Do hives get better overnight
Hives (Urticaria)
What are hives?
Hives, or urticaria, are flat red welts that can appear anywhere on the skin and usually itch. Hives often occur as an allergic reaction to something eaten or something that has contacted the skin. Foods, medicines, and plants are common causes, but sun exposure, stress, infections, and autoimmune diseases have also been known to cause hives.
Symptoms include an itchy, stinging pink rash of slightly swollen skin. The rash may wax and wane in severity. Acute hives typically resolve within six weeks, but chronic hives (urticaria) can persist for months or years.
Hives often resolve on their own, especially in children. Otherwise, treatment for acute hives involves oral antihistamine medications to help relieve the itching and stinging. Chronic hives that do not improve with antihistamines may be treated additionally with corticosteroids, antibiotics, and other stronger medicines. A study found that 35% of people with chronic hives, are symptom free within one year, with another 29% having some reduction of symptoms.
You can safely treat this condition on your own as long as you does not develop trouble breathing. Any antihistamine (like Zyrtec, Clarinex, etc) works.
How long can hives last?
Hives can appear and disappear quickly, with each hive only lasting around 23 hours. However, depending on the cause, they may reappear and continue affecting someone for days, weeks, or longer.
People can have acute hives, which occurs due to a specific trigger and resolves within
This article looks at how long hives last, factors that influence their duration, and treatment.
Each hive lasts only
Acute hives appear quickly and do not last long. Doctors classify hives as acute if the overall duration is less than 6 weeks.
However, around 25% of people go on to develop chronic hives. This is when hives regularly reappear over 6 weeks or more.
For many individuals, chronic hives eventually clear on their own, but this can take months. According to the American Academy of Dermatology Association (AAD), around half of people with chronic hives spontaneously recover within 1 year.
Acute hives often occur in response to an allergen or irritant. When the immune system perceives a substance as a threat, it releases histamine and other chemicals. This causes tiny blood vessels under someones skin to leak fluid, which accumulates and causes the bump.
Some
- food allergens, such as milk, eggs, tree nuts, peanuts, or shellfish
- contact allergens, such as latex or animal dander
- insect bites or stings
- medications
Any drug can cause hives, but some of the medications most commonly associated with this symptom include:
Acute hives can also occur in response to viral infections, parasitic infections, or during times of stress.
According to a 2018 review, doctors are unsure of the cause of acute hives in
Chronic hives may have the same cause as acute hives, but with symptoms lasting longer than 6 weeks. However, chronic hives are often not due to an allergen and instead have a physical cause.
There are two subcategories of chronic hives: inducible urticaria and chronic idiopathic urticaria.
Chronic idiopathic hives
Chronic idiopathic urticaria has no clear cause and is the most common form of chronic hives. Researchers are working to understand why this type of hives occurs, but a leading theory links it with autoimmunity.
Autoimmunity occurs when a persons immune system mistakenly attacks healthy tissue, and several autoimmune conditions are associated with chronic hives. The most common is thyroid disease, which is present in
This suggests that the hives may result from someones immune system not functioning as it should. Other conditions that can occur alongside chronic hives include type 1 diabetes, lupus, and rheumatoid arthritis.
Infections can also be associated with the onset of chronic hives. This includes bacterial, viral, and parasitic infections. Again, this may result from autoimmunity an infection may trigger a change in how the persons immune system works.
Inducible hives
Inducible or physical urticaria is less common than chronic idiopathic urticaria. With this subtype, it is possible to purposely induce the hives by a person exposing their skin to certain triggers, which could include:
- Scratching or pressure: The
most common type of inducible hives is known as dermatographia. This condition involves developing hives as a response to scratching or drawing on the skin. - Cold: Cold hives occur on someones skin or mouth after exposure to cold temperatures. Triggers include consuming iced drinks, touching cold water, or going outside in cold weather.
- Heat: Cholinergic hives occurs when an individuals body becomes hot or sweaty. Hot baths, exercise, and spicy food can be triggers.
- UV light: Solar hives occur in response to UV light from the sun and certain light bulbs, such as those in tanning beds.
- Water: Some people develop hives if their skin comes into contact with water. This is known as aquagenic urticaria and is very rare.
Doctors diagnose hives by performing a physical examination. There is no test to determine whether the persons hives are acute or chronic, so they will use the length of time they recur to do this.
The doctor may also ask an individual:
- when the rash began
- the shape, size, and distribution of the rash
- where on the body they first noticed the rash
- if they have had any insect bites
- if they live or work with common hive triggers, such as chemicals, animals, or latex gloves
- if they have bone or joint pain, fever, or abdominal pain
- if anyone in their family experiences hives
- if they take any medications or supplements
The doctor may use a skin prick test and serum-specific IgE test to check if the acute hives result from a specific substance, such as food, dust mites, or chemicals. Alternatively, they may refer someone to an allergy clinic for these tests.
