Urticaria (Hives)
Urticaria, commonly called hives, is a skin reaction that causes raised, itchy welts. Most episodes are short-lived and resolve on their own, but chronic urticaria can last weeks to years.
Table of Contents
Quick Facts
- ICD-10: L50
- Acute: < 6 weeks
- Chronic: ≥ 6 weeks
When to Call 911
Call 911 for hives with:
- Trouble breathing or wheezing
- Swelling of the lips, tongue, or throat
- Dizziness or fainting
- Rapid heartbeat
These suggest anaphylaxis — use epinephrine if available.
Symptoms
- Raised, red or pink welts (wheals) that may change shape and size
- Intense itching
- Individual welts typically resolve within 24 hours but new ones may appear
- Sometimes associated with angioedema (deeper swelling)
Causes and Triggers
Acute urticaria
- Viral infections (most common in children)
- Foods (nuts, shellfish, eggs, dairy)
- Medications (antibiotics, NSAIDs, opioids)
- Insect stings
- Latex contact
Chronic urticaria
- Often no identifiable trigger (chronic spontaneous urticaria)
- Autoimmune mechanisms
- Physical triggers — pressure, cold, heat, sun, exercise, water
- Underlying thyroid disease or other autoimmune conditions
Treatment
- Non-sedating antihistamines (cetirizine, fexofenadine, loratadine) — first line, often at higher than usual doses for chronic cases
- Avoid identifiable triggers
- Short courses of oral corticosteroids for severe flares
- Omalizumab (anti-IgE) for refractory chronic urticaria
- Cool compresses for itch relief
When to See a Doctor
See a doctor for hives lasting more than a few days, frequent recurrences, hives with angioedema, or hives with systemic symptoms. Seek emergency care for any breathing or swallowing difficulty.
Frequently Asked Questions
How long do hives usually last?
Individual welts usually fade within 24 hours, but new ones may keep appearing. Acute episodes typically resolve within days to a few weeks.
Will my chronic hives ever go away?
Many people with chronic spontaneous urticaria see resolution within 1–5 years, though some have longer courses.
Medical Disclaimer: This information is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider with questions about a medical condition. If you are experiencing a medical emergency, call your local emergency number immediately.
References
- Joint Task Force on Practice Parameters. Chronic Urticaria Practice Parameter.