Hives are itchy welts that come and go within a day.
Hives, or urticaria, are raised, itchy welts on the skin, pale in the middle with a red edge, like the marks from a stinging plant. Each welt fades within a day, usually without a mark, while new ones come up elsewhere. They happen when cells in the skin release histamine, which makes tiny blood vessels leak fluid.
In plain words.
Short-lived hives, lasting days to a few weeks, are very common. Triggers include viral infections (especially in children), painkillers such as ibuprofen, aspirin and diclofenac, some antibiotics, foods such as nuts, shellfish or eggs, and insect stings. Often no cause is found.
Hives that come on most days for more than six weeks are called chronic urticaria. In most people this is not an allergy to a food at all: the immune system switches on the skin’s histamine cells by itself, and heat, pressure, stress and painkillers make it worse. Long lists of food bans rarely help. It usually settles with time, though this can take months to several years.
The usual treatment is a less-drowsy antihistamine such as cetirizine, taken every day while the hives last, not only when welts appear. If one tablet a day is not enough, a doctor may raise the dose, which is standard practice. Steroid tablets are for short bursts only. Sometimes hives come with deeper swelling of the lips, eyelids or hands, called angioedema.
Under one welt
Mast cells sit quietly in the skin beside tiny blood vessels, holding histamine in small grains.
Something sets the mast cells off. Histamine makes the vessels leak fluid, which lifts the skin into a pale welt with a red flare. Each one fades within a day as new ones appear.
An antihistamine blocks histamine where it acts. The vessels stop leaking and the welts settle. Taken every day, it helps prevent new ones.
Go to hospital now if
- Swelling of the tongue, lips or throat, trouble breathing, a hoarse voice or difficulty swallowing: call 112. If you have an adrenaline pen, use it now.
- Hives with feeling faint or dizzy, collapse, or vomiting and tummy cramps after a food, sting or medicine: call 112.
- Swelling of the lips or tongue, with or without hives, while taking a BP medicine whose name ends in “-pril” (such as ramipril or enalapril): go to hospital now, and do not take the next dose until a doctor has seen you.
Call 112 or go to the nearest emergency department. Ambulance: 108 (102 in some states).
See a doctor within a day if
- Hives started after a new medicine
- Each welt lasts more than a day, hurts more than it itches, or leaves a bruise-like mark
- Hives come with fever, joint pains or feeling unwell
- Swelling of the face or eyelids, even without any breathing trouble
Tests that help.
Not everyone needs every test. He decides which ones are worth doing for you.
| Test | What it tells |
|---|---|
| Usually none for short-lived hives | Tests rarely change the treatment; the story matters more. |
| Blood count and ESR or CRP | For hives lasting more than six weeks, to look for inflammation. |
| Thyroid tests (TSH, sometimes thyroid antibodies) | Thyroid problems are more common in long-lasting hives. |
| Other tests only when your story points to them | For example, liver tests or a stool test for worms. |
| Allergy tests | Only when a particular food or sting clearly brings on hives within an hour or two. Not useful for long-lasting hives. |
Have it ready.
Tick them off as you gather them. The ticks stay on this phone only.
Online, or in person?
Painkillers such as ibuprofen, aspirin and diclofenac can bring on hives or make them worse. For pain or fever while you have hives, paracetamol is usually the safer choice; check with your doctor.
A video call can
- Tell ordinary hives from an emergency
- Look for a trigger in your story and your medicines
- Set up a daily antihistamine plan, and adjust the dose
- Arrange tests for hives that last beyond six weeks
Needs a visit in person
- Blood tests, at a laboratory or by home collection
- An allergy specialist for clear food or sting reactions, or hives that stay out of control
- Emergency care for throat swelling or breathing trouble
- Any sign in the red box: that is an emergency
Talk it through with Dr. Arya.
Bring your reports and medicines to a video consultation. He goes through them with you, in plain words, and says clearly if you need to be seen in person.
Book a video consultationDr. Prabhat Arya · MBBS, MD (Internal Medicine) · Delhi Medical Council Reg. No. DMC-83759