Allergic Reactions & Hives

If you have ever had an itchy rash appear on your skin that turned to red welts, you have probably experienced hives urticaria, also known as urticaria or simply hives. You may not know what it was or what is the cause of hives, but you know it was a nuisance. According to the American College of Allergy, Asthma, & Immunology allergic reactions and hives are a common occurrence in both children and adults and usually occur for a variety of reasons. This introduction to hives will give you a better understanding of acute urticaria and what to do when you see it.

Symptoms of Hives Urticaria

An estimated twenty percent of people have had or will have a case of hives, also known as hives urticaria, in their lifetime. When you get hives, they are often characterized by:

  • Bumps or welts that are flesh-colored or red. Urticaria and angioedema (swelling) go hand in hand.
  • Physician urticaria may appear anywhere on the body.
  • Bumps may be connected or appear as tiny red dots.
  • May change shape in a matter of minutes or hours;
  • The center of the hive may be white; an occurrence called blanching;
  • Itching is usually intense.
  • Extreme angioedema, or swelling, can be life threatening, causing airways to close.

Urticaria is allergic reaction hives that is caused by your body’s reaction to an allergen, something you have come in contact with that your body cannot tolerate. There are two different types of hives: acute urticaria and chronic urticaria. Cases of hives that occur regularly and for more than six weeks, are considered chronic. Medical advice from an allergy asthma specialist who can perform blood tests may help. They will evaluate your symptoms, review the common causes of allergic reactions, and go over your health information to determine what is causing you to get hives and how to treat it.

Acute Hives

A trigger can cause hives to last as little as a few hours, 24 hours, even months or years. According to the American Academy of Dermatology, acute hives are reactions that last no more than six weeks. These can be caused by many different things, but cases typically appear due to one of the following causes:

  • Medications – aspirin, penicillin
  • Insect bites – bee stings, mosquito bites
  • Infection – strep throat, hepatitis
  • Certain foods – peanuts, eggs, shellfish, and nuts
  • Food additives and preservatives
  • Latex – latex gloves, balloons
  • Pet Dander – dog and cat dander

These are just a sampling of allergens that can cause a person to develop hives. Allergy specialists test to determine the exact cause of your rash before recommending medications or other treatment.

Chronic Urticaria

According to the American Academy of Allergy, people with urticaria hives for more than six weeks have chronic urticaria. In addition to the typical symptoms of welts and itching, chronic hives may also cause:

  • Angioedema: Hives and angioedema often occurs together. It exhibits as swelling of the body that can happen in the eyes, mouth, genitals, skin, throat, and even hands feet. This can cause difficulty breathing if swelling symptoms cause the throat to close, quickly worsening the person’s health condition. While rare, angioedema with acute hives can lead to death.
  • Stomach cramps
  • Nausea or vomiting

In addition to the list of allergens that could cause acute urticaria, chronic hives include the following additional possible causes:

  • Chronic idiopathic hives; meaning that a known cause cannot be determined. Physicians may not always be able to pinpoint the exact cause for some people. These long term cases may result from underlying health conditions such as cancer, hepatitis, or possibly thyroid disease. In some instances, it is even thought to be the result of an overactive immune system.
  • Viral or bacterial infections that have been an ongoing condition.

Regardless of the cause, treatment of chronic hives is essential in preventing damage to your internal organs that can be long lasting. If left untreated, your GI tract, lungs, and muscles could all be affected.

Diagnosis of Acute and Chronic Hives

Your allergist or dermatologist can usually diagnose physical urticaria just by looking at your skin and knowing what hives usually look like. However, determining the trigger that causes hives can be more complex.

First, your doctor or allergist will take a complete medical history, ask you about your exposure to anything new that could be an allergen, and talk to you about possible stressors that could be causing hives.

Health care practitioners will perform tests including allergy tests, to determine what is causing you to breakout in a rash. An allergist specialist may expose you to many different common allergens using a skin test also known as a patch test. If your skin reacts to the substance, it indicates an allergy specific to that substance.

Treatment for Acute and Chronic Hives

Treatment options for hives vary but there are some medically reviewed treatments available depending on your condition. If you have an occasional reaction to something unaware, the hives will typically go away without medical intervention. If a trigger is determined, you will be advised to steer clear of whatever that may be, whether it’s a chemical substance, pets, or certain foods.

If the hives persist for a day or two, your doctor may recommend antihistamine medications. Antihistamines are commonly found in cold medicines and work by blocking histamines, the substance in the skin that is behind the itching and welts. Antihistamines are long-lasting and highly effective in treating allergic hives.

You can also use skin calming topical lotions like calamine that provide relief from the itching and burning. Cool compresses are also beneficial in reducing swelling and irritation.

For chronic hives your allergist may try multiple non drowsy antihistamines combined to get the desired effect. They may also prescribe prednisone if your symptoms do not subside within a reasonable amount of time.

Anaphylaxis is a severe allergic reaction when swelling hinders breathing and sends the body into shock, which could be fatal. The only treatment option besides a hospital or ambulance, is epinephrine, which opens the airways. Some people may need to carry a prescription epinephrine injection with them at all times in order to prevent a medical emergency, especially if they get angioedema with allergic reactions.

Once your doctor has your chronic hives under control, he will want to treat the allergy that caused the hives. If long-term antihistamines do not keep hives at bay, the allergy test results can be used to formulate a serum or injection. Allergy serums are unique to individuals. You are given minute amounts of the allergens over a period of time. This causes your body to build up an immunity to them, and the reactions either cease or become much less severe.


Allergic reactions and hives are common occurrences that can vary from mild to extreme. Extreme cases can result in anaphylaxis shock, which can lead to death. This is why you must contact a doctor once you have more than one case of hives and let them determine what caused the reaction and get the appropriate treatment.

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