Be Our Partner! Book a Free Consultation Now! Become a Member > Get Involved >
Health Conditions > Health Articles > Find a Practitioner > Events >

Home  /  Health Conditions  /  Hives (Urticaria)

Hives (Urticaria)

Hives are itchy, raised welts on the skin. About 1 in 5 people get them at some point. Most bouts clear within days or weeks, but hives that keep coming back for more than six weeks are called chronic hives. Hives with swelling of the lips, tongue or throat, or trouble breathing, can be anaphylaxis — an emergency.

Call 911 — this may be anaphylaxis — if hives come with any of these: swelling of the lips, tongue or throat; trouble breathing, wheezing or a tight throat; trouble swallowing; dizziness or fainting; or vomiting (MedlinePlus, NHS).

  • Use an epinephrine auto-injector right away if one has been prescribed, and call 911 (MedlinePlus). The NHS advises using it if you think it may be anaphylaxis, even if symptoms seem mild (NHS).
  • Lie down; you can raise your legs, or sit up slowly if breathing is hard. Don’t stand or walk, even if you feel better. If symptoms haven’t improved after 5 minutes, use a second auto-injector if you have one (NHS).
  • After an insect sting, try to remove the stinger if it’s still in the skin (NHS).

Get medical advice soon if hives don’t improve after 2 days, are spreading, keep coming back, come with a high temperature and feeling unwell, or come with swelling under the skin (NHS). No herbal remedy, acupuncture or other complementary approach can treat anaphylaxis.

What are hives?

Hives, also called urticaria (ur-tih-CAR-ee-uh) or welts, are itchy, raised, pink or reddish bumps on the skin (AAAAI). They come in many shapes and sizes, can appear anywhere on the body, and may sting or burn as well as itch. On brown and black skin the color can be harder to see (NHS). Each welt usually fades within 24 hours and leaves no mark or bruise (AAAAI), though new ones can pop up somewhere else. Hives are not contagious (AAAAI).

Hives happen when mast cells in the skin release histamine and other chemicals (AAAAI, NHS). They usually go away on their own (MedlinePlus).

Acute and chronic hives

Doctors sort hives by how long they have been going on (international guideline, 2026):

  • Acute hives last 6 weeks or less — sometimes less than a day (AAAAI).
  • Chronic hives last more than 6 weeks, appearing every day or nearly every day, or coming and going.

Chronic hives come in two forms (international guideline, 2026):

  • Chronic spontaneous urticaria (CSU) appears without any definite trigger. It is often not possible to find the cause, and it is usually not due to an allergy (AAAAI). Experts now regard it as mainly an autoimmune condition, in which the immune system wrongly activates the skin’s mast cells (international guideline, 2026).
  • Chronic inducible urticaria is brought on by a specific physical trigger, such as cold, every time that trigger is strong enough. The welts usually appear within about 10 minutes and fade within 1–3 hours once the trigger is gone (international guideline, 2026).

Neither form is dangerous in itself (AAAAI). Most people with chronic spontaneous hives have them for more than a year (JAMA review, 2024).

What triggers hives?

Acute hives often follow (AAAAI, AAAAI):

Physical (inducible) hives come from things that happen to the skin (AAAAI, NHS):

Chronic spontaneous hives usually have no outside cause that can be found, and they are usually not caused by stress, a pet or foods (AAAAI). But some things can make flares worse, including NSAIDs, stress and infections (international guideline, 2026).

Angioedema: swelling under the skin

Angioedema is swelling deeper under the skin. It usually affects the face, throat, hands and feet, and it can be painful. Swelling in the throat can be life-threatening and needs emergency care (AAAAI). Swelling of the bowel can cause stomach pain (NHS). About 40% of people with chronic hives also get angioedema (AAAAI).

Swelling without hives needs its own checkup (AAAAI):

  • ACE inhibitors, blood-pressure medicines whose generic names end in “-pril” (such as lisinopril), can cause swelling at any time — even after years of taking them (AAAAI). Don’t stop a prescribed medicine on your own; talk to your doctor promptly.
  • Hereditary angioedema is a rare inherited condition. Antihistamines, steroids and epinephrine don’t help these swellings, but targeted treatments are available once it is diagnosed (AAAAI, NHS).

How common are hives?

