along the skin’s blood vessels. This chemical can cause an allergic reaction.

Allergic reactions, chemicals in certain foods, insect stings, sunlight exposure, or medications can all cause histamine release. It can be challenging to find out exactly why hives have formed, so be sure to contact your doctor for help.

Types of Hives

There are several different types of hives to be aware of:

Acute Urticaria: Hives lasting LESS than six weeks. The most common causes are certain foods, medications, or infections. Insect bites and internal disease may also be responsible.

The most common foods that cause hives are nuts, chocolate, fish (shellfish), tomatoes, eggs, fresh berries, and milk. Fresh foods cause hives more often than cooked foods. Certain food additives and preservatives such as food dyes and colorings (tartrazine, annatto, and carmine, etc.) antioxidants (like BHA and BHT) emulsifiers and stabilizers (gums and lecithin) flavorings and taste enhancers (MSG, spices, and sweeteners) and preservatives (like benzoates, nitrates, and sulfites) might also be to blame for a reaction.

Drugs that can cause hives and angioedema include aspirin, non-steroidal anti-inflammatory medications such as ibuprofen, high blood pressure drugs (ACE inhibitors), or painkillers such as codeine.

Chronic Urticaria and Angioedema: Hives lasting MORE than six weeks. The cause of this type of hive reaction is usually more difficult to identify than those causing acute urticaria. For most people with chronic urticaria, the cause is difficult to determine. In some cases, though, the cause may be thyroid disease, hepatitis, infection, or cancer.

Chronic urticaria and angioedema can affect other internal organs such as the lungs, muscles, and gastrointestinal tract. Symptoms include muscle soreness, shortness of breath, vomiting, and diarrhea.

Physical Urticaria: Hives caused by direct physical stimulation of the skin — for example, cold, heat, sun exposure, vibration, pressure, sweating, and exercise. The hives usually occur right where the skin was stimulated and rarely appear elsewhere. Most of the hives appear within one hour after exposure.

Dermatographism: This is a common form of physical urticaria where hives form after firmly stroking or scratching the skin. These hives can also occur along with other forms of urticaria.

Hives and Angioedema Diagnosis & Treatment

The best treatment is to identify and remove the trigger if possible, but this is not always an easy task. Antihistamines are usually prescribed by your doctor to provide relief from symptoms. Antihistamines work best if taken on a regular schedule to prevent hives from forming in the first place.

Chronic hives may be treated with antihistamines or a combination of medications. If antihistamines don’t provide relief, oral corticosteroids may be prescribed. A biologic drug, Xolair (Omalizumab), is also approved to treat chronic hives in those at least 12 years of age.

For severe hive or angioedema outbreaks, an injection of epinephrine (adrenaline) or a cortisone medication may be needed.

Hives and Immunity Issues

Thyroid disease is the most commonly reported autoimmune condition in people with chronic hives, followed by Rheumatoid Arthritis and Type 1 Diabetes. Recent studies have found that Celiac Disease is also associated with chronic hives.

How Can Hives Be Managed?

While you’re waiting for hives and swelling to disappear, here are some tips:

  • Apply cool compresses or wet cloths to the affected areas.
  • Try to work and sleep in a cool room.
  • Wear loose-fitting lightweight clothes.
  • Call your Doctor About hives outbreaks. Don’t delay if symptoms are chronic.

If hives or angioedema occur with any of the following symptoms, contact your doctor right away:

  • Dizziness
  • Wheezing or difficulty breathing
  • Tightness in the chest
  • Swelling of the tongue, lips, or face

Today, hives are a very common problem. Usually, they will go away on their own, but if you have a serious case, you might need medicine or a shot. In rare cases, hives can cause a dangerous reaction, so contact your doctor or health care professional for assistance.

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