Common Causes of Hives

Hive aren't always caused by allergies


Urticaria, also known as hives, is a dermatologic condition that causes swollen, red bumps on the skin. These wheals usually appear rapidly and can appear anywhere on the body. They usually cause itching, burning, or stinging. 

Almost every patient with urticaria that I see in my clinic is concerned that an allergy is triggering their symptoms. Most think that a certain food is the cause of their hives; others think that a change in a soap or detergent is the culprit.

Before they see me, these people have tried to avoid these suspected triggers, yet the hives usually persist.

What are the most common causes of hives? You might be surprised to hear that while allergies may be the problem, other causes are more common. And in a majority of cases, what triggers hives that last for less than six weeks (acute) is different than what causes hives that last longer (chronic).

Viral Infections

The most common cause of acute hives, particularly in children, is a viral infection. This may even be true if a child has not had any obvious recent illness. Acute hives can be related to other infections, such as strep throat, athlete’s foot, and urinary tract infections.

Allergic Reactions

Allergic reactions, particularly to foods and medications, are another common cause of acute hives. Generally speaking, hives that occur as a result of eating certain foods almost always appear within a few minutes to a few hours of eating the food.

Reactions to medications may occur after the first dose, or not until the medication has been taken for a week or two.


Stress is a common cause that acute and chronic hives share. You may not feel particularly stressed, but your body may, especially if you are very busy. Life stressors that can result in hives may be positive or negative.

Other than stress, the causes of chronic hives are quite different when compared to the causes of acute hives. Allergies only cause about 5 to 10% of chronic hives cases. When allergies cause chronic hives, pet allergy is usually to blame. Pollen, mold, or dust mite allergies only rarely cause chronic hives.

Chronic Infections

Chronic infections, such as viral hepatitis, sinus infections, and urinary tract infections, can cause chronic hives. Some studies have shown that infection with Helicobacter pylori, a bacteria commonly connected with stomach ulcers, is also associated with chronic hives.

Metabolic Disease

Metabolic diseases, such as low or high thyroid function, liver disease, and kidney disease, may also be at the root of chronic hives. In addition, it appears that a large percentage of people without an obvious trigger for their chronic hives actually have an autoimmune disease -- a condition in which the immune system attacks healthy tissue, including skin.


Use of certain medications, particularly non-steroidal anti-inflammatory drugs (NSAIDs), are also associated with chronic hives.

Now read everything you need to know about the treatment of hives.


Griffiths, Christopher; Barker, Jonathan; Bleiker, Tanya; Chalmers, Robert; Creamer, Daniel (2016). Rook's Textbook of Dermatology, 4 Volume Set (9 ed.). John Wiley & Sons.

Continue Reading