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Hives (Urticaria)

Urticaria, more widely known as hives, are raised, red, and extremely itchy “welts” (called wheals) on the skin that can last minutes to hours. Hives appear when special skin cells known as mast cells trigger a release of rash-causing chemicals (often in response to some sort of allergen).

Most cases of short-lasting hives are triggered by allergic reactions, medications, or viral infections. Allergies to foods, bee stings, medications, or airborne substances can all cause hives. Physical factors such as pressure, cold, heat, or vibration can also provoke urticaria in certain people. Dermatographism (Latin for “skin writing”) refers to hives that pop up for only minutes after a scratch or irritation to the skin and occur in 2-5% of the population.

Chronic hives – those lasting for more than 6 weeks – are usually not triggered by allergies but are believe to be the result of an abnormal immune response involving mast cells, the cells that release histamine into the skin causing hives to appear.


Hives are described as being extremely itchy, which can lead to disruptions in sleep, school, work, and daily life. Hives typically only last a short time, but it is also possible to experience hives lasting for weeks or months. While chronic hives are not normally due to allergies, the severity of chronic hives can be affected by factors such as stress, medications, temperature, and illnesses. At times, hives can also be associated with angioedema which is a deeper swelling of the skin.

No matter what type of hives you experience, common symptoms may include, but are not limited to:

  • Itchy, red bumps or welts on the skin
  • Swelling of the face, eyes, lips, and/or tongue (called angioedema)


When possible, it is important to identify the cause of hives. The first step in a urticaria diagnosis is consulting with a professional allergist to discuss medical history and receive a physical examination. Hives triggered by food, insect stings, medications, or other allergens can be detected through allergy testing.

Allergy skin tests, and specific allergen blood testing can be used to determine which allergens are causing the hives. In some cases, additional tests such as histamine release tests (HRT) may be recommended to further evaluate underlying causes of hives.

Four Steps to Relief

  1. Planning Your First Visit

    Schedule an appointment at your local office and fill out our pre-registration and medical history forms to help minimize any wait time when you arrive.

  2. Your First Visit

    Your initial visit will consist of a consultation, review of your medical history and a comprehensive exam to build a treatment plan tailored to your unique needs.

  3. Diagnostics and Testing

    We may complete one or more tests to better understand the cause of your symptoms. Common tests include skin testing, pulmonary testing, and blood testing.

  4. Treatment

    Following the evaluation and testing, we’ll provide a comprehensive diagnosis and implement a personalized treatment plan that will deliver relief.


Allergy Partners will work with you to develop an individualized treatment plan to manage your condition. Once your hives triggers are determined, you should avoid allergens as much as possible. If you notice a hives flare-up, there are home remedies you can try before seeking medical assistance, such as:

  • Cold compresses
  • Bathing in an anti-itch solution (such as colloidal oatmeal)
  • Anti-itch moisturizers and solvents (such as calamine lotion or aloe vera)

Histamine-blocking medications are also commonly used to treat hives. These antihistamines include the commonly used diphenhydramine (Benadryl®) and less sedating antihistamines like loratadine (Claritin®), cetirizine (Zyrtec®), or fexofenadine (Allegra®).

Severe or persistent urticaria can be treated with high dose antihistamines or the temporary use of corticosteroids (such as prednisone) under the supervision of a professional allergist. In chronic urticaria it is sometimes necessary to prescribe other medications that act on the immune system to alleviate the symptoms. Your allergist will let you know if this is necessary.

The Allergy Partners Difference

At Allergy Partners, our board-certified and board-eligible specialists are experts in evaluating and treating the numerous causes of hives and other allergic reactions. The evaluation begins with a thorough medical interview and physical examination, followed by any tests that may be required. 

If you or a loved one has developed hives and you’d like to consult with a medical professional in the field of allergy care, please contact Allergy Partners today. Call (828) 277-1300 to request your initial appointment.

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