Inflammatory
Hives
Hives (urticaria) are itchy, raised welts that come and go on the skin. They are common, and most short-term cases clear on their own.
Reviewed by Raashid Haque, MD, board-certified dermatologist
For education only. This guide does not diagnose or treat any condition.
Showing common starting points. Want picks matched to you?
2-minute quizSkin care picks for Hives
Tap a category to see what to look for and the products I recommend.
Tight or rough clothing can set off or worsen welts, so loose soft layers are a common comfort step.
Look for
- Loose or relaxed fit in areas that rub
- Flat or bonded seams
- Tagless or soft printed labels
Full details, cautions and sourcesAvoid
- Tight waistbands and elastic over irritated skin
- Scratchy tags and thick seams on sensitive areas
These are products Dr. Haque has reviewed and recommends for different reasons. Unless a product is clearly marked 'Affiliate link,' it is not one. Most are not.
Food and lifestyle may play a part in Hives too
Anti-inflammatory eating and lifestyleLearn about Hives
Hives are raised, itchy welts that can show up anywhere on the body. Each welt usually fades within 24 hours, but new ones may appear as old ones go away. They can be small or as big as a hand, and they can join together. About 1 in 5 people has hives at some point in life.
How long they last
- Acute hives last less than 6 weeks. They are the most common type and are often linked to an infection, a food, or a medicine.
- Chronic hives come and go for more than 6 weeks, often on most days. In many people, no clear cause is ever found. This is called chronic spontaneous urticaria. Some people have hives set off by a physical trigger, such as pressure, cold, or heat.
Angioedema is swelling deeper in the skin, often of the lips, eyelids, hands, or feet. It can happen with hives or by itself. It tends to feel tight or sore more than itchy, and it can last up to a few days.
How hives look: On lighter skin, hives are often pink or red. On brown and Black skin, redness can be harder to see. Welts may look skin-colored, pinkish, or a bit darker than the skin around them, so the raised bumps and the itch may be the best clues.
Hives are not contagious, and they are not caused by poor hygiene. Hives usually do not leave marks once they fade. Only a clinician can tell hives apart from other rashes.
Self-care
What it is
Simple comfort steps such as a cool, damp cloth, loose soft clothing, and keeping the skin cool.
Often considered when
Often considered for mild hives or while waiting to see a clinician.
Less suitable or needs caution when
Cold packs may be less suitable for people whose hives are triggered by cold. Very hot showers may make some hives worse.
What to watch for
Skin that stays very hot, blistering, or swelling that spreads.
How long to judge it
Relief is often felt the same day, but it does not stop hives from forming.
Questions to ask
- Which comfort steps fit my type of hives?
- Could my clothing or showers be adding to the problem?
What it is
Writing down when hives appear, what was eaten, medicines taken, and activities such as exercise, cold, or pressure.
Often considered when
Often considered when hives come in a pattern, or when a physical trigger is suspected.
Less suitable or needs caution when
Less helpful when hives appear with no pattern, which is common in chronic cases. Cutting out many foods on a guess may do more harm than good.
What to watch for
Do not stop a prescribed medicine on your own. Talk with your clinician first.
How long to judge it
A few weeks of notes can show a pattern, but many people never find one.
Questions to ask
- Could any of my medicines be involved?
- Are tests useful for me, or are they unlikely to help?
- Which triggers should I truly avoid?
Over the counter
What it is
Medicines such as cetirizine, loratadine, or fexofenadine that block histamine, a chemical that causes itch and welts. They are usually the first medicine clinicians consider for hives.
Often considered when
Often considered for acute and chronic hives, and for itch and welts of most types.
Less suitable or needs caution when
Pregnancy, breastfeeding, kidney or liver disease, and use in young children are reasons to talk with a clinician first.
What to watch for
Drowsiness (less common than with older types), dry mouth, headache.
How long to judge it
Clinicians often judge benefit over days to a few weeks. If they do not help enough, the plan may be adjusted by your clinician.
Questions to ask
- Which antihistamine fits me, and for how long?
- What should we do if this is not enough?
- Is this safe with my other medicines or pregnancy?
What it is
Medicines such as diphenhydramine or hydroxyzine that also block histamine but often cause sleepiness.
Often considered when
Sometimes discussed for short-term use when itch keeps someone awake at night.
Less suitable or needs caution when
Less suitable for older adults, people with glaucoma or trouble urinating, and before driving, work, or school. Often not preferred for children.
What to watch for
Drowsiness that can last into the next day, confusion, dry mouth, blurry vision.
How long to judge it
Effects on itch are often felt within hours, but side effects can add up with daily use.
Questions to ask
- Is a sedating type ever a good idea for me?
- How do I stay safe when driving or at work?
Pills
What it is
Steroid pills such as prednisone, taken for a short time to calm a severe flare or significant swelling.
Often considered when
Often considered for a severe flare of hives or angioedema that is not settling with other care.
Less suitable or needs caution when
Less suitable for long-term use. Caution in diabetes, high blood pressure, certain infections, pregnancy, and mood problems.
What to watch for
Trouble sleeping, mood changes, higher blood sugar and blood pressure, stomach upset. Hives may return when stopped.
How long to judge it
Usually judged within days. Clinicians generally try to keep use short.
Questions to ask
- Why a steroid for me, and for how many days?
- What is our plan if hives return after I stop?