Side by side

Six approaches compared

For every condition we look at the same six approaches: what each involves, what it typically costs, and what a patient can realistically expect.

ApproachWhat it involves Estimated costWhat to expect
Conventional medicine (AMA) Finding and avoiding triggers, daily non-drowsy antihistamines (the dose can be raised under a doctor’s care), a short course of steroid tablets for a severe flare, and for chronic spontaneous hives that antihistamines don’t control, omalizumab or dupilumab injections or the remibrutinib pill. Epinephrine for anaphylaxis. Cost estimate being researched. Acute hives usually settle within days to weeks. About half of people with chronic spontaneous hives respond to antihistamines, and most of the rest can be helped by the next steps. Chronic hives often go away within a few years but can return.
Chiropractic No role. We found no research testing chiropractic care for hives. Not applicable. Hives are a skin and immune condition, not a spine or joint problem. See a medical provider for hives that keep coming back.
Acupuncture Fine needles, studied mainly in China for chronic spontaneous hives. About $125–$230 for a first private visit and $90–$185 for follow-ups; community clinics about $50–$90. Medicare covers acupuncture only for chronic low back pain. In the largest trial, acupuncture helped more than sham acupuncture, but the extra benefit was too small to count as clinically meaningful. Reviewers rate the overall evidence as low certainty.
Herbal medicine Little evidence for herbs. Vitamin D has been tried as an add-on to antihistamines; quercetin has only lab and animal studies. Cost estimate being researched. Vitamin D trials are small and mixed; any benefit seems mainly in people who are low in it. Some herbs can themselves cause allergic reactions or interact with medicines. We don’t list doses.
Massage therapy No role during a flare. Rubbing, pressure, heat and vibration can bring on hives in some people. At one national chain, a 60-minute massage was listed at about $125–$160 for non-members, or about $70–$90 a month with a membership. Massage doesn’t treat hives. If you choose it for stress relief when your skin is clear, tell the therapist about your triggers.
MBHA Wellness Coach A daily hives-and-trigger diary, skipping hot baths and showers, loose clothing, avoiding NSAID pain relievers if they set off your hives, stress management, better sleep and an emergency plan. Cost estimate being researched. Practical habits that can cut down flares and help your doctor fine-tune treatment. They support, not replace, medical care.

Approach 1 of 6

Conventional medicine (AMA)

The aim of treatment is complete control of hives while keeping treatment as safe as possible (international guideline, 2026). Allergists and immunologists, and dermatologists (skin specialists), treat hives that don’t settle (AAAAI, NHS). The steps below follow the 2026 international urticaria guideline.

1. Finding and avoiding triggers

  • Medicines: the guideline strongly recommends stopping medicines suspected of making chronic spontaneous hives worse, such as NSAIDs, which worsen hives in up to a quarter of people with CSU. Acetaminophen (paracetamol) and a group called COX-2 inhibitors are considered safer choices. If you take low-dose aspirin to protect your heart, it is not always necessary to stop it — your doctor can help you weigh this (international guideline, 2026). Never stop a prescribed medicine on your own.
  • Physical triggers: avoiding or reducing a known trigger, such as cold, can cut down hives, though it is rarely enough on its own. Simple changes help — for pressure hives, widening the handle of a heavy bag; for cold hives, remembering the wind chill (international guideline, 2026).

2. Non-drowsy antihistamines — the first step

The guideline strongly recommends a standard dose of a modern, “second-generation” antihistamine as the first treatment for all types of hives (international guideline, 2026). Examples include cetirizine, levocetirizine, fexofenadine, loratadine and desloratadine (AAAAI). Tell your pharmacist about any long-term condition before taking one (NHS).

  • Raising the dose: if a standard dose doesn’t control chronic hives, the guideline recommends that the doctor increase the dose of the same antihistamine, up to a set limit, before trying other treatments — and recommends against going beyond that limit (international guideline, 2026). This should only be done under medical supervision; we don’t list doses.
  • Older, drowsy antihistamines such as diphenhydramine (Benadryl) and hydroxyzine cause sleepiness and wear off sooner (AAAAI). They can disturb sleep and impair driving, and the guideline recommends against them as the first choice for chronic hives (international guideline, 2026).

About half of people with chronic spontaneous hives respond to antihistamines (AAAAI).

