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Hives: Diagnosis and treatment


If you have a mild case of hives, it will likely go away in a few days. To get relief until then, dermatologists recommend that you take a non-drowsy antihistamine and use these home remedies.

It can be helpful to see a board-certified dermatologist if the hives:

  • Last longer than a few days

  • Cover a large area of your body

  • Are caused by an allergy

Hives can require emergency care

Get immediate medical care or go to the nearest emergency room if you have hives, along with any of the following:

  • Problem swallowing
  • Feel light-headed or faint
  • Swelling in your mouth or throat
  • Racing heart

You may have anaphylaxis, which can be deadly and requires immediate medical care.

Hives near lips and problems breathing.

How do dermatologists diagnose hives?

A dermatologist can often diagnose hives by looking at your skin.

To find out why you have hives, your dermatologist will ask questions. Knowing why you have hives may help you avoid the cause, which can prevent new hives.

Hives have many causes, so it can be a challenge to find the cause. You can help your dermatologist by taking time to answer these questions before your appointment:

  • How often do you get hives?

  • How long do the hives last?

  • Do the hives itch or feel painful?

  • When you get hives, do you have other symptoms like feeling lightheaded or nauseous?

It can also be helpful to think about what you were doing a few hours before you developed hives. For example, can you answer the following questions?

  • What did you eat?

  • Did you take a medication, including one that you can buy without a prescription, such as ibuprofen?

  • Have you been feeling stressed?

  • Did a bug bite or sting you?

  • Were you out in sunlight, cold, or heat?

  • Did you sweat a lot?

  • Were you wearing tight clothes or carrying a purse or backpack?

Tell your dermatologist if you develop hives hours after eating red meat (e.g., beef, pork, or organ meat), gelatin, or dairy products

Hives can be a sign of alpha-gal syndrome, a food allergy that can develop after being bit by the lone star tick. This tick is found in many U.S. states.

People bitten by a Lone Star tick can develop hives after eating red meat like on this sandwich.

During your appointment, your dermatologist will also ask about your medical history. Be sure to mention any recent medical treatments, including radiation therapy or a blood transfusion.

Your dermatologist may also require one or more of the following medical tests:

  • Allergy tests (on the skin or blood tests)

  • Blood work (to rule out an illness or infection)

  • Skin biopsy

To perform a skin biopsy, your dermatologist removes a small bit of affected skin so that it can be examined under a microscope.

While having answers to these questions and test results is helpful, it’s important to know that the cause of hives cannot always be found.

If a cause cannot be found and you’ve had hives for 6 weeks or longer, the medical term for this is chronic spontaneous urticaria (CSU). Many people have CSU.

Even without knowing the cause, your dermatologist can treat hives.

How do dermatologists treat hives?

When treating hives, the goals are to:

  • Control the itch

  • Prevent new hives (existing hives go away on their own)

  • Avoid what’s causing the hives (when known)

Your treatment plan will be tailored to your needs and may include one or more of the following:

  • Soothing anti-itch lotion or cream: Prax lotion or a cream containing menthol can give you temporary relief from the itch.

  • An antihistamine: This medication can help control the itch and swelling. You can buy some antihistamines like cetirizine (Zyrtec®), loratadine (Claritin®), and Benadryl® without a prescription. Benadryl can make you sleepy, so it’s best taken at bedtime. If you need a stronger antihistamine, your dermatologist may prescribe doxepin.

  • Corticosteroid: When hives are severe, a medication like prednisone can reduce the inflammation and itch. For milder hives, your dermatologist may prescribe a corticosteroid that you apply to your skin to help relieve the itch.

  • Omalizumab: This is an injectable medication that you would use at home to treat chronic hives. It’s prescribed when antihistamines fail to work.

  • Auto-injector: Also known as the EpiPen®, this medication treats a life-threatening allergic reaction.

  • Light therapy: Also called phototherapy, this non-invasive treatment can be effective when antihistamines don’t work. It requires several trips a week for a few months to your dermatologist or phototherapy treatment center.

  • Other medication as needed: Sometimes, hives can be a challenge to treat. If antihistamines and other treatments fail to work, your dermatologist will consider your unique needs and may prescribe another medication like cyclosporine or hydroxychloroquine. These medications work to calm down the immune system so that it doesn’t overreact.

To improve your outcome, your dermatologist may give you self-care tips to follow. To see what dermatologists frequently recommend, go to: Hives: Self-care.

Related AAD resources


Images
Image 1: Used with permission of DermNet NZ
Image 2: Getty Images

References
Antia C, Baquerizo K, et al. “Urticaria: A comprehensive review: Epidemiology, diagnosis, and work-up.” J Am Acad Dermatol. 2018;79(4):599-614.

Antia C, Baquerizo K, et al. “Urticaria: A comprehensive review: Treatment of chronic urticaria, special populations, and disease outcomes.” J Am Acad Dermatol. 2018;79(4):617-33.

Grattan CEH, Saini SS. “Urticaria and angioedema.” In: Bolognia JL, et al. Dermatology. (4th edition). Mosby Elsevier, China, 2018:304-19.

Hide M, Takahagi S, et al. “Urticaria and angioedema.” In: Kang S, et al. Fitzpatrick’s Dermatology. (9th edition) McGraw Hill Education, United States of America, 2019:684-785.

Wong HK. “Urticaria.” In: Medscape (Elston DM., Ed.) Last updated 9/16/2020. Last accessed 8/1/2021.

Yosipovitch G and Kwatra SG. “Chronic urticaria.” In: Living with itch: A patient’s guide. The Johns Hopkins University Press. United States, 2013: 56-9.


Written by:
Paula Ludmann, MS

Reviewed by:
Rajiv Nijhawan, MD, FAAD
Dara Spearman, MD, FAAD

Last updated: 9/28/21

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