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Hives (urticaria)

Dr Karen Martin
Reviewed by Dr Karen MartinReviewed on 19.10.2023 | 2 minutes read
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Hives are also known as urticaria or nettle rash. Red raised circular marks appear called wheals, which resemble a dartboard bullseye. These are usually intensely itchy, and may also sting or burn. Wheals appear anywhere on the body within minutes to hours of meeting an allergen or irritant.

Antihistamine tablets or creams can reduce the reaction, and cooling agents and moisturizers can calm the itch. The wheals should disappear within 24 hours, although redness or a form of bruising may persist.

Hives are not contagious, and cannot be passed on.

Doctor’s advice

What causes hives?

Common culprits include medications (ibuprofen, aspirin, ramipril, enalapril, and antibiotics such as penicillins), animal fur, plants, or certain foods. A recent cold, other viruses, extremes of heat, cold, or sweating can bring on this rash in susceptible individuals. Stinging nettles cause classic urticaria. But more often than not, no cause is found.

Healthwords pharmacists' top tips

If your rash is very localized and in a small area, you can use an antihistamine cream such as Anthisan. If the area of the rash is larger or spreading to other areas, it is best to use an antihistamine tablet to calm the allergic response.

For skin rashes such as hives, diphenhydramine works very well, and a noticeable reduction in symptoms is usually achieved within 12 hours. The only downside is that the tablets need to be taken quite regularly (every four hours), and they can cause some drowsiness.

If the drowsiness is a problem, then other antihistamines are available such as those containing cetirizine (Zyrtec), or loratadine (Claritin), or others. These can be used as an alternative.

The best combination in some cases may be to use a mild steroid cream such as hydrocortisone 1% cream to bring down the itch and redness in the worst affected areas, used alongside an antihistamine tablet. Be sure to avoid using the steroid cream on broken skin, and apply thinly at most twice a day, unless otherwise recommended by a doctor.

Overall, it is important to be aware of what triggers your hives rash and take preventative measures to avoid them where possible, whether it is related to direct contact with skin, environmental factors, or dietary factors.

Am I fit for work?

You are fit for work if you have hives.

When should I see my doctor?

If your rash persists beyond two days, it's worsening or spreading, or you have a recurring rash, you should book an urgent appointment with your doctor. They will discuss your symptoms and examine you. They may send you for a blood test, and refer you to a specialist if necessary.

Angioedema is a related condition, where there is swelling under the skin, there may or may not be wheals, and any rash is sore when pressed but not usually itchy. The throat, tongue, and skin around the eyes can swell - if you experience breathing or swallowing difficulties, call for an ambulance or go to your nearest emergency department immediately, as this may indicate a life-threatening form of angioedema.

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Dr Karen Martin
Reviewed by Dr Karen Martin
Reviewed on 19.10.2023
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