3. Steroid tablets for a severe flare — short courses only

For a bad flare, the guideline suggests a doctor may consider a short “rescue” course of steroid tablets, but strongly recommends against long-term use because of side effects (international guideline, 2026). Steroids may relieve severe symptoms for a few days but aren’t a long-term treatment (AAAAI). Steroid creams are not useful for hives in general (international guideline, 2026). A GP may also prescribe a menthol cream for itching (NHS).

4. When antihistamines aren’t enough: newer treatments for chronic spontaneous hives

  • Omalizumab (Xolair) is an injection that the guideline strongly recommends adding when high-dose antihistamines haven’t worked (international guideline, 2026). It is FDA-approved for chronic spontaneous hives in people 12 and older who still have symptoms despite antihistamines, and is not approved for other forms of hives. Its label carries a warning about anaphylaxis, so the first doses are given in a health care setting (Xolair label, DailyMed). About 65% of people who didn’t improve on antihistamines respond to it (AAAAI).
  • Dupilumab (Dupixent) is an injection FDA-approved for chronic spontaneous hives in adults and children 2 and older who still have symptoms despite antihistamines (Dupixent label, DailyMed). The guideline suggests it as an add-on, noting its effect is likely smaller than omalizumab’s. Because it also treats eczema and asthma, it can be useful for people who have those conditions too (international guideline, 2026); see our Eczema guide.
  • Remibrutinib (Rhapsido) is a pill that the FDA approved in September 2025 for adults with chronic spontaneous hives that antihistamines don’t control; the guideline suggests it as an add-on (international guideline, 2026). Its current label also covers symptomatic dermographism. The label warns about a risk of bleeding, lists medicines to avoid taking with it, and says not to use it in people with liver impairment (Rhapsido label, DailyMed).
  • Cyclosporine is an immune-suppressing medicine used off-label, especially when omalizumab hasn’t worked. It improves symptoms in roughly 54% to 73% of people but can harm the kidneys and raise blood pressure (JAMA review, 2024).

Because hives change over time and can go away on their own, the guideline recommends reviewing whether treatment is still needed every 3–6 months (international guideline, 2026).

5. Epinephrine for anaphylaxis

If hives are part of anaphylaxis, epinephrine (adrenaline) is the emergency treatment: give an auto-injector right away if one is available and call 911 (MedlinePlus). After anaphylaxis, people should be given two auto-injectors (or a prescription) and may be referred to an allergy specialist (NHS).

What it costs

Cost estimate being researched. The guideline notes that omalizumab, dupilumab and remibrutinib are expensive, which limits access for some people (international guideline, 2026).

Find a medical doctor in our directory

Approach 2 of 6

Chiropractic

Chiropractic care has no role in treating hives. Hives come from mast cells in the skin and, in chronic spontaneous hives, mostly from the immune system (international guideline, 2026) — not from the spine or joints.

A PubMed search we ran in October 2026 for hives or urticaria together with chiropractic or spinal manipulation found no studies testing chiropractic care for hives. The only result from a chiropractic journal was a single case report about acupuncture and a gluten-free diet in one woman (Ohlsen, 2011).

Spinal manipulation commonly causes short-lived soreness, stiffness or headache, and rare serious problems, including strokes linked to neck manipulation, have been reported (NCCIH). Hives that keep coming back for more than a couple of days need a medical checkup (NHS).

Find a chiropractor in our directory

Approach 3 of 6

Acupuncture

Acupuncture has been studied for chronic spontaneous hives, almost entirely in China. The international urticaria guideline does not include it among its recommended treatments (international guideline, 2026).

What the research says

  • The largest trial (2023): 330 people with chronic spontaneous hives at three hospitals in China had real acupuncture, sham (fake) acupuncture or no treatment for 4 weeks. Real acupuncture lowered hives-and-itch scores more than either comparison, but the extra benefit was smaller than the amount researchers consider clinically meaningful. About 14% of the acupuncture group had side effects, all mild or short-lived. Participants weren’t allowed antihistamines and were followed for only 4 more weeks (Zheng et al., 2023).
  • A 2026 review of 8 small trials (564 people) found acupuncture compared favorably with antihistamines, but rated the certainty of the evidence as low and found signs of publication bias, so the results need confirming (Tong et al., 2026).

