Acute & Chronic Hives

Acute & Chronic Hives

Nearly one in four people have experienced itchy, red or white bumps, welts or patches on the skin called hives. The medical name for this condition is urticaria. Some hives are classified as acute hives and other cases are chronic based on how long the symptoms last.


Hives are red, raised, itchy skin rashes that are sometimes triggered by allergens. An allergen is something that produces an allergic reaction. It is known by names like urticaria, welts, weals, or nettle rash. When an allergic reaction occurs, the body releases a protein called histamine. When histamine is released, the tiny blood vessels known as capillaries leak fluid. The fluid accumulates in the skin and causes a rash. Hives affect around 20 percent of people at some time in their life. It is not contagious.


Swellings, appear as a rash on the skin.

  • Weals - They are usually pink or red, with an oval or round shape. They can range from a few millimeters to several inches across. They can be extremely itchy, and they have a red flare around them. Weals usually occur in batches, frequently on the face, or extremities, including the arms, hands, fingers, legs, feet, and toes.
  • Welts -long ropy weals normally disappear within 24 hours, but new ones may form. They can appear on just one part of the body, or on several parts.

Symptoms of acute hives normally disappear within 24 hours, but sometimes another weal appears as the last one fades. In some cases, hives can continue for several days. People with chronic hives can have symptoms for months or years.


Hives occur when the body reacts to an allergen and releases histamine and other chemicals from under the surface of the skin.

Examples of known triggers include:

  • Medications, including some antibiotics and non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ACE inhibitors, used for high blood pressure.
  • Food like nuts, shellfish, food additives, eggs, strawberries, and wheat products.
  • Viral infections, including influenza, the common cold, glandular fever, and hepatitis B.
  • Bacterial infections, including urinary tract infections and strep throat.
  • Intestinal parasites.
  • Extreme temperatures or changes in temperature.
  • High body temperature.
  • Pet dander from dogs, cats, horses and birds.
  • Dust mites.
  • Cockroaches and cockroach waste.
  • Latex.
  • Pollen.
  • Some plants, including nettles, poison ivy, and poison oak.
  • Insect bites and stings.
  • Chemicals.
  • Chronic illness, such as thyroid disease or lupus.
  • Sunlight exposure.
  • Scratching.

In over half of all cases, people never find the exact cause.


Acute Hives:

The doctor will probably ask about:

  • When and where the episode began.
  • Whether the patient was bitten by an insect.
  • Whether the patient lives or works in a place where potential triggers may exist, such as latex gloves, chemicals, or animals.
  • Medications the patient has been taking, including herbal supplements.
  • Patient's medical history.
  • Family history of urticaria.
  • Often, the trigger is unclear, but if there appears to be a specific trigger, the doctor may refer the patient to an allergy clinic.
  • Allergy clinics test the patient's blood and skin to find out whether there is an allergy to specific substances, such as chemicals, dust mites, or some food.

Chronic Hives:

If the urticaria continues for more than 6 weeks, the trigger is probably not external, so experts do not recommend allergy tests at this point.

The following tests can be performed:

  • Blood test to check for anemia.
  • Stool sample to identify any parasites.
  • Erythrocyte sedimentation rate (ESR) test, to identify problems with the immune system.
  • Thyroid function test to assess for an overactive thyroid, known as hyperthyroidism, or hypothyroidism, an underactive thyroid.
  • Liver function tests, in case there are liver problems.
  • Factors that may worsen the existing urticaria include:
    • Alcohol.
    • Caffeine intake.
    • Mental health issues, such as stress.


Patients usually use a combination of lifestyle changes and medications. Sometimes, alternate therapies like homeopathy, acupuncture and Ayurvedic treatments are recommended. Antihistamines, such as cetirizine or fexofenadine, help by blocking the effects of histamines and reducing the rash and stopping the itching.


Acute Hives:

  • Non sedating antihistamines, such as cetirizine or fexofenadine, help by blocking the effects of histamine and reducing the rash and stopping the itching.
  • Various antihistamines can be purchased in pharmacies or online.
  • Some antihistamines cause drowsiness, especially if the user also consumes alcohol. Some are not suitable during pregnancy unless prescribed by a doctor.
  • If the patient experiences swelling of the tongue or lips, or if breathing becomes difficult, the doctor may prescribe an epinephrine auto-injector, for example, EpiPen, in case of emergencies.

Chronic Hives:

  • Antibiotics, for example, Dapsone, can reduce redness and swelling.
  • Omalizumab, or Xolair, is an injectable drug that blocks immunoglobulin E, a substance that plays a role in allergic responses. It can reduce symptoms of chronic idiopathic urticaria, a type of hives of unknown origin that can last for months or years.
  • Those with severe symptoms may need to see a specialist.
  • Acupuncture may help treat hives, but needs more research.

Few of the medicines used in infusion are: