Are Your Hives Getting Worse Instead of Better? Here’s How to Tell (With Pictures)

Hives — or urticaria — are a sign of an immune reaction. They develop after an exposure to an allergen. Allergens include things like:

• Food

• Pollen

• Dander

• Medications

• Viruses

• Bacteria

• Insect bites

Hives aren’t dangerous. But if you have hives and other symptoms — like trouble breathing or stomach pain — this could be a sign of anaphylaxis, a life-threatening allergic reaction. The good news is that most people who develop hives don’t develop anaphylaxis. 

It’s possible to get hives from time to time, if you’re prone to them. Hives usually go away on their own. But, sometimes, hives get worse instead of better. If your hives are lingering or worsening, here’s what could be happening and what you should do next. 

How long do hives last?

How long hives last depends on a few factors.

There are two types of hives: 

• Acute hives (acute urticaria) are episodes of hives that come and go but then go away for good in fewer than 6 weeks. 

• Chronic hives (chronic urticaria) are episodes of hives that come and go for longer than 6 weeks. 

During active episodes, individual hives can take anywhere from 30 minutes to 24 hours to go away. And it’s possible to develop new hives even as old ones start to fade. The exact pattern and duration of hive outbreaks will vary from person to person. 

How long does angioedema last?

People with urticaria can also develop angioedema along with hives. Angioedema is the sudden, pronounced swelling of the skin, lips, or eyelids. It’s sometimes painful and can make the skin look red. Angioedema can take up to 72 hours to go away during an episode of urticaria.

Close-up of angioedema of the lips.

Close-up of angioedema of the eyelids.

What do hives look like?

Typically, hives come and go. They can come and go in the same place, or they can reappear in a new place. New hives that appear may be bigger or smaller than previous hives. They might be warmer, itchier, and have a slightly different color too. All of these subtle differences are normal for hives. 

Close-up of the back with large hives.

Close-up of the leg with large hives.

Close-up of the leg with smaller hives.

Close-up of the neck with smaller hives.

Do hives get worse before they get better?

Acute urticaria is usually caused by an exposure to an allergen. If you know what triggered your hives, you can try to stay away from that allergen. In these cases, the immune system starts to calm down once the exposure goes away. This makes the hives go away too.

But your hives can get worse if you have ongoing exposure to an allergen. And hives can continue to come and go even after you get away from the allergen. It can take a few days to a few weeks for your immune system to get back to normal. In this time, you can still develop hives, even if you’re no longer exposed to the allergen. 

If you don’t know what’s causing your hives, it can be hard to adjust your routine. So, you may continue to get exposed to the allergen. This can also result in ongoing hives.

With a typical rash, you can tell it’s worsening if you have more bumps or lesions — or if those lesions get bigger, redder, or more tender. Unlike a typical rash, hives are evanescent. This means they come and go and can change in size. This can give the impression that hives are getting worse. But these changes can be normal with an episode of urticaria.

What could be making hives worse?

It can be tricky to know whether your hives are behaving normally or getting worse. Here are some reasons why your hives might be getting worse, instead of better.

You’re still being exposed to an allergen

Ongoing allergen exposure can lead to prolonged or worsening hives. You can keep getting more hives if you’re not able to completely remove the exposure. For example, if you can’t get away from an outdoor allergen completely, your hives might not get better. 

Infections are the most common trigger for hives. It can take up to 2 weeks for a healthy immune system to fight off a virus. Antibiotics can help your immune system fight off bacterial infections, but the results aren’t immediate. So, you may experience hives until the infection is completely gone. 

You’re not getting the right treatment

Antihistamines are the first-choice treatment for hives. These include:

• Diphenhydramine (Benadryl) 

• Hydroxyzine (Atarax, Vistaril)

• Cetirizine (Zyrtec)

• Loratadine (Claritin)

• Fexofenadine (Allegra)

Sometimes, these medications aren’t enough. In these cases, you might need additional treatment with steroids. 

If you experience side effects with these medications and stop taking them too early, this can result in prolonged or worsening hives.

You’re getting exposed to other things that worsen hives

Some things can make hives worse when your immune system is already in overdrive. 

Stress can worsen hives. That’s because your body can release histamine when you’re stressed. This can worsen skin inflammation and itchiness. 

Sun exposure can also trigger more hives when you’re already having a flare. 

You may find that you have other triggers that worsen your hives. Try to avoid any triggers that you identify.

You don’t have acute urticaria 

Acute urticaria should get better if you’re avoiding your triggers and taking the right medications. So, if you’re taking these steps, it’s possible that your hives are caused by chronic urticaria — or autoimmune urticaria. The underlying cause of those hives is different from acute urticaria. And chronic urticaria behaves differently from acute urticaria. So, chronic urticaria needs to be treated differently too. 

You have a rash or a bug bite

Another reason your hives might be getting worse is that they’re not hives at all. Other rashes or bug bites can be mistaken for hives. 

When should you seek care for hives?

You should seek medical care if your hives aren’t getting better, even though you’re avoiding triggers and taking antihistamines. You’ll want to confirm that you have acute urticaria (rather than another diagnosis) and whether or not you’ll need additional treatment. 

You should also seek care if you have any other rashes or skin changes along with your hives. This could be a sign that your hives are related to another medical condition. 

Seek care right away if you have any symptoms of an anaphylactic reaction (a life-threatening allergic reaction), like:

• Trouble breathing

• Chest tightness

• Voice changes

• Tongue swelling

• Face swelling

• Facial hives

• Runny nose

• Tightness of the throat

• Nausea or vomiting

• Abdominal pain

• Diarrhea

• Dizziness

• A feeling of doom

Why trust our experts?

Written by:

Jennifer Sample, MD

After a fellowship, Dr. Sample worked as the medical director at the University of Kansas Hospital Poison Center (The University Of Kansas Health System Poison Control Center), which served the state of Kansas for poison exposures. In 2007, she returned to Children’s Mercy Hospital in Kansas City, Missouri, as a consultant in clinical pharmacology and medical toxicology.

Edited by:

Patricia Pinto-Garcia, MD, MPH

Patricia Pinto-Garcia, MD, MPH, is a medical editor at GoodRx. She is a licensed, board-certified pediatrician with more than a decade of experience in academic medicine.

Reviewed by:

Maria Robinson, MD, MBA

Maria Robinson, MD, MBA, is a board-certified dermatologist and dermatopathologist who has practiced dermatology and dermatopathology for over 10 years across private practice, academic, and telehealth settings. She is a fellow of the American Academy of Dermatology and the American Society of Dermatopathology.

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