Acupuncture is not a treatment for anaphylaxis or throat swelling.

Safety and cost

Relatively few complications have been reported, but nonsterile needles and poor technique have caused serious harm; most states license acupuncturists (NCCIH). If you have dermographism, tell the practitioner, since rubbing and pressure can raise welts (AAAAI). A first private visit costs about $125–$230, follow-ups about $90–$185, and community clinics about $50–$90 (The Pricer, 2026). Medicare covers acupuncture only for chronic low back pain (Medicare.gov).

Find an acupuncturist in our directory

Approach 4 of 6

Herbal medicine

There is little good evidence that any herb treats hives. The international guideline lists vitamin D among options that are very rarely used and backed by low-level evidence, and none of the herbs below are part of its recommended treatment (international guideline, 2026).

Vitamin D

  • People with hives, especially adults with chronic hives, tend to have lower vitamin D levels; a 2021 review of six supplement trials reported lower symptom scores (Li et al., 2021).
  • In a 2014 U.S. trial, 42 adults with chronic hives all took standard medicines and were randomly given a higher or lower amount of vitamin D for 12 weeks. Symptoms improved further in the higher group, but the difference between the groups only approached statistical significance, and medicine use didn’t differ (Rorie et al., 2014).
  • A 2025 review of 11 studies concluded vitamin D may be a safe add-on, mainly for people who are deficient, but said studies varied widely and better trials are needed (Siddiqui et al., 2025).

Ask your provider whether you need vitamin D and how much; they may want to test your level first (MedlinePlus). We don’t list doses.

Quercetin

Quercetin is a plant compound found in many foods. Lab studies show it can reduce histamine release, but it hasn’t been tested in clinical trials for allergies (Memorial Sloan Kettering); a 2025 study that eased hives was done in mice (Zhao et al., 2025). As a supplement it may interact with medicines, including the blood thinner warfarin (Memorial Sloan Kettering).

Traditional Chinese herbal medicine

A 2025 review of 14 studies reported better response rates with Chinese herbal formulas, but symptom scores weren’t significantly different and outcomes weren’t measured in a standard way (Chen et al., 2025). Thunder god vine (Tripterygium) has been studied as an add-on in China (Li et al., 2023), but the NIH warns that thunder god vine can cause serious side effects, including kidney and liver problems, and rare deaths have been reported (NCCIH).

Herbs can cause hives too. Chamomile can cause allergic reactions, including severe reactions and anaphylaxis, especially in people allergic to ragweed, chrysanthemums, marigolds or daisies (NCCIH). Some people have allergic reactions to echinacea, which may be severe, and some children in a trial developed rashes (NCCIH). If your hives began after starting any herb or supplement, tell your doctor.

Watch for interactions. Some herbs interact with medicines; St. John’s wort, for example, has a high risk of interactions because it speeds up the liver enzymes (cytochrome P-450) that clear many drugs (NCCIH). The remibrutinib label says to avoid medicines that strongly or moderately speed up one of these enzymes (Rhapsido label, DailyMed). Check every supplement with your doctor or pharmacist.

Approach 5 of 6

Massage therapy

Massage therapy has no role in treating hives, and it is not appropriate during a flare. In people with physical hives, the very things massage involves can bring on welts: rubbing and scratching (dermographism), pressure, and vibration, which can cause swelling (AAAAI). Heat and sweating can trigger hives too (NHS), so hot rooms or hot stones may not suit everyone.

Stress can make chronic spontaneous hives worse, and ways to reduce stress can help (international guideline, 2026). If you find massage relaxing, save it for times when your skin is clear and tell the therapist about your triggers. Don’t use massage to put off seeing a health care provider about a medical problem (NCCIH).

Cost: at one national chain (Massage Envy), published 60-minute prices at three locations ran about $125–$160 for non-members; memberships cost about $70–$90 a month for one session a month (The Pricer). Prices vary by location.

Find a massage therapist in our directory

Approach 6 of 6

MBHA Wellness Coach

An MBHA Wellness Coach can help you turn your treatment plan into daily habits and spot the patterns behind your flares.

A coach supports, but never replaces, your medical care. See a doctor for hives that last more than 2 days or keep coming back (NHS).

