What is hives?
Hives (urticaria) are raised, itchy welts on the skin caused by histamine release. Each welt usually lasts less than 24 hours but new ones can keep appearing. Acute hives (<6 weeks) are usually triggered by allergens, infections, or stress. Chronic hives (>6 weeks) are often autoimmune.
Most acute hives resolve with antihistamines and removing the trigger. Chronic hives benefit from a longer treatment plan.
Do I have hives? Common signs
If most of these describe what you're experiencing, telehealth may be a good next step:
What causes it
Acute: foods (nuts, shellfish, eggs), medications (antibiotics, NSAIDs, opioids), infections, insect stings, latex. Chronic: often autoimmune (your own antibodies activate mast cells). Physical triggers: pressure, cold, heat, sunlight, exercise.
Is it contagious?
No.
Antihistamines work — but use the right one at the right dose. Many people are under-treating.
Can it be treated online?
Acute hives without breathing difficulty are well-suited to telehealth. Throat tightness, trouble breathing, or anaphylaxis needs 911. Chronic hives can be managed by telehealth with referral to allergy/immunology for refractory cases.
How hives is treated
Second-generation H1 antihistamines are first-line — cetirizine (Zyrtec), loratadine (Claritin), fexofenadine (Allegra), levocetirizine (Xyzal). Up to 4x normal dose may be needed for chronic hives. Adding an H2 blocker (famotidine) or short steroid course can help severe flares. Chronic refractory cases may need omalizumab (Xolair).
Self-care while you wait
- Identify triggers if possible
- Cool compresses for itch
- Avoid heat, hot showers, tight clothing during flares
- Avoid NSAIDs and aspirin if they trigger you
- Loose, soft clothing
- Reduce stress
How long does it last?
Acute hives usually resolve in days to weeks. Chronic hives can last months to years but typically improve over time.
Frequently asked questions
Do I need to know the trigger to treat hives?
No — most acute cases respond to antihistamines even without identifying the trigger.
Why isn't Zyrtec working?
Chronic hives often need 2–4x the standard dose. Discuss higher dosing with your clinician.
Is it food allergy?
Sometimes for acute hives. Chronic hives are rarely caused by food allergy — most are autoimmune.
Can stress cause hives?
Yes, stress can trigger or worsen hives in many people.
Will allergy testing help?
For acute hives with a specific suspected trigger, yes. For chronic hives, allergy testing is usually low-yield.
