From the Guidelines
Hives can persist for more than 24 hours, as seen in certain types of urticaria, such as physical urticaria, where weals can last up to 48 hours, and urticarial vasculitis, where weals can persist for days. According to the guidelines for evaluation and management of urticaria in adults and children 1, the duration of individual weals can be helpful in distinguishing between different clinical patterns of urticaria. For instance, weals typically last from 2 to 24 hours in ordinary urticaria, while those in physical urticaria can last up to 48 hours.
When considering the management of hives, it's essential to identify and avoid triggers, as well as to provide appropriate treatment. The consultation and referral guidelines citing the evidence 1 suggest that patients with acute urticaria or angioedema without an obvious trigger, or those with chronic urticaria, should be evaluated by an allergist-immunologist to identify potential causes and develop a treatment plan.
Key points to consider in the management of hives include:
- Identifying and avoiding triggers
- Using non-sedating antihistamines as first-line treatment for acute hives
- Considering alternative treatments, such as increasing the antihistamine dose or adding a different class of antihistamine, for persistent or severe cases
- Seeking medical attention promptly if hives persist beyond a few days, are accompanied by difficulty breathing or swallowing, or recur frequently.
In terms of specific treatment options, the guidelines suggest that patients with chronic urticaria may benefit from consultation with an allergist-immunologist to review possible causative factors, consider skin testing or physical challenges, and develop a plan for optimal pharmacotherapy 1. Ultimately, the goal of treatment is to alleviate symptoms, prevent complications, and improve quality of life, while also addressing the underlying causes of the hives.
From the Research
Definition and Duration of Hives
- Hives, also known as urticaria, are a common skin condition characterized by itchy, raised welts 2.
- The lesions typically last less than 24 hours and are usually pruritic 2.
Persistence of Hives
- Acute urticaria lasting less than 6 weeks may be associated with a drug or food allergens 3.
- Chronic urticaria lasting more than 6 weeks is often associated without a known underlying cause 3.
- Some cases of urticaria can persist for more than 24 hours, especially in chronic cases 4, 5.