Hives and stress

One trigger for acute hives may be adrenalin, the American Academy of Dermatology explains.

Research has linked persistent stress with a mild underlying infection in people with chronic urticaria, and experts are interested in finding out whether these issues have a shared underlying mechanism.

Managing stress through meditation, exercise, or counseling may help some people with chronic hives manage their symptoms.

Diagnosis

To diagnose hives and make a treatment plan, a doctor first needs to determine whether the issue is acute or chronic.

Acute urticaria

First, the doctor, who may be a dermatologist, examines the affected areas. Next, they try to identify the trigger.

They often ask:

• when and where the rash began
• about exposure to likely triggers, such as latex gloves, chemicals, or an insect bite
• about any current medications, including herbal supplements
• about the person’s medical history
• whether there is any family history of hives

Often, the trigger is unclear. If there is a likely trigger, the doctor might refer the person to an allergy clinic. If they suspect a food allergy, they may suggest keeping a food diary.

At an allergy clinic, a specialist may do a skin prick test to find out whether there is an allergy to specific substances, such as chemicals, dust mites, or specific foods.

However, a doctor does not usually recommend extensive allergy testing for a single episode of hives.

Chronic urticaria

Most cases of hives resolve after 6 weeks, but around 8% persist for longer. This is chronic urticaria. A doctor may recommend blood tests and other tests to identify the underlying cause, though pinpointing the cause is not always possible.

Chronic urticaria is unlikely to result from an allergy or contact with an irritant, so doctor will probably not recommend a skin prick test.