What it is
When antihistamines are not enough, clinicians may discuss other pills. These can include a leukotriene blocker such as montelukast, or an immune-calming medicine such as ciclosporin in hard-to-treat cases.
Often considered when
Often considered for chronic hives that continue despite antihistamines, often with a specialist.
Less suitable or needs caution when
Immune-calming medicines are less suitable with kidney problems, high blood pressure, or some infections, and need careful follow-up. Pregnancy needs a specific discussion.
What to watch for
Montelukast can affect mood or sleep in some people. Ciclosporin needs blood pressure and kidney monitoring.
How long to judge it
Benefit is usually judged over weeks.
Questions to ask
- Which add-on has the best balance of benefit and risk for me?
- What monitoring would I need?
- Should I see an allergist or dermatologist who treats hives?
What it is
Remibrutinib (Rhapsido) is a daily pill that blocks a protein called BTK involved in the allergic response. In the US, the FDA approved it for adults with chronic spontaneous urticaria whose symptoms are not controlled with antihistamine treatment.
Often considered when
Often considered for adults with chronic spontaneous hives who prefer or are suited to a pill rather than an injection, after antihistamines have not been enough.
Less suitable or needs caution when
Not approved for children in the US. Less suitable with certain bleeding risks, liver problems, some other medicines, or pregnancy. Needs a doctor's review.
What to watch for
Possible bleeding or bruising, infections, and liver tests. Your clinician will explain what to monitor.
How long to judge it
Response is usually judged over several weeks.
Questions to ask
- Is a pill like this an option for me?
- Which of my medicines or conditions could interact with it?
- How would you decide between a pill and an injection?
Injections and biologics
What it is
Biologics are targeted medicines given as injections that calm specific parts of the immune response. In the US, omalizumab (Xolair) and dupilumab (Dupixent) are FDA approved for chronic spontaneous urticaria in people 12 and older whose hives are not controlled by antihistamines.
Often considered when
Often considered for chronic spontaneous hives that continue despite antihistamine treatment. They are not approved for other forms of hives, such as those set off only by physical triggers.
Less suitable or needs caution when
Less suitable with a past serious allergic reaction to the medicine. Other health conditions and pregnancy need a doctor's review. Insurance approval is often needed.
What to watch for
Injection-site reactions, and rarely serious allergic reactions. Your clinician will explain what to watch for.
How long to judge it
Response is usually judged over several weeks to a few months.
Questions to ask
- Am I a candidate for a biologic, and which one?
- What will insurance require first?
- How would we decide whether it is working, and what comes next?
Many things can set off hives. Often more than one factor is involved, and sometimes none is found.
- Infections: colds and other viral illnesses are a common cause of short-term hives.
- Foods: such as nuts, shellfish, eggs, or milk. A true food allergy usually causes hives within minutes to a couple of hours of eating.
- Medicines: antibiotics like penicillin, and pain relievers like aspirin or ibuprofen, may trigger or worsen hives.
- Physical triggers: pressure (tight straps, waistbands), scratching, cold, heat, sweating or exercise, sunlight, water, or vibration.
- Insect stings and bites. Rarely, hives can point to alpha-gal syndrome, a food allergy linked to tick bites.
- Stress may make flares feel worse for some people.
In chronic hives, a clear trigger is often never found. That is common and is not your fault. A simple diary of flares, foods, medicines, and activities can help your clinician.
| Topic | Evidence | What it means |
|---|---|---|
| Mental health and quality of life | Established | Constant itch and unpredictable welts can wear on sleep, mood, and daily life, and many people with chronic hives feel anxious or low. Telling your clinician is part of good care. |
| Stress | Early | Many people notice flares during stressful times, but research on whether stress control reduces hives is limited. Stress care may still help with coping. |
| Diet | Early | A true food allergy can cause hives, but food is an uncommon cause of chronic hives. Some people try low-additive diets, and evidence is limited. Strict diets can cause poor nutrition, so talk with your clinician or a dietitian first. |
| Sleep | Promising | Itch is often worse at night, and poor sleep can make itch feel stronger. Cool bedrooms and a steady sleep routine are low-risk habits, though proof that they reduce hives is limited. |
Read: Anti-inflammatory eating
Avoid very restrictive diets, especially for children, unless a clinician is guiding you.
Hives ·
When to get care soon
- Get emergency help right away (call 911 or your local emergency number) if hives come with trouble breathing or wheezing, swelling of the tongue, lips, or throat, trouble swallowing, a hoarse voice, dizziness or fainting, a racing heartbeat, or repeated vomiting.
- Swelling of the face, eyelids, or lips, even without breathing trouble, should be checked by a clinician the same day.
- Hives that last more than 6 weeks, or that keep coming back.
- Single welts that stay in the same spot for more than 24 hours, leave bruising or dark marks, or burn or hurt more than they itch.
- Hives with fever, joint pain, or feeling very unwell.
- Hives that disrupt sleep, work, school, or mood, or that are not controlled by over-the-counter care.
- Hives in a baby or young child, especially with vomiting or unusual sleepiness.
About the reviewer
Raashid Haque, MD
Board Certified Dermatologist · Charlotte, NC
- 25+ years of clinical experience
- Dermatology at University of Oklahoma - Chief Resident
- Internship at Baylor College of Medicine
- LSU School of Medicine Shreveport - Valedictorian, AOA