Urticaria (hives)


Urticaria, also known as hives, is a common condition characterized by red, itchy, swollen patches on the skin. These hives can vary in size and may appear and disappear quickly. They are typically caused by an allergic reaction to a certain food, medication, or other stimulus, and can last anywhere from a few hours to several weeks. Treatment for hives usually involves avoiding the trigger, taking antihistamines, and using cold compresses.


The most common symptoms of Urticaria (hives) include:

  • Itchy, raised, red welts on the skin that often itch or burn
  • Swollen areas of skin (angioedema) which may be painful
  • Itching or burning sensation on the affected skin
  • Redness, swelling, and welts that may appear in different sizes and shapes, and can move around the body
  • Some people may experience a tingling or burning sensation around the affected area.

Other symptoms may include:

  • Feeling of tightness in the skin or throat
  • Sneezing, coughing, trouble breathing, or hoarseness
  • A feeling of nausea or abdominal cramps
  • Anxiety or irritability
  • Headache
  • Tiredness or fatigue
  • Swollen lymph nodes


The most common causes of urticaria (hives) are allergies and hypersensitivity reactions triggered by exposure to certain substances such as foods (including peanuts, tree nuts, shellfish, eggs, milk, and soy), medications (such as aspirin, antibiotics, and ibuprofen), environmental factors (such as latex, animal dander, and insect stings or bites), and infections (such as colds, the flu, and hepatitis). Other potential triggers of hives include extreme temperatures (either hot or cold), emotional stress, physical activity, and an underlying autoimmune disorder.

Risk factors

Risk factors for urticaria (hives) include:

  1. Allergens – exposure to particular substances, such as food, pollen, pet dander, or drugs, can cause symptoms
  2. Stress – anxiety and emotional distress can trigger urticaria
  3. Physical factors – heat, cold, sunlight, exercise, pressure, or friction can cause redness and itching
  4. Infections – bacterial and viral infections can cause hives to appear on the skin
  5. Medical conditions – thyroid disease, lupus, or other autoimmune diseases can cause episodes of hives
  6. Medications – certain drugs such as antibiotics, nonsteroidal anti-inflammatory drugs, and ACE inhibitors can trigger hives in sensitive individuals.


Urticaria (hives) is usually diagnosed through a physical examination by a doctor. The doctor may ask questions about the patient’s medical history and symptoms, as well as inspecting the rash. Further examination may include a blood test, skin or blood allergy test, and skin biopsy. The doctor may also recommend avoiding suspected triggers and medications to try to treat the hives.


There are three main subtypes of urticaria (hives):

  1. Acute Urticaria: This is the most common type of hives and is often seen in response to an allergen, medication, insect sting, physical contact, and so on. These hives are usually itchy and are accompanied by swelling, redness, and/or welts on the skin. The signs and symptoms of acute urticaria often last for a few days and can resolve on their own without medical intervention.
  2. Chronic Urticaria: This type of hives is seen when the symptoms of urticaria last for longer than six weeks and are not related to any known cause. It is often seen in those who suffer from underlying autoimmune disorders and can be quite uncomfortable.
  3. Physical Urticaria: In this type of urticaria, the symptoms are brought on by physical triggers such as cold, heat, pressure, exercise, and so on. These hives tend to appear quite quickly and can last for a few days to a few weeks.


Treatment options for Urticaria (hives) include the following:

  1. Avoiding triggers: This includes avoiding the foods, drugs, and other allergens that may be causing your hives.
  2. Over the counter medications: These include antihistamines (such as cetirizine or loratadine), as well as topical creams and ointments.
  3. Prescription medications: These include stronger antihistamines, steroids, and immunosuppressants.
  4. Phototherapy: This involves exposing the skin to UVB rays, which can help to reduce the severity of symptoms.
  5. Lifestyle modification: This includes avoiding excessively warm or hot showers and baths, wearing loose-fitting clothes, avoiding stress and staying cool.
  6. Complementary therapies: These include herbal remedies, acupuncture, and reducing the intake of inflammatory foods.


The best way to reduce the risk of Urticaria (hives) is to identify and eliminate any potential triggers. Triggers can be environmental, such as pollen, dust mites, and air pollution, or dietary, such as certain foods. Other lifestyle factors, such as stress and emotional distress, might also play a role and should be addressed in order to reduce the risk of Urticaria (hives). It is also important to take measures to maintain a healthy immune system, such as getting enough sleep, eating a balanced diet, and exercising regularly. Additionally, some people may benefit from taking over-the-counter antihistamines or other medications to manage their symptoms.

Gender differences?

Yes, there are gender-specific differences in the presentation and management of Urticaria (hives). Studies have found that women are more likely to experience chronic urticaria, which is defined as hives lasting for more than six weeks, than men. In terms of management, women are more likely than men to report exacerbating factors such as stress, anxiety, and menstrual cycle changes that can worsen hives, indicating the need for tailored approaches to management. Furthermore, it has been suggested that a higher prevalence of autoimmune and immunologic disorders in women may influence the severity and duration of hives and symptom relief. Finally, studies have also found differences in response to medications, with women being less likely to respond to H1 receptor antagonists, and more likely to respond to H2 receptor blocking agents, than men.


Nutrition plays an important role in the management of Urticaria (hives) because some foods can cause or worsen symptoms. It’s important to identify which foods trigger a reaction and to avoid those. In addition, eating a balanced diet rich in essential nutrients, vitamins and minerals can help support overall health, improve symptoms, and reduce the risk of aggravating hives. Eating a diet rich in essential fatty acids, such as omega-3s, can also be beneficial. Omega-3s help reduce inflammation, which can help ease hives symptoms. Avoiding sugar-rich foods, processed foods, and foods high in histamine can also help reduce hives symptoms. Additionally, staying hydrated by drinking plenty of water is important for alleviating hives symptoms. Finally, it is important to maintain good gut health, as gut health has been linked to skin health and maintaining good gut health can help improve skin health.

Physical Activity

Physical activity can affect hives in a variety of ways. Intense physical activity can cause hives to worsen since it increases sweating and the body’s temperature, both triggers for hives. Similarly, physical activity can also lead to itchiness, which can irritate the skin and cause hives to flare up. Conversely, moderate exercise can help reduce hives as it releases endorphins which can reduce stress, a major factor in hives. Additionally, moderate exercise increases circulation which can help to reduce inflammation in the skin. It is important to note that physical activity should be tailored to an individual’s condition, and should not cause any extreme stress or fatigue during the exercise session.

Further Reading

  1. https://acaai.org/allergies/allergic-conditions/skin-allergy/hives/
  2. https://www.nhsinform.scot/illnesses-and-conditions/skin-hair-and-nails/urticaria-hives
  3. https://www.allergy.org.au/patients/skin-allergy/urticaria-hives
  4. https://www.mayoclinic.org/diseases-conditions/chronic-hives/symptoms-causes/syc-20352719
  5. https://www.medicalnewstoday.com/articles/157260
  6. https://www.uptodate.com/contents/hives-urticaria-beyond-the-basics/print
  7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2696901/

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