The problem: wheals that come and go
After a cold, your tummy and thighs are covered in raised, itchy patches. By midday they have gone from there and turned up on your arms. Or after a hot shower, red streaks stay where the towel rubbed. That is what hives look like in everyday life.
The typical skin change is the wheal: a superficial, skin-coloured or pale swelling, usually with a red flare, that itches or burns a lot. Wheals can be a few millimetres or several centimetres across, form rings or map-like patches and change shape. Each individual wheal is gone after minutes, at the latest within 24 hours (DermNet: Urticaria). Sometimes a deeper swelling appears as well, known as angioedema, for example on the eyelids, lips, hands or feet; it can last up to 72 hours (DermNet: Acute urticaria).
Hives are common: about one in five people gets them at least once in their life (Allergieinformationsdienst), (Zuberbier et al. 2022). They are not contagious (Allergieinformationsdienst). Specialists distinguish the forms by duration and trigger. The overview is based on specialist sources and does not replace a diagnosis; only a medical examination can give you certainty.
| Form | Duration and course | Typical triggers |
|---|---|---|
| Acute spontaneous urticaria (most common form) | up to six weeks, often only hours to days (DermNet: Acute urticaria) | infections, medicines, foods, insect stings; often the trigger remains unknown (DermNet: Acute urticaria) |
| Chronic spontaneous urticaria | longer than six weeks, wheals daily or in flare-ups (DermNet: Chronic urticaria); lasts three to seven years on average, but is not a lifelong condition (Allergieinformationsdienst) | usually no identifiable cause, probably autoimmune processes; heat, infections, tight clothing and certain painkillers can make flare-ups worse (DermNet: Chronic urticaria) |
| Chronic inducible urticaria | wheals only after a specific trigger, usually within minutes, usually lasting less than an hour (DermNet: Urticaria) | cold, heat, sweating, pressure, rubbing and scratching, light (Allergieinformationsdienst) |
Two forms of inducible hives have their own pages: Cold allergy (cold urticaria): wheals from cold – what to do? and Skin itches when you sweat: cholinergic urticaria. This page is about the overall picture and what you can do about wheals all over the body.
Why hives develop – and what winter has to do with it
Mast cells release histamine. The skin contains mast cells. When they are activated, they release histamine and other messenger substances. The blood vessels widen, fluid leaks into the tissue and nerves signal itch. This is how redness, wheals and itching arise (Allergieinformationsdienst), (DermNet: Acute urticaria).
Usually not a true allergy. Many people think of an allergy when they get hives. In fact, a true allergic reaction is only rarely the cause; so-called pseudoallergic reactions to medicines and foods, in which the immune system does not form antibodies, play a bigger role (Allergieinformationsdienst).
Infections are a common trigger. Acute hives can develop after viral infections of the upper airways, after glandular fever, with sinusitis or a dental abscess (DermNet: Acute urticaria). In children, viral infections are behind about 40 per cent of cases, and in about half no trigger is found at all (DermNet: Urticaria in children). In the cold and flu season from autumn to spring, that is an obvious reason for wheals, even without a fever.
Medicines and foods. Antibiotics can trigger allergic hives; painkillers such as acetylsalicylic acid and other non-steroidal anti-inflammatory drugs, opiates and X-ray contrast media can cause wheals without the immune system being involved. With food allergies, milk, egg, peanut and shellfish are typical triggers (DermNet: Acute urticaria). With a cold, infection and medicine often come together; it is then hard to say what triggered the wheals. What to do after starting a new medicine is explained in Skin rash after antibiotics.
Heat, cold and friction. Heat, tight clothing and infections can make chronic hives worse (DermNet: Chronic urticaria). In winter several stimuli come together: cold wind on unprotected skin, then the warmth of overheated rooms, thick layers, a hot bath. With so-called dermographism, line-shaped wheals appear where the skin has been rubbed or scratched, for example by tight clothing or vigorous towelling after a hot shower (DermNet: Urticaria).
Stress. As with many skin conditions, stress can make hives worse; the mechanisms have not yet been clarified in detail (Allergieinformationsdienst). More on this: Dry skin from stress.
When it does not stop. In about one in ten people affected, hives last longer than six weeks (Allergieinformationsdienst). The chronic spontaneous form affects 0.5 to 2 per cent of the population; it is linked with autoimmune processes, and also with chronic infections or thyroid disease (DermNet: Chronic urticaria). That belongs in specialist hands.
