Hives
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Symptoms of hives
The main symptom of hives (also known as urticaria) is an itchy rash. This rash can look and feel different for everyone, but some key features include:
- Raised bumps or patches of skin, which can vary in size and shape
- A rash that can appear anywhere on the body, sometimes in one area or across multiple areas
- An itchy, stinging or burning sensation on the skin
On white skin, the rash often looks pink or red, but on brown and black skin, it may be less visible or show only as raised patches.
While the raised, itchy welts (bumps) are a key feature for all skin types, the colour of the rash may not always appear red or pink as it does on white skin.
On black and brown skin, hives may look like:
- Raised bumps or welts – these may look like swollen patches of skin that can vary in size and shape
- Skin-coloured, darker or greyish welts – on darker skin, hives may blend in, appear grey, brown, purple, or look swollen.
- Visible swelling – the affected area may be puffy or raised, especially if there’s angioedema (deep swelling of the skin)
- Itchy, hot or stinging sensation – the itchiness can be intense, regardless of skin tone and scratching can make the appearance of hives more noticeable
Hives can come and go throughout the day, with new patches appearing as older ones fade. They can last for a few hours or up to several days.
If you're unsure whether it's hives or another type of rash, especially in children, make sure to speak to a GP for advice and support.
What causes hives?
Hives occur when histamine and other chemicals are released under the skin, causing swelling and raised bumps. There are many possible triggers for this reaction, which can vary from person to person.
Common triggers for hives include:
- Certain foods – such as nuts, shellfish, or dairy, can cause an allergic reaction
- Allergic reaction to insect bites or stings
- Environmental allergens – like pollen, dust mites or certain chemicals like latex
- Side effects of certain medication
- Temperature changes – exposure to cold, wind, or heat (like after exercise or eating spicy food)
- Everyday stress – feelings of stress can sometimes trigger or worsen hives
- Infections – like a cold or flu
- Skin pressure or irritation – from tight or itchy clothing or scratching
- Immune system issues – when it reacts abnormally against normal cells
- Water or sunlight – rare triggers but can affect some people
You should also book an appointment with your GP if you’re worried about your child’s hives. In rare cases, hives can be a sign of a serious allergic reaction (anaphylaxis).
Make sure to call 999 immediately if you or someone else experiences any of the following:
- Swelling of the lips, mouth, throat or tongue
- Fast or struggling breathing – this might feel like choking, gasping or wheezing
- Tightness in the throat or difficulty swallowing
- Skin, lips or tongue turning blue, grey or pale – on brown or black skin, check the palms of the hands or soles of the feet
- Sudden confusion, drowsiness or dizziness
- Fainting or loss of consciousness – if the person can’t be woken up
- Limpness or unresponsiveness in a child – their head may flop, or they might struggle to focus on their face
If you can identify what's causing your hives, it may help you avoid them in the future. If you're unsure of your triggers or need support managing hives, your GP or pharmacist can provide advice and guidance.
Book an urgent GP appointment if you notice any of the following:
- Your symptoms haven’t improved after 2 days
- The rash is spreading or getting worse
- The hives keep coming back – this may be linked to an allergy
- You also have a high temperature and feel unwell
- You notice swelling under your skin (angioedema) – often around the lips, eyes, hands or feet
These could be signs of a severe allergic reaction that needs urgent treatment in hospital. Make sure to call 999 or go to A&E immediately.
If you’re unsure about your symptoms or need advice, contact NHS 111 online or by phone. They can help you decide if you need to see a GP, a pharmacist, or seek urgent care.
Types of hives
Hives, also known as urticaria, can be grouped by how long they last and what causes them. The 2 main categories are:
- Acute hives – lasting less than 6 weeks
- Chronic hives – recurrent urticaria, with signs and symptoms recurring most days of the week, for 6 weeks or longer
The symptoms of acute and chronic urtiϲаriа are identical in appearance, so when the problem first develops, it isn’t possible to differentiate the 2. If you’re experiencing hives that are persistent, severe, or affecting your daily life, make sure to speak to your GP.
This is the most common type of hives, usually lasting a few days to three weeks (and less than 6 weeks). It can be easy to treat and triggers may include infections, environmental allergens or certain medications. In some cases, people with acute hives may also experience angioedema (swelling under the skin) and, in severe cases, symptoms like:
• Fever
• Headache
• Joint pain
• Fatigue or feeling tired
If you are experiencing any of these symptoms alongside a rash, it is important to seek medical advice.
