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Urticaria or more commonly referred to as hives are wheals that can burn, itch or sting and that are usually pale or flesh colored. They may occur for many reasons such as due to allergic reactions or as a result of autoimmune disorders. According to Water’s Edge Dermatology, at least 10 – 20 % of the general population will have at least one episode of hives in their lifetime. Their severity varies considerably with even some cases considered a medical emergency. In this article, we explain what urticaria is and what causes it.

Urticaria: Why it Happens & How Can it be Treated?

Appearance of Urticaria

Urticaria, hives or even nettle rash refers to changes in the skin that happen as a result of allergies or diseases. These skin changes come in the form of wheals that are red and swollen and that become pale upon pressure. In fact, this feature of hives is what distinguished them from other conditions according to the American College of Allergy, Asthma & Immunology. Another indicator that the rash is Urticaria is that the wheals move around to different parts of the body. Hives usually appear in clusters, and the size of hive wheals ranges from needle-pin to several centimeters even covering large body areas. Hives tend to be extremely itchy and some can even sting and burn.

Causes of Urticaria

Hives are a result of histamine and other chemicals being released into the skin leading to tissue swelling. This type of reaction is triggered by food, medications, insect bites, clothing materials, infections, autoimmune disorders, and even emotional stress. Hives are classified as either acute when lasting less than six weeks or chronic when lasting longer than six weeks. Removing these triggers is one treatment of stress hives. However, in some cases, it is hard to determine what are causes of hives on skin which is mostly the case in chronic hives. Furthermore, chronic hives are most likely to be a result of autoimmune disorders.

Urticaria Info

Urticaria Info

Diagnosis of Urticaria

According to an article published in the Indian Journal of Dermatology, acute cases of urticaria usually don’t require too many diagnostic tools. In such cases, diagnosis is based on examining patient history to determine what may have triggered the acute episode. This implies asking about foods, medication, and diseases that the patient was exposed to prior to developing urticaria. Only in cases with severe symptoms will doctors check for possible food and drug allergies. If a patient has chronic urticaria, diagnosing the triggers is important to determine any possible triggers or underlying autoimmune disorders.

Treatment of Urticaria

As pointed out in Water’s Edge Dermatology, the best treatment for hives is finding the triggers. Once triggers have been identified, it is fairly easy to eliminate hives. Antihistamines are frequently prescribed to patients with urticaria, and these may be taken in advance to prevent future outbreaks. In severe cases of urticaria that are accompanied by anaphylaxis, emergency treatment with adrenaline injections is required to save a patient’s life. Anaphylaxis is a severe form of allergic reaction that can be life-threatening if not treated promptly. Corticosteroids creams may also be treatment of severe urticaria cases, but their use is meant to be short-term due to their dangerous side-effects.

Chronic Urticaria Causes

Most cases of hives resolve within 24 hours or a bit longer making this condition easily manageable. But in the treatment of chronic urticaria, it is needed to improve overall quality of life. Chronic urticaria may accompany autoimmune disorders such as lupus and rheumatoid arthritis. Other chronic diseases such as hepatitis, thyroid diseases, and intestinal parasites may also cause chronic urticaria. According to NHS Choices, many chronic urticaria patients state that their condition comes and goes and that it is often triggered by things like alcohol intake, pain medicine, food additives, etc.

Chronic Urticaria Prognosis

In most cases, chronic urticaria will resolve after some time, but in some cases, it may persist for years. One study published in Allergy examined the parameters that determined the length of chronic urticaria. The study found that in 70% of cases, the disorder resolved within a year. But in 14% of cases, chronic urticaria persisted even after 5 years. The prognosis was apparently poor in cases with accompanying thyroid disease or who had severe forms of urticaria.


Urticaria or hives is a broad term referring to a reaction in the skin triggered by different environmental and intrinsic factors. When people develop a sudden rash on their skin, they can usually determine the cause by recalling what they ate or did prior to the onset of the rash. In other cases, the underlying cause of hives can be hard to determine even by a doctor. This is especially true for chronic urticaria. Urticaria can also in some instances be life threatening when resulting in anaphylaxis. Urticaria is also fairly common, and a large portion of patients in the allergy clinics are those with urticaria.

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2 Sources

We review published medical research in respected scientific journals to arrive at our conclusions about a product or health topic. This ensures the highest standard of scientific accuracy.

[1] Diagnosis of urticaria
[2] Anaphylaxis


Sam Kramer is a Registered Dietitian, Licensed Dietitian Nutritionist, Six Sigma Green Belt Certified, and Certified Sports Nutritionis