Hives are typically harmless, but you may need to see a doctor if they’re severe, they won’t go away, or they keep coming back. A doctor can help you treat and prevent hives.
Hives (urticaria) are itchy, raised patches or bumps that can erupt on any area of your body. Hives can also occur in mucous membranes, such as the inside of your mouth or under your eyelids.
Hives can make you uncomfortable, but they don’t usually indicate a serious health problem. But there are times when hives should be brought to a doctor or other healthcare professional’s attention.
In this article, we’ll provide information about the causes of hives and go over typical symptoms. We’ll also clarify the instances when seeking medical attention for hives is important.
Hives occur when your immune system releases a chemical called histamine. Histamine is a chemical your body releases when it perceives a threat, such as an allergen.
The main symptom of hives is intense itchiness. Your skin may also feel warm to the touch or have a burning sensation.
The size, shape, and overall appearance of hives varies. They may be large, raised welts or tiny, raised pinpoint bumps. You may have one single hive, a small rash of multiple hives, or a very large rash that covers a significant area of skin.
Your skin tone may also affect the appearance of hives. Hives on paler skin tones are often pink or red in color. If you have light skin and press down on a hive, the discoloration will temporarily disappear (blanch).
Hives on black or brown skin may not take on a different color than the surrounding area of skin.
Mild hives aren’t usually serious. Mild or occasional hives don’t typically necessitate a trip to the doctor. But you should consider mentioning your hives during your next doctor’s appointment.
If your hives are more severe, it may be time to talk with a doctor or other healthcare professional. Here are some factors to consider:
Timing
You should consider talking with a doctor or other healthcare professional if your hives last longer than a few days. Hives typically go away on their own. They may come and go for a few days and look different at different times.
If your hives are consistent and won’t go away, something else may be going on.
If you recently started a new medication or supplement, you may be having an allergic reaction to it. Tell a doctor what’s happening as soon as possible and call 911 or local emergency services if you develop any other symptoms, like fever or shortness of breath.
Allergic reactions to medication can happen within hours of starting a new medication. But they can also happen days or weeks later.
If your hives are recurrent, showing up every few days or weeks, you may benefit from seeing a specialist such as a dermatologist or an allergist.
It can be hard to uncover the cause of hives. You could be having a reaction to anything you regularly come into contact with, such as soaps, foods, or pets.
An allergist may recommend allergy testing to help you identify the triggering allergen.
Response to treatment
In some instances, over-the-counter (OTC) treatments such as antihistamines or topical corticosteroids may not provide enough relief.
If your hives aren’t responding to treatment, you may want to speak with a doctor or other healthcare professional. They can offer additional treatments, such as prescription allergy medications and injections.
Triggers
Hives have many potential triggers, including:
- allergic reaction to a substance in food, medications, or bug bites
- emotions such as stress and anxiety
- pressure on skin from clothing or bag straps
- sunlight, heat, or cold
- infections including strep throat, COVID-19, and urinary tract infections
- medical treatments such as radiation
It can be challenging to determine what’s triggering your hives. You can talk with an allergist about allergy tests that can help you identify the offending substances.
Allergy tests are particularly helpful for things you come into contact with regularly, like foods, pollen, and bug bites. Once you identify your triggers, you can work to avoid them in the future.
Severity
Hives range in severity from mild to severe. If your hives are accompanied by swelling or pain, it may be time to speak with a doctor or other healthcare professional. The same is true for hives that are extremely itchy.
Hives covering a large body area, such as the entire torso, may also warrant a discussion with a doctor or other healthcare professional.
There are times when hives may be a symptom of a medical emergency, such as:
Anaphylaxis
Anaphylaxis is a severe allergic reaction often accompanied by hives and angioedema. Other symptoms include wheezing, swelling, and shortness of breath.
If you or someone else has anaphylaxis symptoms, call 911 or local emergency services. If you have an EpiPen (epinephrine medication), use it immediately.
