Specialist for Hives (Urticaria)

The main symptoms of hives are a raised, itchy rash that can appear anywhere on the body.

Hives can vary considerably in size and shape from one person to another, and may come and go quickly or persist for longer periods. 

In some cases, they may be accompanied by deeper swellings beneath the skin, known as angioedema. If you have any concerns about your symptoms, our specialists are here to help.

Hives occur when immune cells (also called mast cells) release histamine under the skin, causing tissues to swell and become itchy. Common triggers include allergic reactions to food, insect bites or medications, environmental factors such as pollen or dust mites, infection, stress, heat or cold, and occasionally exercise or alcohol.

In many cases, the exact cause isn't immediately obvious, and identifying it often requires a thorough assessment from a specialist. If you're experiencing recurring hives, it's always worth keeping a note of potential triggers, as this can be really helpful when you come to see us.

Our specialists are experienced in identifying the cause of hives – including complex or spontaneous cases where no clear trigger can be found – and will work with you to find the most appropriate treatment plan. 

Hives can be short-lived or long-lasting, and vary considerably from person to person in terms of severity and frequency. There are two main forms:

• Acute urticaria: lasts from a few days up to six weeks and is the most common form. It is usually straightforward to treat with antihistamines, though in severe cases you may also experience symptoms such as a temperature, headache or joint pain. 
• Chronic urticaria (chronic spontaneous urticaria or CSU): lasts for at least six weeks, with recurring episodes of itchy, raised weals that can persist for many months or even years. It can be an unpredictable and deeply exhausting condition, where the underlying cause is often internal rather than related to any allergen or external trigger. It is often accompanied by angioedema – deeper swelling beneath the skin.

There is also chronic inducible urticaria, where hives are triggered by specific external factors such as cold, heat, pressure or exercise.

The good news is that it is treatable. Identifying the type of urticaria you or your child has is an important first step – and something our specialists are experienced in doing. If your hives keep coming back or are difficult to control, we'd be happy to help.

When hives are triggered by something specific, such as friction, stress, heat or cold, this is known as inducible urticaria. In these cases, the skin reacts too easily to a physical trigger, releasing histamine and causing a flare. By understanding your history and, where needed, carrying out specialist testing, our specialists can identify exactly what's causing your symptoms and put the most effective treatment plan in place for you.

They include: 

• Cold urticaria: caused by being exposed to cold temperatures, such as cold water, wind or ice
• Heat urticaria: can occur if you are exposed to heat, for example from your skin being in contact with hot water, hot objects or from high temperatures
• Solar urticaria: triggered by sunlight or UV light
• Aquagenic urticaria: a rare type of hives, triggered by contact with water, for example from swimming, having a bath or sweating
• Exercise-related urticaria: triggered by physical exertion, sometimes made worse by an increase in body temperature, hot baths or certain foods, including spicy foods. This includes cholinergic urticaria and the rarer food-dependent exercise-induced urticaria, which in some cases can carry a risk of anaphylaxis 
• Pressure urticaria: caused by pressure on the skin, often from tight clothing or carrying a heavy bag and which may be delayed
• Dermatographism: a common and harmless condition where lightly stroking or scratching the skin produces raised, red, hive-like welts. It may also be known as ‘Urticaria factitia’ or ‘skin writing’

Hives can be slightly harder to identify if you have darker skin, but a raised itchy rash or weals are a common feature across different skin tones.  

If you’re not sure whether you or your child has hives or a different condition, it’s always a good idea to speak to a doctor, so that they can examine you and help understand what’s going on.

Many cases of hives will resolve on their own within a few days, and over-the-counter antihistamines can be really effective. But if they keep coming back or aren't responding to treatment, we'd always recommend getting them checked out sooner rather than later.

As a general rule, it's worth seeing a doctor if:

• Your symptoms haven't improved with over-the-counter antihistamines after 10 to 14 days
• Your hives keep coming back, even if they go away in between
• You're unsure whether it's safe to take antihistamines regularly – it's a really common question and one we're very happy to answer
• You notice swelling beneath the skin, which may indicate angioedema
• You have a history of serious allergies
• You'd like to rule out underlying conditions that can be associated with urticaria, such as mastocytosis

The sooner we can assess your symptoms, the better. We can prescribe stronger antihistamines, a short course of steroids, or arrange for you to see one of our Consultant Allergists or Dermatologists for a more detailed assessment.

We can usually diagnose hives by examining the weals or rash on your skin, taking a detailed medical history and asking about when your symptoms began, how long each episode lasts and any potential triggers, including recent foods, medications and exposure to allergens such as pollen, cold or heat.

If you have hives at the time of your visit, we can examine them directly – but if not, good quality photos of the rash can be very helpful. If you suspect a food trigger, bringing a sample or a list of ingredients can also be useful.

If your hives have been going on for more than six weeks, we'd recommend keeping a symptom diary beforehand – noting how often they occur, how long each episode lasts, and anything you think might be triggering them.

We may also suggest blood tests or skin prick tests where appropriate, though in many cases, a thorough clinical assessment tells us most of what we need to know. From there, we will work with you to make an accurate diagnosis and put the most appropriate treatment plan in place.

Antihistamines are the first line of treatment for hives. Hives occur when mast cells release histamine in the skin, and antihistamines work by blocking this directly, helping to relieve itching and reduce swelling. If you have a rash you're concerned about, we'd always recommend getting it checked out.

For mild cases, over-the-counter antihistamines are often enough to relieve symptoms.

If your symptoms are more persistent or severe, we may suggest:

• Prescription-strength, higher doses of non-drowsy antihistamines such as cetirizine, fexofenadine or loratadine
• Sedating antihistamines for night-time use, which can also help with sleep
• Montelukast as a second-line option for more complex or resistant cases

If your symptoms don't respond to these treatments, we may consider more advanced options, including omalizumab, which has been effective for some patients with chronic hives.

In select cases, we may suggest other medications to help manage the immune response more effectively. Where medicines are not specifically licensed for hives, we ensure there is appropriate specialist guidance throughout – and we would always take a careful, personalised approach based on your individual medical history and symptoms. 

Chronic hives can have a significant impact on daily life –  affecting sleep, work and the ability to socialise. Our specialists are experienced in managing complex and long-term cases, and will work with you to understand the factors behind your condition and create a personalised treatment plan.

This may include daily antihistamines at higher doses where needed, omalizumab injections, immunosuppressants under careful supervision, or short courses of prednisolone to control flare-ups.

We will also help you identify any lifestyle or environmental factors that may be contributing to your symptoms, from diet and stress to your home environment, and provide evidence-based guidance on how to manage these alongside your treatment.

A sudden outbreak of hives, particularly in children, can be really worrying. Our team of Consultant Paediatric Allergists, Consultant Dermatologists and experienced GPs are here to help, offering expert assessment and personalised care from some of London's leading specialists in urticaria.

We offer:

• A multidisciplinary team including Consultant Paediatric Allergists with significant urticaria care experience, Consultant Dermatologists, Consultant Allergy Specialists and experienced GPs
• Same-day appointments for urgent consultations where possible
• Detailed consultations and expert skin assessments to accurately understand your symptoms
• Dedicated support to help identify your triggers
• Medication to quickly reduce inflammation and relieve discomfort
• Ongoing care and treatment to manage and control symptoms
• Access to our wider integrated team, including a nutritional therapist, mental health specialist and Consultant Endocrinologist