However, in cases of chronic hives, allergy testing is rarely useful. A doctor may check for other underlying health conditions by performing additional tests, such as:
The most suitable treatment depends on whether the person has acute hives or chronic hives.
Acute hives
Doctors typically recommend second-generation antihistamines as the first-line treatment for acute hives, such as:
- loratadine (Claritin)
- desloratadine (Clarinex)
- fexofenadine (Allegra)
- cetirizine (Zyrtec)
- levocetirizine (Xyzal)
They may prescribe a standard dose or increase by up to 4 times if the individual does not respond.
If these medications do not improve symptoms, the doctor may recommend an additional antihistamine, such as cimetidine (Tagamet), famotidine (Pepcid), or ranitidine (Zantac). They may recommend a 310-day course of corticosteroids to help control the symptoms in severe cases.
The doctor may prescribe an epinephrine auto-injector if they think the individual is at risk of anaphylaxis, which is a severe allergic reaction that restricts breathing. This provides emergency medicine to treat anaphylaxis quickly.
The doctor will then reassess the individual in 26 weeks.
Chronic hives
Doctors may recommend a four-step treatment plan for chronic hives. This approach involves using an antihistamine daily, which may be up to 4 times the regular dosage depending on how the individual responds.If necessary, they may prescribe a second antihistamine or another medication, such as montelukast (Singulair). With persistent hives, they may suggest a high potency antihistamine, such as hydroxyzine or doxepin.
The final step is for a doctor to refer the individual to a specialist for immunomodulatory therapy. This may involve taking medications such as omalizumab (Xolair) or cyclosporine (Sandimmune).
Once symptoms are under control, a doctor may gradually reduce the dosage of these medications. If the hives have an identifiable cause, such as cold or heat exposure, adopting changes to avoid the triggers wherever possible is also important.
The AAD suggests the following methods for people to reduce irritation and itchiness in hives:
- applying topical anti-itch medications, such as calamine lotion
- wearing loose-fitting clothing
- moisturizing with fragrance-free lotion to prevent dry skin
- using cold compresses several times per day
However, it is important for individuals to try to determine whether the hives have a specific trigger, in addition to relieving symptoms. If someone has cold hives, for example, a cold compress may make them worse.
Therefore, it is a good idea for people to keep a symptom diary, recording when the hives occur and any factors that might have contributed. Symptom diaries are also useful to refer to at medical appointments. A person can take note of:
- the date and time the hives appear
- what they were doing just before they developed
- what they have had to eat or drink
If any common factors emerge when the hives occur, a person can try to temporarily avoid these to see if it helps. It is important for people to do this with the guidance of a doctor, allergist, or dietitian if someone has food-related hives.
Learn more about remedies and treatments for hives here.
Hives do not last long, taking only 23 hours to fade. However, more can appear, which makes the symptoms last longer. Acute hives can develop and resolve on their own within 6 weeks, while chronic hives can last much longer.
Doctors treat acute and chronic hives differently, so it is advisable for people to speak with a medical professional about this symptom, especially if the hives last longer than 6 weeks.
If hives or swelling occur in the mouth and airways, making it difficult to breathe, dial 911 or the number of the nearest emergency department immediately.
What causes hives that come and go daily?
Some people experience a flare-up of hives that goes away on its own. Other people may have hives that come and go daily.
Hives are itchy, raised bumps on the skin. Doctors diagnose chronic hives in people who experience them for at least 6 weeks. Each hive typically lasts for 24 hours before disappearing. Usually, the condition does not have an identifiable cause, but sometimes it does.
Some people experience chronic hives due to an underlying condition. Therefore, it is important for individuals to speak with a doctor about hives that keep returning.
Keep reading to learn more about the symptoms, causes, diagnosis, and treatment of hives that come and go daily.
Chronic hives is a condition that causes hives that keep coming back. Each one lasts less than 24 hours but, as old hives fade, new ones appear. If this continues for 6 weeks or longer, a doctor will diagnose chronic hives. Acute hives lasts less than 6 weeks.
The symptoms of both acute and chronic hives are the same. A person will have welts that come and go. In some cases, symptoms can hinder daily activities and impair sleep.
Chronic hives look identical to acute hives. In both cases, they can flare up and resolve, but chronic hives keep coming back for 6 weeks or longer and typically occur daily.
Hives are itchy, raised welts on the skin that may be red or the same color as a persons skin. Hives can develop anywhere on the body, move around, and change shape. They can also appear and disappear suddenly.