Angioedema
In some instances, hives may be accompanied by deep, painful swelling within the skin or mucous membranes (angioedema).
The swelling caused by angioedema can occur in these areas:
- under eyelids and around the eyes
- on the lips, mouth, and throat
- beneath the skin
Angioedema can make it hard to breathe and can quickly become a medical emergency. Angioedema is common during anaphylaxis.
Alpha-gal syndrome
Hives can sometimes be a symptom of alpha-gal syndrome, a medical emergency that requires immediate treatment. Alpha-gal syndrome is an allergic reaction to alpha-gal, a sugar molecule found in:
- red meat, including beef, pork, venison, and lamb
- gelatin, including gelatin-coated medications, cosmetics, and foods such as candy
- dairy products, including cow’s milk
- bites from lone star ticks and possibly, other types of ticks
It’s also known as the red meat allergy. It can develop in adults who have been bitten by a lone star tick.
Alpha-gal syndrome is usually accompanied by symptoms such as:
- nausea and vomiting
- diarrhea
- indigestion
- heartburn
- stomach pain
When to seek emergency care
If your hives are accompanied by swelling that makes it hard for you to breathe, call 911 or local emergency services or go to an emergency room immediately.
Other symptoms that indicate an emergency include:
- shortness of breath
- trouble swallowing
- fainting
- dizziness
- lightheadedness
- racing heart rate
- sudden dip in blood pressure
A doctor will examine your skin to assess whether you have hives or a different condition, such as dermatitis or eczema.
A doctor will ask you about your medical history, your symptoms, and how severe they have been. They’ll want to know how often you get hives, how long they last, and any potential triggers you suspect.
You may undergo diagnostic tests, such as blood work or a skin biopsy, to rule out underlying illnesses or infections such as ringworm.
Allergy tests, such as a skin prick test, can help you identify your triggers. For this test, a doctor will insert a variety of potential allergens under your skin to see if any elicit an allergic reaction.
If you’re able to identify your triggers, eliminating those substances will be an important part of treatment.
In some instances, alleviating anxiety and stress may also be helpful. A doctor or other healthcare professional may recommend medication or stress-reducing activities, like meditation, yoga, and therapy.
A healthcare professional may recommend prescription-strength oral antihistamines, such as Clarinex (desloratadine). Prescription-strength hydrocortisone cream may also help treat reoccurring hives and reduce itching.
Depending on the severity of your condition, a doctor or other healthcare professional may recommend allergy shots. Allergy shots are a long-term treatment option used to decrease your sensitivity to allergens in your environment. But the treatment schedule is time-intensive and can often last for years.
Allergy shots may be beneficial if you have severe hives or hives caused by unavoidable allergens. This treatment isn’t used for hives caused by food allergies.
Mild hives often respond quickly to OTC antihistamines. There are several types of antihistamines, and they can be taken by mouth or applied to the skin. They work by reducing the effects of histamine.
There are many different brands of antihistamines you can choose from. Some cause marked drowsiness, dry mouth, and other symptoms. Read the label so you know what to expect before you buy.
Topical steroid creams can also be beneficial for reducing swelling and itching. These medications work by constricting blood vessels and reducing inflammation.
To prevent, alleviate, or reduce the symptoms of hives, you can try these at-home remedies:
- remove potential triggers and allergens from your environment
- use sun protection such as sunscreen or sun-protective clothing
- avoid wearing tight or restrictive clothing
- place cool compresses on the affected areas of skin
- avoid scratching itchy skin
- take a colloidal oatmeal bath or use colloidal oatmeal lotion on the affected area
- treat the skin with witch hazel or calamine lotion
Hives usually dissipate within a few days or faster with at-home treatments.
In some instances, hives may require medical treatment. A doctor or other healthcare professional may prescribe oral medications or recommend allergy injections if you have long-term, severe, or recurring hives.