Hives
Hives symptoms, causes, treatment options available in Australia, and when to see a doctor. Evidence-based medical information.
Overview
Hives (urticaria) is a common skin condition marked by the sudden appearance of raised, red or skin-coloured welts (wheals) that are often itchy, burning, or stinging.
Lesions can range from a few millimetres to several centimetres, merge together, and typically resolve within 24 hours, though new ones may continue to appear.
The pathophysiology involves:
- Mast cell degranulation → release of histamine and other inflammatory mediators.
- Increased vascular permeability → localised swelling, redness, and itching.
Types:
- Acute urticaria: Symptoms resolve within 6 weeks; often triggered by food, infections, or medications.
- Chronic urticaria: Persists beyond 6 weeks; may be autoimmune or idiopathic, sometimes linked with thyroid disease, autoimmune conditions, or ongoing infections.
Common triggers:
- Food allergens (nuts, shellfish, eggs)
- Medications (NSAIDs, antibiotics, ACE inhibitors)
- Viral or bacterial infections
- Physical stimuli (heat, cold, pressure, exercise)
- Stress or idiopathic (no identifiable cause in many cases)
Statistics and Prevalence in Australia
There is no specific national prevalence data for hives (urticaria) in Australia.
Globally, acute urticaria affects up to 20% of people at least once in their lifetime.
Chronic urticaria is less common, with international studies estimating prevalence at 0.5–1% of the population at any given time.
In Australia, the ABS National Health Survey (2022–23) reported that 14% of Australians live with an allergic condition (including eczema, hay fever, asthma, and hives).
Urticaria accounts for a significant proportion of dermatology and GP presentations, particularly in children and young adults.
Symptoms and Clinical Presentation
Typical presentation:
- Raised, red welts (anywhere on the body)
- Itching, burning, or stinging sensation [4]
- Lesions may change shape, disappear, and reappear rapidly
Severe symptoms:
- Angioedema (deep swelling), especially around eyes and lips [5]
🚨 Red flag signs requiring immediate care:
- Difficulty breathing
- Throat swelling
- Rapid rash spread → may indicate anaphylaxis [4]
Differential diagnosis includes: eczema, contact dermatitis, and autoimmune disorders [5].
Causes and Risk Factors
Allergic triggers:
- Foods, medications, insect stings, latex
Non-allergic triggers:
- Stress, infections, exercise, extreme temperatures [3]
Underlying pathophysiology: mast cell & basophil activation → histamine release → symptoms [2].
Risk factors:
- Family/personal history of allergy
- Autoimmune disease (e.g., thyroid disease, lupus)
- Certain infections [5]
Diagnosis
In Australia, diagnosis is primarily clinical, based on:
- Patient history
- Examination of rash [4]
Laboratory testing is usually unnecessary unless:
- Atypical or chronic presentation → further tests to rule out systemic disease [5].
RACGP recommends thorough assessment to identify triggers and guide management [4].
Treatment Options in Australia
First-line:
- Non-sedating antihistamines → relieve itch & reduce welts [4]
If insufficient:
- Corticosteroids
- Leukotriene receptor antagonists [5]
Chronic hives:
- Omalizumab (monoclonal antibody), PBS-subsidised in Australia [4]
Lifestyle / supportive strategies:
- Avoid triggers
- Wear loose clothing
- Apply cool compresses [5]
Severe cases:
- Anaphylaxis management → adrenaline auto-injector [4]
Living with Hives
Self-management:
- Keep a symptom diary → identify triggers
- Follow-up with healthcare providers
- Learn to recognise early signs of flare-ups [5]
Lifestyle modifications:
- Stress reduction (mindfulness, relaxation)
- Practical coping strategies (clothing, skincare routines)
Patient education is essential for improving quality of life [4].
Prevention
Prevention strategies:
- Avoid known triggers
- Manage underlying health conditions
- Stress management (e.g., mindfulness) [5]
For allergic patients:
- Carry an adrenaline auto-injector
- Have a clear action plan [4]
Related Articles
You might also be interested in:
- Allergy — Understanding allergic reactions and management
- Pollen Allergy — Managing hay fever and seasonal allergies
- Food Allergy — Understanding food allergies and avoiding triggers
- Hives — Managing urticaria symptoms and identifying causes