Hives: Causes, Relief and When to Get Help

What hives look and feel like

Hives are swellings in the upper skin caused by leaky blood vessels. Typical features:

• raised welts with a pale center and red rim, or uniform pink bumps
• intense itching, sometimes burning or stinging
• welts that join into large patches or rings and change shape over minutes to hours
• each individual welt goes within 24 hours and leaves normal skin
• welts blanch (turn white) when pressed

On darker skin, hives may look the same color as surrounding skin or slightly darker, and are easier to feel than see.

Hives can come with angioedema: deeper, less itchy swelling of the lips, eyelids, hands, feet or genitals that lasts up to 72 hours.

Common causes of hives

In more than half of people with hives no clear trigger is found. This is called spontaneous urticaria.

Hives all over the body

Widespread hives usually come from an allergen absorbed into the bloodstream (food, medicine, sting) or from a viral infection. Hives all over the body are not dangerous by themselves, but watch closely for any breathing, throat or circulation symptoms. Hives limited to an area that touched something suggest contact urticaria.

Things that look like hives

• Insect bites: fixed bumps that last days, often with a central punctum
• Eczema: dry, scaly, itchy patches rather than smooth welts
• Viral rashes: flat spots that do not move around
• Erythema multiforme: target-like rings that stay in place for days
• Urticarial vasculitis: welts lasting more than 24 hours that burn more than itch and leave bruising; needs a doctor

How to get rid of hives

Immediate relief

• Take a non-drowsy antihistamine such as cetirizine, loratadine or fexofenadine. Follow the label dose. Your doctor may advise a higher dose for persistent hives.
• Apply a cool compress or take a cool shower.
• Wear loose, soft cotton clothes.
• Avoid hot showers, alcohol, exercise and overheating while hives are active.
• Avoid aspirin and NSAIDs like ibuprofen, which can worsen hives; acetaminophen (paracetamol) is a safer choice for pain.
• Calamine lotion or menthol cream can soothe itch.

Find and avoid triggers

Note what you ate, drank, took or touched in the hours before hives appeared, and any patterns. If hives follow a specific food or medicine, avoid it and see a doctor or allergist.

When hives need a doctor

See a doctor if hives last more than a few days despite antihistamines, keep returning, come with fever or joint pain, leave bruises, or followed a medicine. Hives that keep coming back for more than 6 weeks are called chronic hives. These are rarely caused by allergy and are covered in detail on our page about hives (urticaria) as a condition.

Anyone who has had hives with breathing difficulty or collapse needs an allergy assessment and usually an epinephrine auto-injector. See also anaphylaxis.

Hives in children

Hives are common in children, especially with viral infections, and usually settle within a few days with an antihistamine suitable for the child's age. Get urgent help for a child with hives plus breathing difficulty, lip or tongue swelling, repeated vomiting, or pallor and floppiness. Hives in a child with fever who looks unwell should be checked the same day.

Frequently asked questions

What causes hives to suddenly appear?

Sudden hives are often triggered by a viral infection, a food, a medicine such as an antibiotic or NSAID, an insect sting, or a physical trigger like heat, pressure or cold. In more than half of cases no specific cause is found, especially when hives keep returning.

How long do hives last?

Each individual welt fades within 24 hours, but new ones can appear. An episode of acute hives usually settles within a few days and always within 6 weeks. Hives that keep returning for more than 6 weeks are called chronic hives and often last months to years.

How do I get rid of hives fast?

Take a non-drowsy antihistamine such as cetirizine or loratadine, following the label dose, and apply cool compresses. Avoid heat, alcohol and NSAIDs. If hives come with lip or throat swelling or breathing trouble, use epinephrine if prescribed and call 911 or your local emergency number.

Are hives contagious?

No. Hives themselves are not contagious. However, hives can be triggered by a contagious infection, such as a cold or strep throat, and that underlying infection can spread to others.

Can stress cause hives?

Stress does not usually start hives on its own, but it can trigger flares or make existing hives worse, particularly chronic spontaneous hives. Managing stress, sleep and overheating can help reduce flares alongside antihistamine treatment.