Hives (urticaria)

Overview

Hives, also called urticaria or nettle rash, are raised, itchy bumps or patches on the skin called weals. They can be pink, red or white, round or ring-shaped, small or several centimetres wide. Each weal fades within 24 hours without leaving a mark, but new ones may keep appearing. Some people also get deeper swelling of the lips, eyelids, tongue, hands, feet or genitals. This is called angioedema. It is usually sore or tingly rather than itchy and can take up to three days to go down.

Hives happen when cells in the skin called mast cells release histamine and other chemicals. Doctors split hives into acute urticaria, which lasts less than six weeks, and chronic urticaria, which comes back on most days for six weeks or more. Acute hives are common in children and often follow a viral infection such as a cold. Chronic spontaneous urticaria affects about 1 in 100 people worldwide, is more common in women aged 30 to 50, and usually has no outside trigger. In many people it is an autoimmune problem, where the immune system acts against the body's own mast cells.

Most hives are not caused by an allergy and are not dangerous. They usually go away in time, though chronic hives can last for months or a few years. Itch and poor sleep can affect work, school and mood, so good symptom control matters. Rarely, hives come with breathing problems or collapse as part of anaphylaxis (a severe allergic reaction), which is an emergency.

Symptoms

• Raised, itchy bumps or patches (weals) that can be pink, red or white and may join together
• Each weal fades within 24 hours without bruising or a mark, while new ones appear elsewhere
• Weals that can appear anywhere, often where clothing presses, such as the waistline, armpits and groin
• Swelling of the lips, eyelids, tongue, hands, feet or genitals (angioedema), which is often sore, numb or tingly rather than itchy
• Itch that can disturb sleep
• Weals that come up in lines after the skin is scratched or rubbed (dermatographism)
• In some people, weals that appear after a clear physical trigger such as cold, heat, sweating, pressure or sunlight

Causes and risk factors

Causes

• Release of histamine and other chemicals from mast cells in the skin, which makes small blood vessels leak fluid
• Viral infections, which are the cause of about half of acute hives in children
• An autoimmune reaction, where antibodies switch on the body's own mast cells; this is thought to drive most chronic spontaneous urticaria
• Physical triggers in inducible urticaria, such as pressure, cold, heat, sweating, exercise, water or sunlight
• Medicines such as ibuprofen and other NSAID painkillers, aspirin and some blood pressure medicines, which can start or worsen hives
• Less often, a true allergy to a food, insect sting, latex or medicine; this usually causes hives within about an hour of contact

What makes it more likely

• Being female, especially between the ages of 30 and 50, for chronic spontaneous urticaria
• A recent viral or other infection, particularly in children
• Autoimmune thyroid disease and other autoimmune conditions such as coeliac disease or lupus
• Taking NSAID painkillers or aspirin
• Stress, tiredness, poor sleep and hormonal changes such as periods, which can make hives flare
• Having asthma, hay fever or eczema, which are more common in people with chronic hives
• Hepatitis C infection, which has been linked with some chronic hives

Complications

For most people hives are uncomfortable but not dangerous. Chronic hives can last for a long time: about a third to a half of people are clear within a year, but some still have symptoms after five years. Constant itch, swelling and poor sleep can seriously affect quality of life, work and school, and anxiety and depression are common in people with chronic hives. Rarely, hives are part of anaphylaxis, a severe allergic reaction that affects breathing or blood pressure and needs emergency treatment. Hives that last more than a day, hurt, or leave bruises may be urticarial vasculitis (inflammation of small blood vessels), which can be linked to other diseases and needs a specialist.

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Diagnosis

Hives are usually diagnosed by looking at the rash and asking about how long it has lasted, how long each weal lasts, any swelling, new medicines, recent infections and possible triggers. For acute hives, tests are usually not needed. Allergy tests are only useful if hives come on within about an hour of a food or another clear trigger, because most hives are not allergic.

For chronic hives, a doctor may check a full blood count and an inflammation marker (CRP or ESR). Some guidelines also check thyroid function. Wider blood tests, food allergy tests and infection screens are usually not needed unless your history points to a cause. If you think a physical trigger is to blame, simple challenge tests can help, such as holding an ice cube on the skin for cold urticaria. A skin biopsy (a small sample of skin) is only needed if the weals last more than a day, are painful or leave bruises. Swelling without hives may need complement blood tests (C3 and C4) to look for a rare condition affecting a protein called C1 inhibitor.

