Urticaria (Hives)
Urticaria — commonly known as hives — causes raised, intensely itchy welts on the skin that can appear and disappear rapidly, often within hours. Triggers include allergens, medications, infections, and stress. Treatment can provide rapid relief and, for chronic urticaria, identifying triggers helps prevent recurrence and significantly improves quality of life.
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This page provides general health information only. Urticaria with swelling of the lips, tongue, or throat, or difficulty breathing, is anaphylaxis — call 112 immediately.
What is urticaria?
Urticaria occurs when mast cells in the skin release histamine and other chemicals, causing localised swelling, redness, and intense itching. The individual welts (wheals) typically appear suddenly, are pale or pink, and resolve within 24 hours — though new ones may appear elsewhere. Angioedema — deeper swelling under the skin, most commonly affecting the face, lips, and throat — can accompany urticaria.
Acute urticaria lasts fewer than 6 weeks and usually has an identifiable trigger. Chronic spontaneous urticaria persists for more than 6 weeks, often without an identifiable cause, and requires longer-term management.
Common triggers
- Medications — NSAIDs (ibuprofen, aspirin), antibiotics, and ACE inhibitors are common causes
- Food allergens — nuts, shellfish, eggs, milk, and food additives
- Infections — viral or bacterial infections frequently trigger acute urticaria
- Insect stings — wasp and bee stings are a very common cause in Portugal and Spain
- Physical triggers — pressure (dermographism), cold, heat, exercise, or water
- Stress — a significant trigger for chronic urticaria flares
- Autoimmune causes — in chronic urticaria, autoantibodies against mast cells are frequently found
- Latex — particularly relevant for healthcare workers
If urticaria is accompanied by swelling of the lips, tongue, or throat, difficulty breathing, dizziness, or a drop in blood pressure — this is anaphylaxis, a life-threatening emergency. Use your EpiPen if available and call 112 immediately.
When to seek urgent help
Seek non-emergency medical assessment if urticaria is widespread, recurring, severely affecting sleep, or persisting beyond 6 weeks. Seek emergency care immediately for any swelling of the airways, difficulty breathing, or signs of anaphylaxis.
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Treatment options
- Non-sedating antihistamines (cetirizine, loratadine, fexofenadine) — first-line treatment; high doses (up to 4x standard) are safe and often needed for chronic urticaria
- Trigger avoidance — removing the causative agent resolves most cases of acute urticaria
- Short courses of oral corticosteroids — for severe acute episodes
- Omalizumab (Xolair) — a biologic injection highly effective for antihistamine-resistant chronic spontaneous urticaria
- Adrenaline (EpiPen) — prescribed for anyone with a history of anaphylaxis; must be carried at all times
How eMedClinic can help
Our doctors assess urticaria, identify likely triggers, prescribe appropriate antihistamines, and refer for allergy testing and specialist management for chronic or severe cases. We also prescribe EpiPens and provide guidance on anaphylaxis emergency management for anyone at risk.
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