The solution step by step
| Step | What you do | Why |
|---|---|---|
| Check straight away | If your lips, mouth, tongue or throat swell, you find it hard to breathe, you feel dizzy or start vomiting: call 112. | These are signs of a severe allergic reaction (NHS: Hives), (Ring et al. 2021). |
| Cool | Hold a clean cloth under cool water, wring it out and place it on the itchy areas for a few minutes; a fan works too. | Cooling is recommended for acute hives (DermNet: Acute urticaria). Exception: with wheals caused by cold, cold is the trigger. |
| Avoid heat | Shower lukewarm rather than hot, pat the skin dry instead of rubbing, keep the bedroom heating lower, no thick layers indoors. | Heat, sweating and rubbing can trigger wheals (NHS: Hives), (DermNet: Urticaria). |
| Clothing | Loose, soft clothing; avoid tight waistbands, belts and rucksack straps while the wheals are there. | Pressure and tight clothing can make wheals worse (DermNet: Chronic urticaria). |
| Observe | Take photos, because wheals are often gone by the time of the appointment; note when they appeared and what you ate, took and did beforehand. | A diary helps the practice look for triggers (Allergieinformationsdienst). |
| Medicines | Ask at the pharmacy for an antihistamine and tell them if you are pregnant, breastfeeding, have a long-term condition or need it for a child. Take medicines only as the package leaflet, pharmacy or practice instructs. | Antihistamines are the first choice for all forms of urticaria (Allergieinformationsdienst); they are not automatically suitable for young children or with some long-term conditions (NHS: Hives). |
| Painkillers | If you take painkillers for a cold, ask at the pharmacy whether the medicine can make wheals worse and what you could take instead. Do not stop medicines prescribed by a doctor on your own; call the practice. | Acetylsalicylic acid and other non-steroidal anti-inflammatory drugs can trigger or worsen wheals (DermNet: Acute urticaria), (Allergieinformationsdienst). |
| Get it checked | See a doctor if there is no improvement after two days, if wheals keep coming back or after more than six weeks; if it becomes chronic, see a dermatologist or allergist. | That is the advice of the British health service (NHS: Hives); with chronic urticaria, causes are searched for specifically (Allergieinformationsdienst). |
With acute hives, extensive tests are usually not needed; allergy tests are mainly worthwhile if a food or a painkiller is suspected (Allergieinformationsdienst).
What helps – and what doesn't
| Measure | Assessment |
|---|---|
| Cool, damp cloths, a fan | helps many people cope with the wheals (DermNet: Acute urticaria); not with cold urticaria |
| Hot showers, sauna, hot-water bottle | rather not: heat is one of the common triggers and aggravating factors (NHS: Hives) |
| Scratching, rubbing, brushing | no: rubbing can trigger new, line-shaped wheals (DermNet: Urticaria) |
| Strict diet on suspicion | rather not: a true food allergy is very rare in chronic hives; the data are not sufficient for general advice to cut foods out. A trial diet should last at least two to three weeks (Allergieinformationsdienst); discuss it with your doctor first |
| Antihistamines from the pharmacy | first choice (Allergieinformationsdienst); do not increase the dose on your own, that is for the specialist to decide |
| Steroid tablets | only from a doctor, for severe cases and for a short time (DermNet: Acute urticaria) |
| Home remedies such as vinegar or quark wraps | we have not found any studies on these; a cool, damp cloth cools just as well |
| Cream or body oil | does not prevent wheals. A cool lotion can feel pleasant (DermNet: Acute urticaria); better not try new, perfumed products during a flare-up |
Common mistakes
The most common mistake: cutting out whole food groups on suspicion. Usually something else is behind it, often an infection, and a true food allergy is very rare in chronic hives (Allergieinformationsdienst). Second, people take hot showers or baths against the itch; that feels good briefly and makes the wheals worse afterwards. Third, medicines prescribed by a doctor are stopped on one's own because they are suspected as the trigger; that always belongs in the hands of the practice. Fourth, people wait to see whether swelling of the lips or tongue goes down instead of calling the emergency number. And fifth, hives that keep returning for weeks are simply accepted, even though chronic urticaria can be treated by a specialist.
When to seek medical advice?
Call 112 if, with or without wheals, your lips, mouth, tongue or throat suddenly swell, you breathe very fast, wheeze or can hardly breathe, your throat feels tight or swallowing is difficult, your skin, tongue or lips turn blue, grey or pale, you suddenly become confused, drowsy or dizzy, or someone faints; in children also if they are floppy or not responding as usual (NHS: Hives). Skin symptoms together with stomach cramps, vomiting or a circulatory collapse after contact with a possible trigger, such as an insect sting, a food or a medicine, can also be anaphylaxis (Ring et al. 2021). If you have been prescribed an adrenaline auto-injector, use it as you were trained and call the emergency number.
