Hives (urticaria) is a skin reaction characterized by slightly raised, smooth, red bumps that are often itchy.
Hives are usually temporary and go away on their own within several hours, or at worst, a few days, though they may recur over several weeks. When episodes of hives last more than six weeks, it is considered chronic hives (chronic urticaria).
The main causes of hives on the skin include allergies such as:
- Food allergies
- For example, allergies to peanuts, tree nuts, shellfish, and eggs
- Drug allergies
- The most common drugs that cause allergic reactions include:
- Non-steroidal anti-inflammatories (NSAIDs)
- Angiotensin-converting enzyme (ACE) inhibitors
- Penicillin antibiotics
- Sulfa antibiotics
- Aspirin
- HIV medications
- Anti-seizure medications (anticonvulsants)
- The most common drugs that cause allergic reactions include:
- Physical contact (contact hives), which is an allergic reaction that occurs when a substance comes into contact with the skin
- Insect bites or stings
- Hypersensitivity reactions
- May occur from ingested, inhaled, or injected substances
Non-allergic reactions to substances that cause the body to react in ways similar to an allergic reaction may also cause hives. Causes of nonallergic hives include:
- Certain drugs
- Narcotics (opiates), succinylcholine, and certain antibiotics
- Certain food and beverages
- Aged cheeses, red wine, and spoiled fish are common causes
- Certain venoms
Medical causes for hives include:
- Infectious diseases
- Streptococcal infection
- Viral infections such as acute viral syndromes, hepatitis (A, B, and C), Epstein-Barr virus (EBV), and herpes simplex virus
- Chronic parasitic infections
- Hormonal changes
- Oral contraceptive use or changes in the menstrual cycle
- Pregnancy
- Endocrine tumors or ovarian disease (rare)
- Lymphoma
- Hypothyroidism and hyperthyroidism
- Systemic lupus erythematosus (SLE), rheumatoid arthritis, juvenile rheumatoid arthritis, or other rheumatologic diseases (rare)
Physical causes for hives include:
What Is the Treatment for Hives?
Treatment for hives depends on the cause. The easiest way to treat hives is to avoid any known triggers.
Medications may be used to control itching, including:
- Antihistamines (H1 antagonists) such as diphenhydramine (Benadryl), chlorpheniramine (Chlor-Trimeton), hydroxyzine (Vistaril), loratadine (Claritin, Alavert), fexofenadine (Allegra), desloratadine (Clarinex), and levocetirizine (Xyzal)
- H2 antagonists such as famotidine (Pepcid) and cimetidine (Tagamet)
- Not usually used alone for hives, but may be combined with an antihistamine because the combination can be more effective than an antihistamine alone
- Corticosteroids such as prednisolone (Pediapred, Orapred, Millipred), methylprednisolone (Medrol, DepoMedrol, SoluMedrol), and prednisone (Deltasone, Rayos)
- Sympathomimetics such as epinephrine (Adrenalin, Epi-Pen) for severe hives or anaphylactic reactions
- Tricyclic antidepressants such as doxepin (Silenor, Zonalon, Prudoxin)
- Monoclonal antibodies such as omalizumab (Xolair)
- Immunomodulatory and anti-inflammatory therapy such as cyclosporine (Sandimmune, Neoral, Gengraf), colchicine (Mitigare, Colcrys), and dapsone (Aczone)
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