Approach to the Patient with Hives

Med Clin North Am. 2020 Jan;104(1):15-24. doi: 10.1016/j.mcna.2019.08.010. Epub 2019 Oct 28.


Urticaria is a common presenting problem to the primary care provider. Acute urticaria lasting less than 6 weeks may be associated with a drug or food allergens. Chronic urticaria lasting more than 6 weeks is often associated without a known underlying cause. Inducible stimuli causing hives should be excluded using specific provocation testing. Treatment follows a standardized algorithmic approach as outlined by the Joint Task Force Practice Parameter and/or International Urticaria guidelines. Patients not responsive to steps 1 or 2 should be referred to an urticaria specialist for further evaluation and treatment. The prognosis and outcome of urticaria is generally very favorable for most patients.

Keywords: Acute urticaria; Chronic spontaneous urticaria; Differential diagnosis; Guidelines; Inducible urticaria; Treatment algorithm.

Publication types

  • Review

MeSH terms

  • Acute Disease
  • Advisory Committees / standards
  • Chronic Disease
  • Drug Hypersensitivity / complications
  • Drug Hypersensitivity / diagnosis
  • Food Hypersensitivity / complications
  • Food Hypersensitivity / diagnosis
  • Humans
  • Practice Guidelines as Topic
  • Primary Health Care / methods*
  • Primary Health Care / standards
  • Prognosis
  • Referral and Consultation
  • Urticaria / diagnosis*
  • Urticaria / etiology