See a doctor the same day, or the out-of-hours medical service (116 117 in Germany), if
- the wheals come with a fever and you feel clearly unwell (NHS: Hives),
- deep swellings appear under the skin, for example on the eyelids, hands or feet, without breathing being affected (NHS: Hives),
- the wheals appeared shortly after starting a new medicine; call the practice or pharmacy instead of stopping the medicine yourself,
- joint pain, swollen lymph nodes or fever come along, or the patches leave bruises (DermNet: Acute urticaria),
- you are worried about your child (NHS: Hives).
See a doctor soon if the wheals do not improve after two days, spread or keep coming back (NHS: Hives), or if individual wheals stay in the same place for longer than 24 hours; that does not fit the typical picture and can point to inflammation of the blood vessels (DermNet: Urticaria in children).
See a dermatologist or allergist if the hives last longer than six weeks. Causes are then looked for, for example with blood tests and provocation tests, and a treatment is planned that goes beyond the acute remedies (Allergieinformationsdienst), (Zuberbier et al. 2022).
Frequently asked questions
Are hives contagious?
No. The wheals themselves are not passed on (Allergieinformationsdienst). At most, an infection that triggered the hives, such as a cold, can be contagious.
How long do hives last?
Each wheal disappears within 24 hours. Acute hives usually settle after hours to days. If they last longer than six weeks, this is called chronic urticaria; it lasts three to seven years on average (Allergieinformationsdienst).
What triggers hives in adults?
Often infections, medicines such as antibiotics or certain painkillers, less often foods or insect stings. In adults the cause often remains unknown (DermNet: Urticaria). With chronic hives, specialists usually suspect autoimmune processes.
What to do about hives in a child?
Cool the skin, use loose clothing, keep fingernails short and call your paediatrician. In children, viral infections are often behind it, even without a fever (DermNet: Urticaria). Antihistamines for children only after checking with a doctor or pharmacist. Swelling of the lips or tongue, difficulty breathing or a floppy child: call 112.
Hives on the face: is that more dangerous?
Not automatically. Watch out for swelling of the eyelids, lips and tongue. If the tongue or throat thickens or breathing becomes difficult, that is an emergency.
What do hives look like?
Raised, itchy patches, pink or red on light skin and harder to see on brown or black skin (NHS: Hives). It is typical for the wheals to move around.
Scabies or hives?
Hive wheals change place within a day. If itchy bumps stay in the same places for days, for example between the fingers, and itch at night, that is a different picture; more in Scabies or eczema?. Only a medical examination can tell for certain.
Are hives an allergy?
Only rarely. The wheals are caused by released histamine, but usually not by a classic allergy with antibodies (Allergieinformationsdienst). That is why allergy tests often add little in acute hives unless there is a specific suspicion.
At forpeople
We have no suitable product for hives and do not recommend one here. No cream and no oil prevents wheals; what matters is cooling, avoiding triggers and medical treatment. During a flare-up, it is better not to try new skin care products; many of our products contain essential oils or resin.
If your skin is dry between flare-ups in winter, Itchy skin in winter: showering, skin care and when to see a doctor explains what matters.
More on this: Cold allergy (cold urticaria) · Cholinergic urticaria · Skin rash after antibiotics · Skin itches at night in bed · Wool scratches the skin · Reacted to a cosmetic product · Dry skin or atopic eczema?
Sources
- Allergieinformationsdienst (Helmholtz Munich): Urtikaria. Last updated 24 Sep 2018. Accessed 30 Oct 2026. allergieinformationsdienst.de/krankheitsbilder/urtikaria
- Zuberbier T, Abdul Latiff AH, Abuzakouk M, Aquilina S, Asero R, Baker D et al. (2022): The international EAACI/GA²LEN/EuroGuiDerm/APAAACI guideline for the definition, classification, diagnosis, and management of urticaria. Allergy 77(3): 734–766. https://doi.org/10.1111/all.15090
- DermNet: Acute urticaria. Oakley A, January 2015. Accessed 30 Oct 2026. dermnetnz.org/topics/acute-urticaria
- DermNet: Urticaria – an overview. Oakley A, January 2015, revised April 2021. Accessed 30 Oct 2026. dermnetnz.org/topics/urticaria-an-overview
- DermNet: Urticaria in children. Allen N, Oakley A, April 2019. Accessed 30 Oct 2026. dermnetnz.org/topics/urticaria-in-children
- DermNet: Chronic urticaria. Oakley A, January 2015, updated April 2021. Accessed 30 Oct 2026. dermnetnz.org/topics/chronic-urticaria
- NHS: Hives. Last reviewed 26 Apr 2024. Accessed 30 Oct 2026. nhs.uk/conditions/hives
- Ring J, Beyer K, Biedermann T, Bircher A, Fischer M, Fuchs T et al. (2021): Guideline (S2k) on acute therapy and management of anaphylaxis: 2021 update. Allergo Journal International 30(1): 1–25. https://doi.org/10.1007/s40629-020-00158-y
