Hives (Urticaria) – Causes, Symptoms & Treatment

Hives (urticaria)

Hives (urticaria) , also nettle fever , is a complicated and complex skin disease. It arises as a result of a hypersensitive reaction to various chemical and natural substances or external stimuli on the skin. Around 10 to 20 percent of people in Germany have had hives at some point in their lives. Hives are not contagious, but should be examined and treated by a doctor as soon as possible, as in some cases it can lead to circulatory shock and then a life-threatening situation.

What is hives (urticaria)?

Hives are known in medical terminology as urticaria and are characterized by characteristic red wheals on the skin that arise from smaller, red bumps. These can basically appear on any part of the body, some are more susceptible to it than others.

Acute urticaria is a form that lasts 6 weeks at the longest and then resolves. If the symptoms last longer, it is called chronic hives.


Most hives are triggered by histamines secreted by the skin’s mast cells. As a result, the small elevations form first, which gradually spread to wheals. The reasons for the release of histamine are different. This can be an autoimmune reaction, for example. The body does not tolerate its own substances that it releases itself.

In response, hives develop. However, there can also be a hypersensitivity to a substance that either comes into direct contact with the skin or passes through the digestive tract. These can be coloring or flavoring substances, but also pathogens such as bacteria, which only express themselves through this symptom. In rarer cases, there is a real allergy , which is noticeable by hives.

The other two major causes of hives include the physically and psychologically induced condition. External stimuli such as pressure or scratching can cause red wheals to appear on the affected area, which disappear over time or only after a longer healing process. Stress or mental stress can also be the trigger of hives.

Symptoms, Ailments & Signs

The first signs of hives are itching and the typical wheals . As a result of the accumulation of water , the surface of the skin swells and inflamed areas develop, which are sharply defined and painful on contact. These wheals can be white to reddish and a few millimeters to two centimeters in size.

Several wheals can combine to form a large-scale skin change. This can lead to bleeding and, in isolated cases, to the development of ulcers . Typical accompanying symptoms are also feelings of tension and skin irritations, for example sensory disturbances or overheating. Occasionally, the wheals are accompanied by so-called angioedema.

This is cushion-like, swollen subcutaneous tissue that is usually painless. However, redness , itching and a feeling of tension can occur. Angioedema occurs mainly on the face, palms and soles. In some cases, the mucous membranes are also affected.

Wheals resolve within a day. In chronic hives, the skin changes can last for weeks, months or even years and affect large areas of the skin. If hives occur as part of an allergy , anaphylactic shock can occur, which is associated with shortness of breath , outbreaks of sweating , tachycardia and finally circulatory shock.

course of the disease

The course of hives depends on the form of the disease. In the acute form, the disease usually only lasts a few days or a few weeks. The maximum duration of acute hives is six weeks. As already mentioned, typical symptoms are a very itchy skin rash with reddish wheals and, in rare cases, painful swelling of the skin.

Chronic hives , however, can last up to several years or appear again and again. However, the symptoms of acute hives are less common. Chronic hives should always be treated by a doctor to find out the cause and potential allergies or sensitivities to certain foods that are responsible for the chronic hives.


In most cases, those affected by hives suffer from various skin complaints. These are very uncomfortable and can mean a significantly reduced quality of life for those affected. In most cases, a rash develops on the skin. This rash is also associated with itching, so scratching can also form scars.

Children in particular scratch themselves constantly, which can also lead to bleeding. The skin itself is white in color on the affected areas and also slightly swollen in some cases. Hives can also spread to the tongue or mucous membranes. It can also lead to shock and, in the worst case, heart failure.

However, this case occurs only very rarely. As a rule, hives can be reduced relatively easily with the help of medication. The patient may need light therapy. However, no particular complications arise. The hives usually do not negatively affect the life expectancy of the patient.

When should you go to the doctor?

If the skin symptoms remain unchanged for days, this should be clarified by a doctor. If skin changes increase, a doctor’s visit is advisable in the next few days.

If itching, antipruritic medication may be needed. Which medications are suitable or what alternatives there are to drug therapy can be clarified with your family doctor . If shortness of breath, circulatory problems or swelling of the body occur, emergency action is required as a life-threatening condition can arise. If swelling occurs, for example on the face, an emergency medicine specialist can quickly alleviate the symptoms with medication. In the case of chronic courses, urticaria advice can be sought in special treatment centers. The focus here is on helping people to help themselves. This avoids frequent visits to the doctor, which can reduce the quality of life.

