Hives and Angioedema

Hives and Angioedema

Hives (medically termed urticaria) are raised, itchy areas on the skin, ranging in size from small raised areas of skin to large welts. Angioedema, which may accompany hives or may occur on its own, is swelling below the skin’s surface. Angioedema generally appears on the face, neck, feet, and hands.

Hives usually come and go within 24 hours. If new hives continue to appear for six weeks or longer, the condition is called chronic hives (aka chronic urticarial). Angioedema usually clears up in a few days. It can be life threatening if the swelling occurs in the tongue or throat and hinders breathing.


People sometimes mistake hives and angioedema for one another, but the symptoms are distinct.

Hives symptoms

  • Welts that appear reddish or skin-colored on light skin, or purplish on dark skin.
  • Mild to severe itchiness and skin may be warm to the touch.
  • Hives range in size from tiny to large and can be contained to one small area of cover large areas of the body.
  • Hives may disappear and then reappear, or new ones may develop elsewhere. The attack may subside in a day or last for a few days or a few weeks.

Angioedema symptoms

  • Swelling of the deeper soft tissue develop within a few minutes to several hours.
  • Often causes tenderness and warmth and normally are not itchy.
  • Typically forms on the face around the lips or eyes.
  • Usually lasts two or three days.


The most common cause of acute hives, especially in children are viral infections.  Additional causes of hives and angioedema can be broken down into several categories.

Allergy related

The cause of allergy related hives is usually obvious with a distinct preceded trigger

  • Food allergy. Particularly peanuts, eggs, nuts and shellfish.
  • Insect stings or bites.
  • Type I (IgE mediated) drug allergy. Includes cephalosporin, penicillin, and neuromuscular blocking agents.
  • Other allergies. Latex or something else a person is allergic to touches the skin.

Inducible urticaria and physical urticaria

This occurs when hives are brought on by environmental stimuli and includes:

  • Hives are formed by scratching the skin.
  • Cold-induced urticaria. Occurs quickly — usually right after exposure to cold air, ice, cold water or ingesting something cold.
  • Cholinergic urticaria. Brought on by an increase in the body’s temperature.
  • Vibratory urticaria. Triggered by things such as lawn mowing, mountain biking, riding horses or motorcycles.
  • Solar urticaria. Caused by exposure to the sun.
  • Aquagenic urticaria. This rare condition is set off when water contacts the skin.
  • Exercise-induced urticaria. Reactions occur after working out or just performing daily activities.
  • Heat-induced urticaria. Another rare condition triggered by contact with a heat source.


Medications especially antibiotics and NSAIDs like aspirin, ibuprofen and naproxen can cause hives and/or angioedema. Certain type of blood pressure or heart failure medication called ACE-inhibitors may trigger a very dangerous form of non-immediate angioedema without urticarial. This category also includes:

  • Radiocontrast media. used as contrast agents in radiography.
  • Serum sickness. This is a reaction to certain proteins in antiserum.
  • ACE-inhibitors and possibly a class of diabetic medications called ‘gliptins’. which in some people can cause angioedema (but usually not hives) through a similar cause as ACE-inhibitors, which is through a buildup of substance in the body.


Chronic spontaneous urticaria are hives and/or angioedema (40% of time only urticaria; 40% of time urticaria and angioedema; 20% of time only angioedema) that last more than six weeks is rarely allergic in nature, and is called chronic spontaneous urticarial: the previous name was chronic idiopathic urticarial which indicates the exact cause in not clear.  Exacerbators of chronic spontaneous urticarial can include viral infections or other infections, stress, heat, exercise, pressure applied to skin (such as tight undergarments), certain times during the menstrual cycle, NSAIDs, and drinking alcoholic beverages “It is more common in women than men and in some cases may have an autoimmune cause.

C1 inhibitor deficiency

C1 esterase inhibitor is an enzyme normally found in blood plasma and serum. A deficiency of this enzyme or loss of function of this enzyme can cause life-threatening swelling of the throat and tongue. Swelling can also occur in other places including the intestines, resulting in severe abdominal pain.

Risk Factors

Risk factors for hives and angioedema include:

  • Women
  • Having a personal or family history of an autoimmune disease
  • Having a first degree relative with C1 inhibitor deficiency
  • Less common: acquired angioedema with C1-INH deficiency (AAE) which may be caused, in part, by certain cancers or autoimmune diseases


Complications from angioedema include:

  • Swelling of the throat and tongue can cause a fatal airway obstruction (this may happen in some situations including in patients taking ACE-inhibitors or having C1 inhibitor deficiency, but may happen with severe allergic reactions)
  • Hives and or angioedema can be one of the signs of anaphylaxis, a life-threatening, whole-body allergic reaction that causes breathing difficulty.

When to See a Doctor

It’s important to visit a healthcare provider if hives or welts don’t go away — or if they last more than six weeks. Contact your provider if your angioedema is severe, it doesn’t respond to treatment or you have never had it before. Treat the condition as an emergency and call 911 or go to the emergency room if you experience abnormal breathing sounds, difficulty breathing, wheezing or fainting.

Prevention and Treatment

Hives and angioedema will often go away without treatment. There are steps to take to avoid flare-ups and ease the symptoms, including:

  • Many causes of hives and swelling are not known or caused by viral infections, in situations where there is a known allergic cause recommend avoid specific food(s), medications, insect stings, or other applicable allergic cause.
  • Non-sedating antihistamines are the mainstay of treatment
  • Doctors may recommend different types of medicine, including other types of antihistamines, an oral corticosteroid, Xolair, and, for rare airway swelling, epinephrine.

A Helping Hand

If you experience trouble with these skin conditions, seek out the complete medical care offered by the Florida Medical Clinic Orlando Health Department of Allergy, Asthma & Immunology. Our conveniently located offices are staffed with professionals who can help with your hives or angioedema.

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