10/01/2026
**acute urticaria** (hives),
covering its definition, causes, symptoms, management, and when to seek medical help.
# # # **Definition**
**Acute urticaria** is the sudden appearance of itchy, raised, red or skin-colored welts (wheals) on the skin, with individual lesions lasting **less than 24 hours** (though new ones may appear). The entire episode lasts **less than 6 weeks**. If it persists beyond 6 weeks, it is classified as *chronic urticaria*.
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# # # **Key Characteristics**
* **Wheals:** Raised, often with a pale center and red flare. They "blanch" (turn white) when pressed.
* **Angioedema:** In about 50% of cases, there may be accompanying deeper swelling of the lips, eyelids, hands, feet, or ge****ls.
* **Itchiness (Pruritus):** Ranges from mild to severe and debilitating.
* **Transient:** Individual hives come and go, usually disappearing within a few hours without leaving a mark.
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# # # **Common Causes & Triggers**
Acute urticaria is often an allergic-type reaction, but not always IgE-mediated. The most frequent triggers include:
1. **Infections (Most Common Cause in Children & Adults):**
* **Viral:** Upper respiratory infections (common cold, influenza), viral gastroenteritis.
* **Bacterial:** Sinusitis, strep throat, urinary tract infections.
2. **Foods & Food Additives:**
* Common culprits: nuts, shellfish, fish, eggs, milk, soy, wheat, berries, and food colorings/preservatives (e.g., sulfites).
3. **Medications:**
* **Common:** Antibiotics (especially penicillin, sulfa), NSAIDs (ibuprofen, naproxen), aspirin, opioid painkillers, vaccines.
4. **Insect Stings or Bites:**
* Bees, wasps, fire ants, mosquitoes.
5. **Direct Physical Triggers (Physical Urticaria):**
* Pressure, cold, heat, sun exposure, vibration, or exercise (can be acute or chronic).
6. **Other:** Latex, pollen, pet dander, or plants.
**Important Note:** In many cases (up to 50%), a specific trigger is never identified.
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# # # **Management & Treatment**
The cornerstone of management is **avoidance of identified triggers** and **symptomatic relief**.
**Step 1: Non-Drug Measures**
* Apply cool compresses or take cool baths.
* Wear loose, lightweight clothing.
* Avoid known triggers (foods, medications, etc.).
* Use gentle, fragrance-free soaps and moisturizers.
**Step 2: Medication (First-Line)**
* **Second-Generation, Non-Sedating H1 Antihistamines:** These are the mainstay of treatment.
* **Examples:** Cetirizine, Loratadine, Fexofenadine, Desloratadine, Levocetirizine.
* **Dosing:** Often, standard doses may need to be increased (under doctor's guidance) for full control. They are taken daily, not just "as needed."
**Step 3: Additional Therapies (if first-line is insufficient)**
* **First-Generation H1 Antihistamines:** Diphenhydramine (Benadryl) or Hydroxyzine. Effective but cause drowsiness; best for nighttime use if itching is severe.
* **H2 Antihistamines:** Ranitidine or Famotidine, sometimes added for a synergistic effect.
* **Short Course of Oral Corticosteroids:** (e.g., Prednisone for 3-7 days). Used only for severe, debilitating episodes **under medical supervision**.
**For Severe Allergic Reactions (Anaphylaxis):**
* If hives are accompanied by **difficulty breathing, throat tightness, swelling of the tongue, dizziness, or drop in blood pressure**, it is a medical emergency.
* **Treatment is immediate intramuscular Epinephrine (EpiPen) and call emergency services.**
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# # # **When to See a Doctor**
Seek medical attention if:
* Hives are severe, widespread, or very uncomfortable.
* Symptoms persist despite over-the-counter antihistamines.
* You suspect a medication or food as the trigger.
* Hives are accompanied by **any** symptoms of angioedema (facial/lip swelling) or anaphylaxis (as above).
* Hives last for more than a few days or recur frequently.
# # # **Diagnosis**
Diagnosis is primarily based on **history and physical examination**. The doctor will ask detailed questions about:
* Timing of onset
* Possible exposures (food, drugs, insects)
* Recent illnesses
* Past medical history
Tests (like blood work or allergy testing) are not routinely needed unless a specific trigger is suspected or the condition becomes chronic.
# # # **Prognosis**
Acute urticaria is usually **self-limiting**. Most episodes resolve within days to a few weeks with appropriate treatment. The goal is to control symptoms until the reaction runs its course.
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