Symptoms of Urticaria (Hives)

A Common Skin Reaction With Many Uncommon Causes

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Urticaria is the medical term used to describe a skin reaction commonly known as hives. Hives are characterized by itchy welts on the skin that range in size from tiny spots to larger blotches or patches.

The hive, or wheal, is the result of vascular changes to the skin that causes it to rise, often with association with localized itchiness or pain. As most people don't develop just one hive, we tend to refer to it in the plural (hives).

Urticaria is known to occur in up to 20 percent of the population at one time or another. It can affect any person of any race, at any age, or in any season of the year. It most often shows up in the evening or in the morning just after waking. Itching is typically worse at night, often interfering with sleep.

Quality of Life With Hives

Urticaria is one of those skin conditions that can be mildly annoying in some and downright nerve-wracking in others. So severe can symptoms be that the quality of day-to-day life can be seriously impacted.

In addition to sleep and discomfort, urticaria can affect one's self-image. This is especially true for those experiencing a persistent or severe outbreak. It can interfere with social activities and sexual relationships both emotionally and physically. Depression and anxiety are not uncommon in those experiencing chronic outbreaks.

Antihistamines are typically prescribed for those whose condition is triggered by an allergic reaction.

 Corticosteroids and autoimmune drugs may also provide relief when antihistamines alone are unable to do the trick.

Types of Urticaria

Urticaria is classified as being either acute or chronic depending on how long the rash has been present. Acute hives last for less than six weeks, while chronic hives extend well beyond that period.

Acute urticaria is more common in children and young adults. The majority of these are classified as idiopathic, meaning we don't know their cause. If a diagnosis is made, the culprit will likely to be an infection, an insect sting, or a food or drug allergy. Acute hives usually resolve on their own.

Chronic urticaria, by contrast, does not resolve quickly and may require medical treatment. In one study, 75 percent of people with chronic hives had symptoms that lasted longer than a year, while 50 percent had symptoms for more than five years and 20 percent have symptoms for more than a decade. In half of all these cases, the offending agent was never found.

Chronic urticaria occurs more often in middle-aged women and rarely in children. It can be caused by the many of the same things as acute urticaria but can also be a symptom of certain diseases.

Hives called physical urticaria are also possible. These are caused by specific stimuli (like the repetitive stroking of skin or exposure to extreme cold) and tend to disappear when the stimulus is removed.


  • Amar, S. and Dreskin, S. "Urticaria." Primary Care. 2008; 35:141-157.
  • Grattan, C. and Kobza Black, A. "Urticaria and Angioedema." Dermatology. 2nd. Ed. Jean Bolognia. New York: Mosby, 2008:261-276.
  • Guldbakke, K. and Khachemoune, A. "Etiology, classification, and treatment of urticaria." Cutis. 2007; 79: 41-49.
  • Zuberbier, T. and Maurer, M. "Urticaria: current opinions about etiology, diagnosis, and therapy." Acta Derm Venereologica. 2007; 87:196-205.