Mysterious Hives? Here’s What Your Skin Might Be Telling You

What Are Hives?

Hives, also called urticaria, are red, pink, or skin-colored bumps that can suddenly appear on any part of your body. They’re itchy and can change shape or size.

Each hive usually fades within 24 hours, but new ones can continue to appear in different locations. Sometimes, hives come with angioedema, which is a deeper swelling that can be seen around the eyes, lips, or throat.

Two Types of Hives

1. Acute Urticaria: Lasts less than 6 weeks. Often triggered by infections, certain medicines, foods, or bug bites.
2. Chronic Spontaneous Urticaria (CSU): Lasts more than 6 weeks. Affects around 1–3% of people in their lives (thelancet.com, aafp.org, pubmed.ncbi.nlm.nih.gov).

Why Do Hives Happen?

Hives form when certain immune cells called mast cells release a chemical called histamine. This makes your skin swell and become itchy.

Some hives are caused by allergies to certain foods, medications, or insect bites. Other times, there’s no clear cause. Things like heat, cold, pressure, or stress can also make them appear.

When hives keep coming back for more than 6 weeks, it’s called chronic spontaneous urticaria (CSU). For many people, CSU is linked to changes in the immune system that keep mast cells activated without a clear trigger.

Common Triggers

Short‑term Hives (Acute):

• Infections (like colds or viruses)
• Certain foods
• Medicines (e.g., antibiotics)
• Insect bites or stings

Long‑term Hives (Chronic):

• Often no clear cause (called idiopathic)
• 30–50% may be linked to an overactive immune system
• Other triggers can include pressure, temperature changes, or stress

When Should You See a Dermatologist?

It’s a good idea to see a dermatologist, virtually or in-person, if you have:

• Hives happening almost every day for over 6 weeks
• Itchy hives that make it hard to sleep or do daily activities
• Hives that aren’t getting better with antihistamines
• No obvious reason for hives to begin

Early help means fewer emergency visits and faster relief.

How Doctors Evaluate Hives

During a visit, doctors will:

1. Ask your story: When did the hives start? Do they come with swelling or pain?
2. Check for causes: New foods, medicines, stress, or weather changes
3. Use a score like UAS7 to track hives/day and itchiness over a week (onlinelibrary.wiley.com, aafp.org, aad.org)
4. Order labs if needed: CBC, CRP, thyroid tests, IgE levels, or autoimmune markers

Treatment Options

When treating hives, the goals are to:

• Control the itch
• Prevent new hives
• Avoid what’s causing the hives, when possible

Your treatment plan will be personalized based on your symptoms. It may include one or more of the following:

• Non-drowsy antihistamines, like cetirizine (Zyrtec), loratadine (Claritin), or fexofenadine (Allegra), to calm itching and swelling
• Prescription allergy medications, such as desloratadine or hydroxyzine, if over-the-counter options aren’t enough
• Short-term oral steroids, for severe flare-ups—used only for a few days
• Topical creams or lotions with anti-itch ingredients, like pramoxine to help soothe the skin
• Advanced treatments, like:
  • Omalizumab (Xolair): a monthly shot that helps block allergic pathways
  • Dupilumab (Dupixent): an injection for hard-to-treat hives
  • Cyclosporine: a strong immune-suppressing medicine used in rare cases

Researchers are also studying new targeted therapies—including daily pills—that aim to quiet the immune system in people with chronic hives. These could offer even more options in the near future.

If swelling affects your lips, tongue, or throat—or you have trouble breathing—get emergency help right away. You may need an epinephrine autoinjector (like an EpiPen) in the future.

When Hives Won’t Go Away

If hives persist after antihistamines, one of the advanced treatment options may be a necessary next step. Your doctor can help you find the option that works best for you and your symptoms.

New Treatments on the Horizon

Exciting new medications are emerging. The New England Journal of Medicine recently published a study showing that remibrutinib, a daily pill, helped significantly reduce hives and itching in just 12 weeks (nejm.org).

How Telehealth Helps You

Virtual care works well for treating hives:

• Send photos of your hives
• Share your full story with your doctor
• Follow personalized treatment plans
• Get lab tests ordered if needed
• Track your symptoms over time
• Adjust your treatment based on how you’re responding, all from home

Summary: What You Should Know

• Hives are itchy bumps and welts caused by histamine released from mast cells
• If they last over 6 weeks, they’re called chronic hives and need a plan.
• Treatment may start with antihistamines but can include advanced options when needed, especially for long-term or hard-to-treat cases.
• Many people can manage their care virtually with the right support and guidance.

What to Do Now

If hives have been bothering you for weeks or you’ve tried home remedies without success–don’t wait.

Book a virtual appointment with Tono Health.

Book Appointment 

Our trusted board-certified dermatologists and allergists will help you:

• Discover what’s causing hives
• Build a step-by-step treatment plan
• Track your improvement
• Add advanced therapies when needed

Start your path to clear skin today!

References

1. Zuberbier T., Abdul Latiff A.H., Abuzakouk M., et al. The international EAACI/GA²LEN/EuroGuiDerm/APAAACI guideline for the definition, classification, diagnosis, and management of urticaria. Allergy. 2022; 77(3):734–766. https://doi.org/10.1111/all.15090
2. Kolkhir, P., Giménez-Arnau, A.M., Kulthanan, K., et al. Urticaria. Nature Reviews Disease Primers. 2022; 8:61. https://doi.org/10.1038/s41572-022-00389-z
3. Kaplan A., Lebwohl M., Giménez-Arnau A.M., Hide M., Armstrong A.W., Maurer M. Chronic spontaneous urticaria: Focus on pathophysiology to unlock treatment advances. Allergy. 2023; 78(2):389–401. https://doi.org/10.1111/all.15603
4. Zuberbier T, Ensina LF, Giménez‑Arnau A, et al. Chronic urticaria: unmet needs, emerging drugs, and new perspectives on personalised treatment. Lancet. 2024;404(10450):393–404. https://doi.org/10.1016/S0140-6736(24)00852-3
5. Keller L., Stitt J. Chronic Spontaneous Urticaria: Quality of Life and Economic Impacts. Immunol Allergy Clin North Am. 2024 Aug;44(3):453-467. https://pubmed.ncbi.nlm.nih.gov/38937009/
6. Maurer M., Rosén K., Hsieh H.J., et al. Omalizumab for the treatment of chronic idiopathic or spontaneous urticaria. N Engl J Med. 2013;368(10):924–935. https://doi.org/10.1056/NEJMoa1215372
7. Metz M, Giménez-Arnau A, Hide M, et al. Remibrutinib in Chronic Spontaneous Urticaria. N Engl J Med.2025;392(10):984–994. https://doi.org/10.1056/NEJMoa2408792
8. American Academy of Dermatology. Hives: Diagnosis and treatment. AAD.org. Accessed 2025. https://www.aad.org/public/diseases/a-z/hives-treatment
9. Schaefer P. Acute and Chronic Urticaria: Evaluation and Treatment. Am Fam Physician. 2017 Jun 1;95(11):717-724. https://www.aafp.org/pubs/afp/issues/2017/0601/p717.html
10. Saini S.S., Kaplan A.P. Chronic Spontaneous Urticaria: The Devil's Itch. J Allergy Clin Immunol Pract. 2018;6(4):1097–1106. https://doi.org/10.1016/j.jaip.2018.04.013

This information is for educational purposes only. If you are experiencing a medical emergency, call 911 right away.