If you are unsure whether a doctor’s visit is necessary, it is advisable to do so as a precaution. Accompanying psychological complaints, which are a consequence of the itching, for example, can also be addressed by the family doctor. A further referral to specialists who specialize in psychological support or skin diseases is made by the general practitioner.

Treatment & Therapy

Acute urticaria is usually not treated. In most cases, the wheals will go away on their own Depending on the cause, this can happen within a few minutes, but it can also take a few weeks.

Chronic hives are treated with antihistamines and cortisol . However, both active ingredients only suppress the symptom of an underlying disease. Therefore, it must be determined at the same time why chronic hives developed. It can only be permanently eliminated if the trigger is also eliminated. If there is an underlying bacterial infection of the digestive tract, hives will only go away permanently if the bacteria are fought and killed. Accordingly, individual therapy with specific drugs for the respective disease is required.

Drugs do not help with psychological causes. In such cases, it is important to find the trigger and eliminate it in the long term. A psychologist can help with this.

Outlook & Forecast

There are already very good treatment options for hives these days. The most important thing is to find out what caused the disease. This can be done by keeping a diary. If the drug treatment works well, the patient can be symptom-free. The unpleasant hives are prevented by avoiding the trigger and by taking long-term medication. The prognosis of hives is therefore very good with successful treatment.

If left untreated, hives lead to spontaneous swelling of the skin, redness, itching and burning. The symptoms are very uncomfortable for those affected. They can last up to 24 hours and severely restrict the patient’s everyday life and quality of life. Insomnia, loss of concentration and performance (at school or work) are not uncommon. As a result, sex life can suffer and depression , withdrawal and anxiety can massively affect those suffering from hives.

The prospect of healing or learning to live with the disease is very good in today’s modern medical age. There is not only sufficient specialist literature for extensive research into the causes, but also enough medicinal and homeopathic approaches that enable a symptom-free life with hives.


Hives can only be prevented if the cause is known. If it is physical, it is important to avoid situations in which it could arise again.

In allergic reactions , the body must be kept away from the substance to which it is reacting. The same applies to hives that occur as a result of an intolerance.

Prevention becomes more difficult when it comes to psychosomatic hives. Since stress in particular can hardly be avoided effectively in everyday life, the patient must be taught to process stressful situations effectively and thus prevent the development of physical symptoms.


When those affected have gone through the acute treatment phase, it must be determined which trigger has caused the hives. This may be induced by chemical or biological factors such as infection, food, medication, or insect venom, or it may be the result of physical irritation from friction, cold, pressure, heat, or light.

If there is a high probability that the trigger is in the diet, an elimination diet should be followed. This is important to avoid serious complications such as glottic or Quincke edema in the future. With this special form of nutrition, the patient receives only tea, water, potatoes and rice for a week.

These foods are generally considered to be minimally irritating, meaning they contain no flavors, fragrances, colors, or preservatives that could lead to urticaria. When the immune system has been cured after a week of dieting, the series of provocation tests begins in the follow-up care. Gradually, the patient receives a food that may be responsible for the hives.

The cause can be identified through strict documentation of the skin and mucous membrane reaction. The provocation test also includes a skin test in which a small area is exposed to various physical stimuli. Here, too, the reactions are precisely documented. If those affected then know about the causes of urticaria, they can avoid this unpleasant condition in the future.

You can do that yourself

In everyday life, people affected by hives should ideally know exactly what they are allergic to. This makes it possible to avoid certain ingredients as much as possible. It is not always easy to find out what you are reacting to with hives. It can therefore be helpful to keep a log: When do the wheals appear and in what context? Sometimes it is possible to identify a trigger for the itching and wheals with a close-meshed protocol.

Especially when potential triggers of hives are unclear, it is important that those affected have the necessary medication in their medicine chest. The hives can be so severe that the eye swells up completely. In the worst case, the respiratory tract can also be obstructed in severe uricaria. Self-help in acute cases is not possible here.

While milder symptoms of hives in everyday life can often be alleviated by appropriate antihistamines, shortness of breath is always a medical emergency. Relatives should be familiar with the external symptoms and know that they must call an emergency doctor immediately if they have difficulty breathing . This can quickly stop the allergic reaction with special drugs that are administered intravenously.

Lisa Newlon
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Hello! I am Lisa Newlon, and I am a medical writer and researcher with over 10 years of experience in the healthcare industry. I have a Master’s degree in Medicine, and my deep understanding of medical terminology, practices, and procedures has made me a trusted source of information in the medical world.