If hives last for more than 6 weeks, they’re classed as chronic urticaria. Symptoms like redness, hives and itching may persist for months or even years, often without a clear trigger. Chronic urticaria without a clear trigger is referred to as chronic spontaneous urticaria.
Angioedema (deep swelling of the skin) is more common in chronic hives and can affect areas like the face, hands, feet or genital area, causing discomfort and irritation.
Hives can be triggered by a variety of factors, from temperature changes to pressure on the skin. While most hives are short-lived, some types can be more persistent or linked to specific triggers, such as exercise, water, or sunlight. Each type of hive has its cause, but they all result in raised, itchy welts on the skin. The different types include:
Urticaria factitia (dermatographism)
- Triggered by rubbing, scratching, or pressure on the skin
- Raised, itchy welts appear shortly after the skin is scratched
Cold urticaria
- Caused by exposure to cold temperatures, such as cold water, wind, or ice
- Triggered by sudden skin contact with cold items or environments
Heat urticaria
- Triggered by exposure to heat, such as warm water, hot objects, or high temperatures
- Welts may appear after contact with hot surfaces or environments
Solar urticaria
- Triggered by sunlight or UV light exposure
- The skin may develop red, itchy hives after being in direct sunlight
Pressure urticaria
- Occurs when pressure is applied to the skin, such as wearing tight clothing or carrying a heavy bag
- Swelling often develops in areas under pressure
Aquagenic urticaria
- A rare form of hives triggered by contact with water, regardless of its temperature
- Symptoms may develop after bathing, swimming, or sweating
Cholinergic urticaria
- Triggered by body heat from activities such as exercise, hot baths, or spicy foods
- Symptoms may include small, raised bumps (similar to goosebumps) along with itching and warmth
Exercise-induced urticaria - Caused by physical exertion or intense exercise
Diagnosis & treatment of hives
Hives are typically diagnosed through an examination of the rash. The raised, red or pale patches on the skin are often prominent enough to be examined by a GP.
To help understand their cause, you may be asked about:
- When your symptoms started
- How long the hives last (do they appear and disappear within hours, or do they stay for longer?)
- Possible triggers (like certain foods, medications, or exposure to heat, cold or pressure)
Your GP may recommend further tests to help identify potential triggers or rule out other causes. These may include blood, urine, or skin assessments.
If your symptoms don’t improve with initial treatment, your GP might refer you to a specialist dermatologist or immunologist for further support.
Treating hives
If you have hives (urticaria), there are ways to manage the symptoms and find relief. While hives often clear up on their own, treatment can help ease itching, swelling, and discomfort.
A pharmacist is often the first port of call for managing hives. They can recommend treatment to help reduce itching and swelling, including:
- Antihistamines – these help to block the effects of histamine, the main chemical that causes hives
- Cooling creams – menthol-based creams can help to soothe irritated skin and provide a cooling effect
Not all treatments are suitable for everybody, so make sure to check with your pharmacist.
It’s important to speak to a GP if:
- Your symptoms haven’t improved after 2 days
- The rash is spreading or getting worse
- The hives keep coming back – this may be linked to an allergy
- You also have a high temperature and feel unwell
- You notice swelling under your skin (angioedema) – often around the lips, eyes, hands or feet
- You’re worried about your child’s hives
Your GP may prescribe treatment to help manage your symptoms. If your hives persist or do not improve with treatment, you may be referred to a dermatologist (skin specialist) for further support.
Can hives cause complications?
While hives (urticaria) often clear up on their own, some people may experience complications. Key complications to watch for include:
Angioedema is a deeper swelling under the skin. It often affects areas such as the lips, eyes, hands, feet, and genitals. Unlike hives, which are raised welts on the surface of the skin, angioedema causes deeper swelling that can feel firm or puffy. If you experience sudden swelling, especially around your mouth, tongue, or throat, make sure to seek urgent medical advice. If it affects your ability to breathe or swallow, call 999 immediately.
For some people, hives can affect their mental wellbeing, especially if the rash is persistent, itchy, or is in visible areas. Everyday stress, anxious feelings and embarrassment about the appearance of hives can affect daily life and emotional health. It can also affect you in different ways which include:
- Sleep disruption – constant itching can make it difficult to sleep
- Self-consciousness – hives in visible areas such as the face, neck or hands may cause self-esteem issues
- Anxious feelings – worrying about flare-ups, especially in social or work settings, can add emotional strain
If hives are affecting your mental well-being, make sure to talk to your GP. They can offer support, advice and treatment options to help you feel more in control.
Anaphylaxis is a life-threatening allergic reaction where the immune system responds intensely to an allergen.