Treatment

1. Avoid any clear trigger, such as an NSAID painkiller, tight clothing or cold, if you know what sets off your hives.
2. Take a non-drowsy (second-generation) antihistamine. For chronic hives it works best taken every day rather than only when the rash appears. Antihistamines control symptoms but do not change how long the hives last.
3. If symptoms are not controlled, your doctor may raise the antihistamine dose above the usual amount step by step, or switch to a different non-drowsy antihistamine. Do not raise the dose yourself.
4. For a severe flare, a doctor may give a short course of steroid tablets. Long or repeated courses are avoided because of side effects.
5. If hives are still not controlled, a doctor may add another medicine such as a leukotriene receptor antagonist. A specialist in dermatology, immunology or allergy may then offer omalizumab injections for severe chronic spontaneous urticaria, or ciclosporin if other treatments have failed.
6. If you have had anaphylaxis, your doctor should prescribe an adrenaline auto-injector and show you how to use it.
7. Once hives have settled for some weeks or months, your doctor may slowly stop the antihistamine and restart it if symptoms come back. Your doctor decides the medicine and the dose.

Medicines in Pakistan

Medicines a doctor may use, by group. Read the role: some are only for special cases. Each link opens our page for that medicine, with every brand and its official DRAP price. Your doctor decides which medicine and dose are right for you.

Also used (not yet in our price list): Omalizumab (anti-IgE injection for severe chronic spontaneous urticaria, given by a specialist), Famotidine (H2 antihistamine), Menthol-containing creams (to soothe itch)

Self-care and prevention

Self-care

• Take your antihistamine regularly as your doctor or pharmacist advises, rather than stopping and starting
• Do not drive or use machines if the antihistamine makes you drowsy, even if it is a non-drowsy type
• Avoid ibuprofen, aspirin and other NSAID painkillers if they make your hives worse, and ask a pharmacist before buying painkillers
• Notice and avoid your own triggers, such as tight clothing, heat and sweating, cold, or scratching and rubbing the skin
• If cold sets off your hives, avoid swimming in cold water, as it can cause severe reactions
• A menthol-containing cream may soothe the itch
• Do not cut foods out of your diet unless hives clearly appear within an hour of eating a food; most hives are not caused by food
• Try to get enough sleep and manage stress, as tiredness and stress can make hives worse

Prevention

• Avoid known triggers, including any medicine, food or physical trigger that has caused hives before
• Keep taking daily antihistamines during a long spell of chronic hives, as advised by your doctor
• Tell every doctor, dentist and pharmacist if NSAID painkillers or other medicines have given you hives
• If you have had anaphylaxis, carry your adrenaline auto-injectors at all times and follow your emergency plan

Common questions

Are hives an allergy?

Usually not. About 9 in 10 cases of hives in children are not caused by allergy, and most chronic hives have no outside cause. An allergy is more likely if hives come on within about an hour of a food, medicine or insect sting.

How long do hives last?

Each weal fades within a day. Acute hives usually settle within days to a few weeks. Chronic hives last six weeks or more and often go on for months or a few years, but most people get better in time.

Can medicines cause hives?

Yes. Ibuprofen and other NSAID painkillers, aspirin and some blood pressure medicines can start hives or make them worse. Some blood pressure medicines called ACE inhibitors can cause swelling of the face, lips or tongue. Do not stop a prescribed medicine on your own; talk to your doctor first.

Do steroid creams help hives?

No. Steroid creams have no proven role in hives. The main treatment is a non-drowsy antihistamine taken regularly. A doctor may sometimes give a short course of steroid tablets for a severe flare.

Is it safe to take antihistamines for a long time?

Non-drowsy antihistamines can be taken daily for long periods when needed, under the guidance of your doctor or pharmacist. Your doctor will review them and may stop them slowly once the hives have settled.

Sources

1. StatPearls (NCBI Bookshelf). Chronic Urticaria - StatPearls - NCBI Bookshelf (2026).
2. NICE. Full evidence summary (ESUOM31: off-label doses of cetirizine for chronic urticaria) (2014).
3. NICE. Omalizumab for previously treated chronic spontaneous urticaria (TA339): 1 Guidance (2015).
4. Nottinghamshire Area Prescribing Committee (NHS). Urticaria and/or angioedema in adults Primary Care Pathway v3.0 (2026).
5. Hull University Teaching Hospitals NHS Trust. Urticaria and Angioedema - Information for Parents and Carers (2024).
6. Healthier Together (NHS). What is Urticaria and Angioedema? (Healthier Together, acute urticaria) (n.d.).
7. Aga Khan University (Scholars). Frequency of depression and anxiety among patients with chronic spontaneous urticaria visiting a tertiary care hospital in Karachi, Pakistan (2020).

Prepared from the sources listed below by the MedInfoBase team. Last reviewed 16 October 2026. This page is general health information, not medical advice. It gives no doses and does not replace a doctor: talk to your doctor or pharmacist before starting, stopping or changing any medicine. How we write and check our pages.

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Allergic rhinitis (hay fever)Eczema (atopic dermatitis)Underactive thyroid (hypothyroidism)Anxiety disorders

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