Hives

Also called Urticaria, Nettle rash, Angioedema

Raised itchy weals that come and go within hours. Usually harmless, and occasionally the first sign of anaphylaxis.

What it is

Hives affect around 1 in 5 people at some point. Raised, itchy weals appear, move around, and individual weals disappear within 24 hours, though new ones keep coming.

Acute urticaria lasts under six weeks and is often triggered by a viral infection, a medicine, or occasionally a food. Chronic urticaria lasts longer than six weeks and in most cases no trigger is ever found, which people find deeply frustrating.

Angioedema is deeper swelling, of lips, eyelids, hands or, importantly, the tongue and throat.

The reason this is an urgent-tagged entry: hives with any breathing difficulty, throat tightness, tongue swelling or feeling faint is anaphylaxis until proved otherwise, and adrenaline comes first.

Signs you might notice

Raised, itchy weals, pink or skin-coloured, of varying size, that move around.

Individual weals lasting less than 24 hours. Weals lasting longer, or leaving bruising, suggest a different diagnosis and need assessment.

Angioedema: swelling of lips, eyes, hands or genitals.

Emergency signs: swelling of the tongue or throat, difficulty breathing or swallowing, a hoarse voice, feeling faint, or widespread symptoms after a food, sting or medicine.

Angioedema without hives, particularly on an ACE inhibitor, needs specific assessment.

How it can affect day-to-day life

Chronic urticaria is exhausting and dismissed. It disrupts sleep, it is visible, and being told no cause can be found feels like being told nothing is wrong.

Antihistamines are the treatment and they are commonly under-dosed. Guidelines support increasing non-sedating antihistamines up to four times the standard dose in chronic urticaria, under medical advice, and most people are never offered that.

Heat, alcohol, stress, tight clothing and anti-inflammatories all worsen it without causing it.

Supporting someone well

Learn the anaphylaxis signs and act on them immediately. Adrenaline first, then 999.

Take a non-sedating antihistamine regularly rather than only when itchy, and ask about increasing the dose if it is not controlling it.

Keep cool, avoid tight clothing, and avoid ibuprofen and aspirin, which worsen urticaria in many people.

Keep a simple diary in acute urticaria, though in chronic urticaria accept that a trigger often will not be found.

Ask for referral to dermatology or immunology for chronic urticaria that is not controlled; further treatments exist including omalizumab.

Report angioedema on an ACE inhibitor immediately; the drug needs stopping.

Where to get help

A pharmacist can supply antihistamines; a GP for persistent or severe urticaria.

999 for any breathing difficulty, throat or tongue swelling, or faintness.

Allergy UK helpline: 01322 619898.