Hives can look different from person to person, but the hallmark symptoms include:

• Raised welts (wheals): Pink, red, or skin-colored bumps that can vary in size from small dots to large patches
• Itching or burning: The most common symptom, which may be intense
• Changing appearance: Individual welts may fade within hours, while new ones appear elsewhere
• Swelling (angioedema): In some cases, deeper swelling occurs around the eyes, lips, hands, feet, or genitals
• Duration:
  • Acute hives: Last less than six weeks and often triggered by allergies, infections, or medications
  • Chronic hives: Persist for six weeks or more, often with no clear cause

Although hives are usually temporary, they can significantly affect comfort and quality of life.

Hives result from the release of histamine and other chemicals from immune cells in the skin, leading to swelling and redness. Common triggers include:

• Foods: Nuts, shellfish, eggs, milk, and other food allergens
• Medications: Antibiotics (penicillin, sulfa drugs), aspirin, NSAIDs, and others
• Infections: Viral or bacterial infections are common causes in children and adults
• Insect stings or bites: Can provoke allergic reactions
• Environmental factors: Heat, cold, sunlight, or pressure on the skin
• Stress: Emotional stress may worsen or trigger hives in some people
• Chronic (spontaneous) urticaria: In many long-lasting cases, no specific trigger can be identified

Because the causes are varied, proper evaluation is essential to guide effective treatment.

At Peak Skin Center, diagnosis of hives begins with a thorough history and physical exam. Our board-certified dermatologists will:

• Ask about recent foods, medications, travel, infections, or insect exposures
• Review timing, frequency, and duration of the welts
• Assess for signs of angioedema (deeper swelling)
• Determine whether the hives are acute or chronic

In some cases, additional testing may be recommended:

• Allergy testing referral: To identify possible food, medication, or environmental triggers
• Blood work or urinalysis: To rule out underlying conditions contributing to chronic hives

Because many cases resolve spontaneously, testing is most useful when hives are persistent, recurrent, or severe.

Treatment for hives focuses on relieving symptoms and addressing underlying triggers when possible. At Peak Skin Center, our dermatologists create customized plans that may include:

Avoidance of Triggers

• Identifying and avoiding known triggers is the first step in preventing recurrence.
• Careful review of diet, medications, and environmental exposures may uncover the cause.

Medications

• Antihistamines: Non-sedating antihistamines (such as cetirizine, loratadine, or fexofenadine) are the first-line treatment and help block the histamine response.
• Corticosteroids: Short courses may be prescribed for severe acute flares, but are not suitable for long-term use.
• Biologic therapy (omalizumab): For chronic hives that do not respond to antihistamines, omalizumab injections can provide significant relief.

Supportive Care

• Cool compresses and loose-fitting clothing can reduce itching.
• Stress management techniques may help minimize flares in stress-sensitive patients.