Hives usually do not break the skin, but bleeding can occur if a person scratches them.
Chronic hives can happen for various reasons. In most cases, however, it is not possible to identify the trigger.
Chronic idiopathic urticaria
The medical name for chronic hives that have no clear trigger is chronic idiopathic urticaria.
According to the American Osteopathic College of Dermatology (AOCD), the immune system is overactive in about half of people who have chronic idiopathic urticaria. Doctors consider these cases autoimmune, as they stem from the immune system attacking healthy tissues.
However, some
Bacterial infections associated with chronic hives include:
Viral infections associated with the condition include:
Parasitic infections associated with chronic hives include:
Autoimmune conditions
Some cases of chronic hives may stem from an underlying autoimmune disease.
Conditions associated with chronic hives include:
Research suggests that
Physical stimuli
Chronic hives can stem from physical stimulation, such as scratching or rubbing the skin. This is known as physical urticaria or dermatographism. The most common trigger is scratching or rubbing the skin firmly. The hives are not always itchy.
Other physical triggers may include:
- exercise
- cold temperatures
- hot temperatures
- sunlight
- vibration
- pressure
Allergies
As with acute hives, chronic hives can also occur due to an allergy. However, unlike acute hives, this is a
Some common allergens that can trigger hives include:
- certain foods
- food additives and preservatives
- latex
- medications
Reactions to medications can happen at any time after someone starts taking one. Some common triggers include:
Diagnosing chronic hives may begin with consulting a primary care physician, an allergist, or a dermatologist. They will examine the hives and ask the person questions to rule out common causes, such as a medication reaction.
A doctor may order diagnostic tests to check for other conditions that could be causing symptoms. This could include allergy testing, blood tests to detect inflammation markers, or tests for celiac disease or thyroid problems.
If the hives are not always apparent, it may help for a person to take photographs to show a doctor at the appointment. Keeping a diary of when the hives appear and any possible contributing factors may also help. People can track:
- food they eat
- medication they take
- exposure to physical stimuli, such as the sun, friction, or pressure on the skin
In cases where there is no clear cause, treatment focuses on managing the hives.
A doctor may recommend the
- Second-generation H1-antihistamines: This is the first-line treatment for chronic hives, and includes drugs such as cetirizine and loratadine. Routine use of first-generation H1 antihistamines, such as diphenhydramine (Benadryl), is not recommended by doctors due to sedating side effects.
- Omalizumab (Xolair): If symptoms do not respond to the first-line treatment, practitioners may add Xolair for a second-line treatment. It is a monoclonal antibody, which blocks the action of substances in the body that produce hives.
- Cyclosporine (Gengraf): Doctors may prescribe this when someone does not respond to a combination of an H1-antihistamine and omalizumab.
- Corticosteroids: Short-term use of these anti-inflammatory drugs may be an option to alleviate flare-ups of chronic hives. They are not suitable for long term use due to the risk of cataracts and other possible adverse effects.
If a person knows the trigger, avoiding it can help manage symptoms.
Chronic hives can go away. One study found that 35% of participants with chronic hives had no symptoms after 1 year, and another 29% experienced a reduction in symptoms during this time.
Among individuals with idiopathic chronic hives, 48% experienced remission within 3 years. However, only 16% of those with physical hives experienced remission within 3 years.
If a person has flare-ups of hives for 6 weeks or longer, the American Academy of Dermatology recommends visiting a board-certified allergist, dermatologist, or primary care doctor.
If someone experiences severe hives inside their mouth or airways that affect breathing, call 911 or the number of the nearest emergency department. This could be a sign of a severe allergic reaction, or anaphylaxis, which can make it hard to breathe and can be life threatening.
Here are some questions people often ask about chronic hives.
Why am I getting chronic hives?
In many cases, it is not clear what is causing hives. However, they may be linked to allergies and some immune conditions, such as lupus and celiac disease. Physical stimuli for instance, heat, pressure and vibration may also contribute.
Will chronic hives ever go away?
Chronic hives can go away over time, or symptoms may improve. However this does not happen for everyone. If hives go away, they can also come back in some cases.
How can I get rid of chronic hives?
It might not be possible to get rid of chronic hives, but treatment options such as antihistamines, corticosteroids, and other drugs can help manage symptoms.
Hives that come and go daily for at least 6 weeks are chronic hives. Most cases do not have an identifiable cause, but it is associated with an infection, autoimmune condition, allergy, or physical cause in some people.
Physical hives can occur due to exercise, vibration, or exposure to hot or cold temperatures. However, chronic idiopathic urticaria when there is no known cause is more common.
Chronic hives can affect a persons quality of life, but doctors can prescribe medications to help manage the symptoms.
