If you’ve ever had hives, you know firsthand how horrible they can feel. They’re prickly and itchy. They can be red or white, and they appear as raised welts.

The medical name is urticaria. It often (but not always) results from an allergic reaction. But finding the exact cause can be difficult. Sometimes, patients are forced to treat the problem without ever knowing how it began. (Optum Perks can help with that: Our free discount card saves you money at the pharmacy.)

But there’s good news. With quick action, you can reduce your suffering. Keep reading to learn how.

What kinds of allergies cause hives?

Hives are a type of immune reaction that develops very quickly, says Blair Murphy Rose, MD, a board-certified dermatologist based in New York. “The most common allergic triggers of hives are medication and food allergies,” says Dr. Rose. Common medications linked to hives include:

The list above is not exhaustive, of course. And medications aren’t the only cause of hives. Many things can spark your body’s immune system to overreact and create an itchy rash.

Airborne allergens, such as pollen, animal dander, dust mites and mold, are common agitators, says Katie Marks-Cogan, MD. She’s a board-certified allergist who practices in Los Angeles. She also notes that contact allergens, such as saliva from cats or dogs, can cause hives. (We’ve uncovered the secrets to saving money on allergy medications. Click here to learn more.)

Infections and insect bites and stings might also be responsible. And then there is the list of physical causes. For some people, heat or sunlight can do it. So can pressure or rubbing from clothing. In some people, even vibrations can spark hives. (This is called vibratory urticaria. A bumpy car ride could set it off.)

In some cases, hives are just one part of a bigger immune response. “Hives associated with other symptoms, such as wheezing, decreased blood pressure, diarrhea, vomiting, abdominal pain or dizziness, may be due to anaphylaxis,” says Dr. Marks-Cogan. Anaphylaxis is a quick, dangerous immune response. Danger is highest among people with severe allergies to bee stings or food allergens such as nuts. If that describes you, think about carrying an auto-injector of epinephrine (Epipen®). It could save your life. There are several versions available, so talk to your doctor to see which is best for you. (You can save on your prescription — and find the best price near you — with the Optum Perks app. Download it now.)

Another condition related to hives is angioedema, or rapid swelling, just beneath the skin. This tends to be more painful than itchy, says Dr. Marks-Cogan. “It usually occurs in the lips, mouth, eyelids, face, larynx, extremities and genitalia,” she says.

How long do hives from an allergic reaction last?

The duration of hives can be hard to predict. They might last minutes, or they might recur for months or years, according to the American College of Allergy, Asthma & Immunology. But generally, you can expect symptoms to clear up in less than 24 hours without treatment.

That said, sometimes new hives emerge as quickly as the old ones disappear, says Dr. Marks-Cogan. If you can’t identify the cause, you might accidentally keep exposing yourself.

What’s the deal with chronic hives?

When hives last longer than 6 weeks, they’re considered chronic, says Dr. Rose. “An autoimmune condition or physical stimulus are the most common causes of chronic hives,” she says. “Very often the cause is idiopathic, meaning the trigger is unknown.”

To find a cause, doctors may explore your medical history and run laboratory tests. But according to Dr. Marks-Cogan, only 20% of patients with chronic hives ever learn what the cause is.

What are the best treatments for hives?

When it comes to treating hives, doctors typically use a combination of medication and non-medication options. Here are some to consider:

  • Gently rub on a hydrocortisone topical, such as Cortaid®.
  • An antihistamine such as diphenhydramine (Benadryl®). You can take these every 4 to 6 hours, but they could make you drowsy.
  • Oral allergy medications can help. Over-the-counter options recommended by Dr. Marks-Cogan include cetirizine (Zyrtec®), levocetirizine (Xyzal®), fexofenadine (Allegra®) and loratadine (Claritin®). (Are you using the right allergy medication? Read more about what sets each one apart.)
  • A histamine type 2 receptor blocker may need to be added for some people. Examples of this medication include famotidine (Pepcid AC®) and cimetidine (Tagamet HB®). You can take them 1 or 2 times per day. “These medications are most often used for heartburn, but we also use them to help control hives,” says Dr. Marks-Cogan.
  • Cover the rash with a cool washcloth or with ice cubes wrapped in a towel. This can soothe itching, says the American Academy of Dermatology Association. You can do this several times throughout the day.
  • For more severe hives, doctors may prescribe a steroid such as prednisone or methylprednisolone (Medrol®).
  • For chronic hives that don’t respond to the above treatments, Dr. Marks-Cogan says a biologic medication such as omalizumab (Xolair®) may need to be prescribed.

Can hives be a sign of something more serious?

In rare cases, yes. Hives could be a sign of a serious illness. Dr. Marks-Cogan points to the following conditions associated with urticaria:

  • Hashimoto thyroiditis
  • Systemic lupus erythematosus
  • Sjögren syndrome
  • Rheumatoid arthritis
  • Vasculitis (blood vessel inflammation)
  • Celiac disease
  • Mastocytosis
  • Lymphoma

If your hives don’t go away quickly, and especially if they’re chronic, see your doctor. You want to rule out the possibility of a more serious condition.

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Additional resources
How to recognize chronic hives: Mayo Clinic