Urticaria (hives)
Urticaria is a rash of weals that itch intensely and — this is the defining feature — each individual weal disappears within 24 hours without leaving a mark…
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Medicines commonly prescribed for Urticaria (hives)
For informational purposes only. Always consult a doctor before using any medicine.
Dosage form: ORAL SOLUTION/SUSPENSION DROPS, 10 mg cetirizine dihydrochlorideActive substance: cetirizineManufacturer: Retrain, S.A.U.Prescription requiredDosage form: TABLET, 10 mg/coated tabletActive substance: cetirizineManufacturer: Towa Pharmaceutical S.A.Prescription requiredDosage form: ORAL SOLUTION/SUSPENSION, 1 mg cetirizine dihydrochloride/mlActive substance: cetirizineManufacturer: Retrain, S.A.U.Prescription required
Urticaria is a rash of weals that itch intensely and — this is the defining feature — each individual weal disappears within 24 hours without leaving a mark, while new ones appear elsewhere. It is very common: around one in five people has it at some point in life. In most cases it is benign, if extremely uncomfortable, and it responds well to antihistamines.
How it presents
- weals: pink or skin-coloured raised areas with a paler centre and a red halo;
- from a few millimetres to large plaques that merge;
- intense itching, sometimes burning;
- they move around: appearing and disappearing within hours;
- they can occur anywhere on the body;
- they often worsen in the evening and at night;
- when they go they leave no scaling and no mark.
Angio-oedema: in nearly half of cases there is also deeper swelling of the eyelids, lips, hands, feet or genitals. It is more uncomfortable than itchy and takes longer to settle, up to 72 hours.
When urgent care is needed
- swelling of the tongue, lips or throat;
- difficulty breathing or swallowing, a hoarse voice, a sense of a lump in the throat;
- wheezing;
- dizziness, a drop in blood pressure, loss of consciousness;
- vomiting and severe abdominal pain alongside the rash;
- symptoms began minutes after a food, a medicine or a sting.
This may be anaphylaxis. If you carry an adrenaline auto-injector, use it and call the emergency services.
Types
- acute: lasting less than six weeks. Most cases. Usually caused by a viral infection — particularly in children — a medicine or a food;
- chronic: flares for more than six weeks. In most cases no external trigger is found and the mechanism is autoimmune. This surprises many people, who spend months hunting a culprit food that does not exist;
- inducible: reproducibly triggered by a specific physical stimulus.
Inducible forms
- from pressure or friction, including dermographism: scratching the skin produces a linear weal;
- from cold: cold water, cold air;
- from heat;
- from exertion and sweating — cholinergic urticaria, with very small weals;
- from sunlight;
- from vibration;
- from contact with water.
Common triggers in the acute form
- viral infections, the commonest cause in children;
- medicines: antibiotics, non-steroidal anti-inflammatories, opioids, contrast agents;
- foods: nuts, shellfish, egg, milk, strawberries;
- insect stings;
- latex;
- stress, which does not cause it but does worsen it.
When to see a doctor
- the weals have lasted more than six weeks;
- itching is stopping you sleeping or working;
- standard antihistamines are not working;
- there is angio-oedema, even mild;
- an individual weal lasts more than 24 hours in the same place, is painful or leaves a dark mark — that is not ordinary urticaria and may be urticarial vasculitis, which needs investigation;
- there is fever, joint pain, weight loss or general malaise;
- it appeared after a new medicine;
- episodes recur without explanation.
How it is investigated
In acute urticaria no tests are needed: the trigger is identified from the history. Running a broad panel of allergy tests "just in case" adds nothing and produces false positives that lead to unnecessary diets.
In chronic urticaria a basic set is arranged: full blood count, inflammatory markers, thyroid function and thyroid antibodies. Allergy testing is done only if the history points to something specific. In inducible forms, specific challenge tests are used — an ice cube, pressure, exercise. If a weal lasts more than a day, a biopsy is taken.
Treatment
- second-generation antihistamines — the foundation. They are non-sedating and taken daily rather than only when weals appear;
- increasing the dose up to four times the standard one if the standard dose is not enough: this is an established approach and is directed by a doctor. Many people abandon antihistamines believing "they do nothing", when in fact the dose was too low;
- omalizumab for chronic urticaria that does not respond: highly effective;
- ciclosporin in selected cases;
- oral corticosteroids only in very short courses during a severe flare, never continuously;
- an adrenaline auto-injector if there has been anaphylaxis;
- withdrawal of the triggering drug, always with a doctor.
What you can do
- cool compresses and lukewarm showers;
- loose cotton clothing;
- avoid heat, alcohol and non-steroidal anti-inflammatories, which worsen flares in many people;
- do not scratch: scratching produces more weals;
- keep a flare diary with time, foods, medicines and activity;
- take the antihistamine continuously through the active period;
- manage stress and sleep well;
- do not eliminate foods without a specific reason: a prolonged restrictive diet rarely improves chronic urticaria.
Common questions
Is it always an allergy? No. Most chronic urticaria is not allergic.
How long does the chronic form last? It varies widely: in around half of people it settles within a year, and in others it lasts longer. It nearly always resolves eventually.
Is it contagious? No.
Can I take antihistamines long term? Second-generation ones are safe long term under medical supervision.
What about in pregnancy? There are antihistamines with a good safety profile; check before taking anything.
Online consultation
In an online consultation the doctor reviews photographs and, above all, how long each individual weal lasts — the single most informative detail — distinguishes acute from chronic urticaria and from urticarial vasculitis, adjusts the antihistamine dose and advises which investigations are worthwhile and which are not.
This material is for information only and does not replace a medical consultation.
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Reviewed on Aug 12, 2026
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