Allergic Urticaria ICD-10: L50.0
Often searched as: hives on skin, itchy red welts, rash after taking medication, allergic reaction on skin, raised bumps that itch, hives that move around body, skin reaction to medicine, red splotches that come and go…
Clinical urgency level
Systems Affected
Severity Levels
mild
A few scattered hives that resolve within hours, no swelling of lips or throat, no systemic symptoms — manageable with antihistamines.
moderate
Widespread hives covering large body areas, significant itching, lasting more than 24 hours or recurring over days despite antihistamines.
severe
Hives accompanied by angioedema (swelling of lips, tongue, or throat), difficulty breathing, drop in blood pressure, or dizziness — constitutes anaphylaxis, a medical emergency.
Red Flags
- Swelling of the lips, tongue, or throat
- Difficulty breathing or wheezing
- Dizziness, fainting, or feeling of impending doom
- Hives spreading rapidly over the entire body
- Hives lasting more than 6 weeks (chronic urticaria — needs evaluation)
- Reaction occurring after a bee sting, food, or medication — allergy assessment needed
Clinical Presentation
Classic urticaria — raised red itchy welts on the forearm
Source: Wikimedia Commons (CC BY-SA 3.0 )
Urticaria image gallery — DermNet NZ
View gallery on DermNet NZ (image gallery reference)When to See a Doctor
Call emergency services immediately if hives are accompanied by throat swelling, difficulty breathing, or dizziness — this may be anaphylaxis. See a doctor or allergist if hives last more than a few days, keep coming back, or if you don't know the trigger. Chronic hives (lasting more than 6 weeks) always require medical evaluation.
Differential Diagnosis
- Chronic spontaneous urticaria (no identifiable trigger)
- Physical urticaria (triggered by cold, pressure, or exercise)
- Urticarial vasculitis (hives lasting >24h with bruising)
- Contact dermatitis
- Erythema multiforme
- Insect bite reactions
- Angioedema (without hives)
Comorbidities
- Allergic asthma
- Allergic rhinitis (hay fever)
- Atopic dermatitis
- Food allergies
- Anaphylaxis history
- Thyroid disease (in chronic urticaria)
- Anxiety (chronic hives have significant psychological impact)
Prognosis
Acute allergic urticaria from an identifiable trigger (medication, food, insect sting) typically resolves within hours to days once the trigger is removed and antihistamines are taken. Recurrence is prevented by avoiding the trigger. Chronic urticaria (lasting >6 weeks) is more challenging — it resolves spontaneously in 50% of patients within 1 year, but can persist for years. Omalizumab (Xolair) is an effective treatment for chronic cases unresponsive to antihistamines.
Detailed Overview
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