Hives (Urticaria): Causes, How Long They Last and Treatments for Acute and Chronic Hives

Written by Naurah Gaspard, DNP, FNP-C, FNP-BC · Medically reviewed by Cherlie Joseph, MSN, FNP-BC · Updated November 2026

Hives are raised, itchy welts that appear suddenly, fade within 24 hours and often pop up somewhere else. Most short bouts are triggered by a viral infection, a medicine, a food or an insect sting and clear within days to a few weeks. Hives lasting 6 weeks or longer are called chronic hives; they usually have no outside trigger and are treated with daily non-drowsy antihistamines and, if needed, newer prescription options.

What hives look like

• Raised welts (wheals) that can be tiny dots or large patches that merge
• Red or pink on lighter skin; may look skin-colored or slightly darker on brown and Black skin
• The center turns pale when pressed
• Intense itch, sometimes burning
• Each welt fades within about 24 hours without leaving a mark, while new ones appear

Some people also get angioedema, deeper swelling of the lips, eyelids, hands or feet that can last a few days. Swelling of the tongue or throat is an emergency.

If a spot lasts longer than a day in the same place, leaves a bruise, or hurts more than it itches, it may not be ordinary hives and should be checked. Our rash identifier guide compares look-alikes.

Acute vs chronic hives and common causes

	Acute hives	Chronic hives
How long	Less than 6 weeks	6 weeks or more, often for months
Common causes	Viral infections (very common), medicines like antibiotics and NSAIDs, foods such as shellfish, nuts and eggs, insect stings, latex	Usually no outside trigger (chronic spontaneous urticaria), often an immune process; sometimes linked to thyroid disease
Physical triggers	Pressure or scratching, heat and sweating, cold, sun or water can trigger hives in either type
Things that worsen both	Stress, alcohol, NSAIDs like ibuprofen and naproxen, tight clothing and heat

How hives are treated

Non-drowsy (second-generation) antihistamines are first-line for both acute and chronic hives. Options include cetirizine (Zyrtec), levocetirizine (Xyzal), fexofenadine (Allegra) and loratadine (Claritin). For chronic hives, taking one every day, rather than only when welts appear, keeps hives under better control.

• If the standard dose does not control chronic hives, guidelines allow a provider to raise the dose above the label amount. Do this only under a provider's direction.
• Older antihistamines like diphenhydramine (Benadryl) work but cause drowsiness and can affect driving and memory, so they are not preferred for daily use.
• A short course of oral steroids is sometimes used for a severe flare of acute hives, but steroids are not a long-term treatment.
• Cool showers, loose clothing and avoiding NSAIDs and alcohol during a flare help with itch.
• Stop any new medicine that may have triggered hives, but call your prescriber before stopping something important.

Newer treatments for chronic hives

Over half of people with chronic spontaneous hives still have symptoms on antihistamines, even at higher doses. For them, an allergist or dermatologist may suggest:

• Omalizumab (Xolair), an injection every 4 weeks that has been used for chronic hives for years.
• Dupilumab (Dupixent), an injection approved for chronic spontaneous hives in 2025.
• Remibrutinib (Rhapsido), the first pill in its class, approved by FDA in September 2025 for adults whose chronic hives continue despite antihistamines.
• Other options, such as cyclosporine, in selected cases.

These are specialist treatments with real costs; ask about insurance coverage and manufacturer savings programs, as prices change. The good news: chronic hives often go away on their own over time, even if it takes a year or more.

Tracking triggers and testing

For acute hives, the cause is often clear from timing, like a new antibiotic or a meal. For chronic hives, extensive allergy testing usually does not find a cause, and guidelines suggest only limited blood tests, such as a CBC and an inflammation marker, sometimes with thyroid tests.

A simple diary helps: note when hives appear, what you ate, medicines (including ibuprofen), stress, heat, exercise and pressure from clothing. Photos help your provider too.

Frequently asked questions

How long do hives last?

Each welt fades within about 24 hours, but new ones can keep appearing. Acute hives clear within 6 weeks, usually within days. Chronic hives last longer than 6 weeks and often fade on their own over months to years.

Can stress cause hives?

Stress can trigger or worsen hives, especially chronic hives. It is rarely the only cause, so managing stress helps alongside daily antihistamines.

Are hives contagious?

No. Hives themselves are not contagious, though a viral infection that triggered them can be.

Sources

• MedlinePlus: Hives
• MedlinePlus: Angioedema
• Novartis: FDA approval of Rhapsido (remibrutinib), September 2025

Keep reading

• Rash identifier guide
• Contact dermatitis
• Eczema in adults
• Browse all conditions and treatments A to Z

This article is for general education and is not a substitute for medical advice. Treatment, including any prescription, is decided by a licensed provider after reviewing your health history. OurTopClinic is not for emergencies; if you have a medical emergency, call 911. OurTopClinic serves adults located in Florida, New Mexico, Oregon and Washington. Learn more at ourtopclinic.com.