Urticaria (Hives) and Other Skin Allergy

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What is urticaria?

Urticaria is also known as ‘nettle rash’ or ‘hives’. This condition consists of wheals – spots or patches of raised red or white skin – each of which usually clears away in a few hours to be replaced by other fresh wheals. Urticaria is very common and affects one in five people at some point in their lives.  The more common type of urticaria rash (hives) lasts up to 24 hours, produces larger wheals and may not completely clear for several days.  It sometimes occurs together with swelling of various parts of the body (angioedema) – typically the face, hands, and feet, although anywhere may be affected.

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Example of urticaria

Types of urticaria and hives

The many different clinical forms of urticaria and they can be divided according to their duration into acute (less than 6 weeks) and chronic (more than 6 weeks) and other.

  • Acute spontaneous urticaria

    • The most common form of urticaria is acute urticaria or “acute spontaneous urticaria”, which lasts a maximum of six weeks (usually a few days to three weeks) and is usually easy to treat. In some patients, angioedema (swelling of deep skin) also occurs. Severe acute spontaneous urticaria may also be accompanied by fever, headache, diarrhea, difficulty in breathing and swallowing, joint pain, and tiredness/fatigue.

  • Chronic spontaneous urticaria

    • If urticarial symptoms—redness, hives, and itching—persist much longer than 6 weeks, it is called chronic spontaneous urticaria. Discomfort can persist for several months or years. Angioedema can also occur, especially in the facial area or on the hands and feet, and in the genital area.

  • Other types of urticaria include;

    • Urticaria factitia can be caused by rubbing, scratching, or scrubbing the skin.
    • Cold urticaria occurs when there is contact between the skin and cold.
    • Heat urticaria occurs when contact between the skin and warmth/heat.
    • Solar urticaria is caused by UV light or sunlight.
    • Pressure urticaria presents with swelling at sites of pressure.
    • Aquagenic urticaria occurs when there is contact between the skin and water.
    • Cholinergic urticaria presents where contact between the skin and raised temperatures (for example hot baths) occurs.
    • Exercise-induced urticaria/anaphylaxis occurs during instances of physical strain.

Symptoms of urticaria

Urticaria can appear suddenly, often without warning. You may wake up one morning to find red, raised welts on your skin, or they may develop rapidly throughout the day. The welts associated with urticaria are usually accompanied by intense itching. This itching can be so severe that it becomes difficult to focus on anything else, and scratching may provide only temporary relief.

The main symptom of hives is an itchy rash and the rash can appear as;

  • Raised bumps or patches in many shapes and sizes.
  • Appear anywhere on the body.
  • Be on one area or spread across the body.
  • Feel itchy, sting or burn.
  • Look pink or red when affecting someone with white skin; the colour of the rash can be harder to see on brown and black skin.

Chronic spontaneous urticaria (CSU)

Our information factsheet explores the ins and outs of urticaria and hives. Backed by the latest research and developed in collaboration with allergy experts, this resource is your go-to guide for understanding the causes, symptoms, and management of this common allergic condition.

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Download our urticaria information leaflet

Created in collaboration with allergy specialists and dermatologists, our concise yet comprehensive leaflet dedicated to chronic spontaneous urticaria (CSU) is aimed at helping individuals living with allergies and hives.

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How is urticaria currently diagnosed?

Chronic spontaneous urticaria (CSU) can be diagnosed with a detailed patient history. A GP will usually ask a patient to keep a symptom diary to record any potential triggers in order to exclude or confirm a diagnosis of CSU. It is important to record the onset, duration and course of CSU. The duration of the individual wheals and rash should also be recorded accurately. Any occurrence of angioedema should be noted. Further tests may include evaluations of the skin, blood and urine. If initial treatment is ineffective, GPs should refer patients to see a specialist dermatologist or immunologist for further treatment.

See a GP if;

  • The symptoms do not improve after 2 days
  • You’re worried about your child’s hives
  • The rash is spreading
  • Hives keeps coming back – you may be allergic to something
  • You also have a high temperature and feel generally unwell
  • You also have swelling under the skin – this might be angioedema

A GP may prescribe menthol cream, stronger antihistamines or steroid tablets. If your urticaria does not go away with treatment, you may be referred to a skin specialist (dermatologist).

How is urticaria currently treated?

Until recently, antihistamines were the only licensed therapy option for people living with chronic spontaneous urticaria (CSU). Medical guidelines recommend doctors increase the dosage up to four times the licensed dose; however, 40% of people with CSU still do not experience relief from symptoms from this increased dose.

Non-sedating antihistamines are usually prescribed in the first instance, but sedating antihistamines may be prescribed, particularly at night to help with nighttime itch. However, patients may need to face the additional issues of dealing with fatigue and restriction on daily activities (such as driving), due to sedating treatment.

In the absence of alternative licensed treatments, guidelines suggest second-line therapy with drugs such as corticosteroids and montelukast. Third-line therapy includes treatments which act upon the immune system, such as ciclosporin, mycophenolate and methotrexate. Although not specifically licensed or designed to treat the condition, they may be successful in a percentage of patients. Recently, omalizumab, a drug that modifies the immune response, has received a licence for the treatment of CSU following publication of positive trial data.

Living with chronic spontaneous urticaria

People living with CSU experience unpredictable outbreaks of itchy and painful wheals which can have a knock-on effect on their work, sleep, hobbies and social activities. Nearly three quarters of people living with CSU report having to miss out on social occasions because of their skin condition.

Most people living with the condition experience symptoms of CSU for at least a year, with a considerable proportion of people experiencing symptoms for much longer.

The unpredictable nature of CSU has a strong emotional and psychological impact and is associated with a more substantial effect on quality of life than other skin conditions. Couple this with the cosmetic disfigurement and embarrassment sometimes caused by CSU and you can see why many patients suffer from anxiety and depression. We hear from sufferers who are in utter despair over their treatment and feel completely trapped by the condition.

Chronic Spontaneous Urticaria (CSU) Poster

Don’t let urticaria hold you back any longer. Download our free poster today and take the first step toward a happier, healthier you! Simply click the link below to get started.

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Wheals of Despair report

The aim of this report is to establish the significant impact CSU has on the lives of patients and to outline what must be done to ensure they have access to the optimal care they deserve. Therefore it is vital that healthcare professionals and commissioners understand the role they can play in improving the quality of life of those with CSU and in ending the ‘wheal’ of despair in which patients are trapped.

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What is angioedema?

Angioedema is another skin allergy and is the name given to deeper swelling affecting the skin over the arms, legs, torso, or face. It may also affect the tongue, mouth, throat and sometimes the upper airway. These swellings commonly last for more than 24hrs, and usually there is no itching. It is not possible to identify an underlying cause for angioedema in the vast majority of cases.

Urticaria and angioedema often occur at different times or together in the same person. They occur in about 15 per cent of the population at some time or other in their lives, with women more commonly affected than men.

Allergic angioedema is triggered by an allergic reaction to certain foods, medications, insect stings, or other allergens. It is often associated with hives (urticaria) and can be life-threatening if it affects the throat or airways, leading to difficulty breathing or swallowing.

Symptoms of angioedema typically include swelling, often with redness or warmth in the affected area. The swelling may be accompanied by itching or a burning sensation. In severe cases, particularly when angioedema affects the throat or airways, it can lead to difficulty breathing, swallowing, or speaking, which requires immediate medical attention.

What is Chronic Spontaneous Urticaria?

Allergy UK has created an educational video to support people with this skin condition and to raise awareness for others suffering without a diagnosis and manageable treatment

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