Overview
Urticaria happens when mast cells in the skin release histamine, producing weals that appear suddenly, itch intensely and usually fade within 24 hours without leaving a mark. Angioedema is deeper swelling of the lips, eyelids or hands.
Acute urticaria often follows a viral infection, medication or food trigger. Chronic spontaneous urticaria lasts over six weeks and usually has no identifiable trigger; it is an immune-driven condition rather than an allergy.
When to seek urgent medical help
- • Swelling of the tongue or throat, difficulty breathing or swallowing - call emergency services
- • Feeling faint, dizzy or unwell with the rash
- • Weals lasting more than 24 hours, painful or bruising in appearance
Symptoms and signs
- Raised pink or pale weals of varying size that move around the body
- Intense itch, often worse in the evening
- Individual spots that disappear within 24 hours
- Swelling of lips, eyelids, hands or feet (angioedema)
- Weals triggered by pressure, heat, cold, exercise or scratching
- Symptoms recurring over weeks or months in chronic urticaria
Management and treatment
Non-sedating antihistamines are the foundation of treatment, and guidelines support increasing the dose up to four times the standard amount under medical supervision if standard dosing fails.
Your ChatDoc doctor will confirm the pattern, rule out red flag features, set out a stepped antihistamine plan and arrange onward referral if symptoms are resistant.
Prescription treatment options
Non-sedating antihistamines
Daily cetirizine, fexofenadine or loratadine as first-line treatment, taken regularly rather than as needed.
Up-dosed antihistamine regimen
Doctor-supervised increase up to four times standard dose for persistent hives.
Short oral steroid course
Reserved for severe acute flares over a few days, not for long-term control.
Referral for omalizumab
Specialist biologic treatment for chronic urticaria that does not respond to antihistamines.
Any prescription is issued only after a doctor has reviewed your case and considers the treatment safe and appropriate for you.
Your online Urticaria (Hives) assessment
- 1
Tell us about your concern
Share symptoms, past treatments, medicines and relevant health information.
- 2
Upload clear photos
Upload photos of your concern where applicable.
- 3
Doctor reviews your case
Technology helps organise your answers, but every assessment and prescription decision is made by a doctor, who may message you if they need more information.
- 4
Get your personalised plan
A personalised prescription is issued if treatment is clinically appropriate.
Prognosis and outlook
Acute urticaria usually resolves within days to a few weeks. Chronic urticaria improves spontaneously in around half of people within 12 months and most within a few years.
Between flares the skin is completely normal, and hives do not scar even when the itch is severe.
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This page is general medical information and does not replace a personal consultation. Always seek urgent care for severe or rapidly worsening symptoms. ChatDoc is not an emergency service. Call 999 (UK) or 112 (EU) for life-threatening emergencies or 111 for urgent non-emergency help. Do not wait for an online reply.