Another approach

How hives are diagnosed

Hives are diagnosed mainly by talking with you and examining your skin. Because welts come and go, your doctor will also look at any photos you’ve taken (international guideline, 2026). You don’t need to have hives on the day of your visit (AAAAI).

  • Acute hives: the guideline recommends against routine tests. A careful history looking for triggers, such as a recent cold, is usually enough. The exception is when a food or medicine allergy is suspected; then allergy tests can help confirm it (international guideline, 2026).
  • Chronic spontaneous hives: only limited tests are recommended — a blood count and a test for inflammation (CRP and/or ESR). Specialists may add total IgE and a thyroid antibody test (anti-TPO), which can hint at how well treatment will work. Further tests depend on your history, and costly broad screening isn’t advised (international guideline, 2026). Broad allergy skin testing isn’t helpful for chronic spontaneous hives (AAAAI).
  • Physical (inducible) hives: doctors use provocation tests, such as a cold test or a pressure test, and measure how much of the trigger it takes to cause hives (international guideline, 2026). For dermographism, firmly stroking the skin brings up hives within minutes (AAAAI).
  • Ruling out look-alikes: your doctor may ask how long each welt lasts. Ordinary hives fade within 24 hours (AAAAI); welts that last longer can point to other conditions, such as inflamed blood vessels (urticarial vasculitis). Swelling without hives calls for checks for medicine causes such as ACE inhibitors and for hereditary angioedema (international guideline, 2026). Several other itchy skin conditions are sometimes mistaken for hives (AAAAI); our Skin Problems guide is being written.

Another approach

Living with chronic hives

Thyroid and other autoimmune links

Chronic spontaneous hives are linked with autoimmune thyroid disease: about 20% of people with CSU have autoimmune thyroiditis (JAMA review, 2024). A 2017 systematic review found thyroid antibodies and thyroid problems are more common in people with CSU; an underactive thyroid and Hashimoto’s thyroiditis are more common than an overactive thyroid and Graves’ disease (Kolkhir et al., 2017). If you have a thyroid condition, see our Graves’ Disease guide and tell your hives doctor about it. Chronic hives can also be related to other autoimmune conditions such as rheumatoid arthritis or lupus, but then there are usually other signs, such as joint pain or fevers (AAAAI).

Mood, sleep and daily life

Chronic hives can affect sleep, work, school and emotional well-being (international guideline, 2026). Anxiety affects about 10% to 31% of people with CSU and depression about 7% to 29% (JAMA review, 2024). Tell your doctor if hives are getting you down — mental health is part of hives care (international guideline, 2026). If you ever have thoughts of harming yourself, call, text or chat 988 (988 Lifeline).

Will it go away?

Usually, yes. Chronic hives can last for years but often go away: they clear in about half of people within one to two years, and 80–90% improve within five years. They can come back months or years later (AAAAI). With today’s treatments, most people can get their hives under control (AAAAI).

Member stories

Living with Hives (Urticaria)? Share your experience

Real experiences help others choose. Tell us what you tried — conventional medicine, chiropractic, acupuncture, herbs, massage or coaching — what it cost and what changed.

No stories have been published for this condition yet. Yours could be the first.

Which approaches have you tried?

What did you try, what did it cost, and what changed for you? Please leave out anything you’d rather keep private.

We read every story before it’s published and may shorten it. Stories describe one person’s experience; results vary. See our Privacy Policy.

Sources

This page is for education only and is not medical advice. Costs are typical U.S. ranges and estimates; yours will depend on your provider, location and insurance. Talk with your doctor before starting, stopping or combining any treatment. In an emergency, call 911. See our disclaimer.

Find the right practitioner

Search MBHA’s Health Directory for doctors, chiropractors, acupuncturists and massage therapists across the Monterey Bay.

Search the Directory All Health Conditions

The Monterey Bay Holistic Alliance is a charitable, independent registered nonprofit 501(c)(3) organization and does not endorse any particular products or practices. Claims and statements herein are for informational purposes only and have not been evaluated by the Food and Drug Administration. We strongly recommend that you seek out your trusted medical doctor or practitioner for diagnosis and treatment of any existing health condition. MBHA provides administrative support, education and navigation — not medical, legal or tax advice — and cannot guarantee claim, billing or fundraising outcomes. MBHA is not an emergency service: in an emergency, call 911 or go to the nearest emergency room.