It can include symptoms like:
- Sudden swelling of the lips, tongue, mouth or throat
- Difficulty breathing or wheezing
- Fast or struggling breathing – feeling like you’re choking or gasping for air
- A tight throat or difficulty swallowing
- Skin, tongue or lips turning blue, grey, or pale (may be easier to spot on the palms of the hands or soles of the feet in brown or black skin)
- Sudden confusion, drowsiness or fainting
Make sure to call 999 immediately if you or someone else shows signs of anaphylaxis. It requires urgent medical attention and early treatment with adrenaline can be lifesaving.
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Frequently asked questions
Hives (urticaria) happen when your body releases histamine and other chemicals under the skin, causing raised, itchy welts. This can be triggered by a variety of things, including:
- Allergies – to foods, medications, pollen or animal dander (particles shed by animals, mostly skin cells but also hair)
- Skin irritation – from scratching, pressure or tight clothing
- Changes in temperature – like cold weather, hot baths or sun exposure
- Feelings of stress – anxiousness can trigger or worsen hives
- Infections – like colds or other viral infections
Sometimes, hives can happen for no clear reason. If your hives last for more than 6 weeks or keep coming back, it’s known as chronic urticaria. If you're worried about your symptoms, make sure to speak to your GP.
Hives (urticaria) often go away on their own, but there are ways to help soothe symptoms and ease discomfort. While it may not be possible to get rid of hives instantly, you can try these steps for faster relief:
- Consider taking an antihistamine – these can help to reduce itching, swelling and redness. You can ask a pharmacist to recommend a suitable option
- Apply a cool compress – gently place a cold, damp cloth on the affected area to help reduce itching and swelling
- Wear loose, comfortable clothing – tight clothes can rub and irritate the skin, so try to stick to soft, breathable fabrics
- Avoid known triggers – if you know what causes your hives (like certain foods, heat, or everyday stress), try to avoid those triggers
- Don’t scratch – scratching can make the rash worse and irritate the skin further
If your hives don’t improve after 2 days, keep coming back or are affecting your daily life, it’s important to speak to a GP for extra support and treatment options.
Yes, hives (urticaria) often go away on their own without treatment. Most hives clear up within a few hours to a few days, especially if they’re caused by a mild trigger like food, temperature changes or everyday stress. For some people, hives may last longer or keep coming back. If hives persist for more than 6 weeks, it’s known as chronic urticaria and may need further investigation by a GP. If your hives don’t improve after 2 days, keep coming back or are affecting your daily life, it’s important to speak to a GP or pharmacist for advice.
No, scratching doesn’t spread hives to other parts of your body, but it can make them feel worse. Scratching triggers the release of histamine, a chemical in your skin that can cause more itching, swelling and redness.
Scratching can also irritate the skin, leading to more visible hives or a longer-lasting rash. For relief, try these tips:
- Apply a cool compress – this can calm the itch and reduce swelling
- Take an antihistamine – it can block the effects of histamine and ease itching
- Wear loose, soft clothing – tight or rough fabrics can make hives feel more uncomfortable
Hives due to a period of prolonged everyday stress cause raised, itchy bumps (welts) on the skin, just like other types of hives (urticaria). They can look different depending on your skin tone:
- On lighter skin, they may appear red or pink
- On brown or black skin, hives might look darker, grey, purple or slightly raised with no obvious colour change
Key features can include:
- Raised, puffy welts that can be small or large, often in clusters or patches
- Itchy, tingly or burning sensation on the skin
Hives may appear anywhere on the body, including the face, neck, chest, arms and legs. The rash can come and go quickly, sometimes disappearing within hours or reappearing in a different spot.
If you’re looking for relief from the itching and swelling caused by hives, certain creams can help soothe your skin. You can consider:
- Menthol cream – provides a cooling, soothing sensation to calm itchy, irritated skin
- Calamine lotion - delivers a cooling effect and can help ease mild irritation. Always read the label.
If hives don’t improve after 2 days, keep coming back or cause swelling under the skin (angioedema), it’s important to speak to a GP for advice.
Yes, for some people, hives can feel worse at night. This is because histamine levels (the chemical that causes itching and swelling) naturally rise in the evening and at night. This can make the itching more intense and disrupt sleep.
Other factors that can make hives feel worse at night can include:
- Heat from bedding – warm temperatures under blankets can trigger or worsen hives
- Sweating at night – sweat can irritate sensitive skin, leading to more itching
- Increased body awareness – without daytime distractions, you may notice the itching more
If hives keep coming back or disrupt your sleep, a GP or pharmacist can recommend treatments to help you get a better night's rest.
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