Urticaria occurs when immune cells in the skin called mast cells become activated and release histamine, causing redness, itching and swelling.
For most people with persistent hives (urticaria), treatment focuses on controlling symptoms. Antihistamines are the main treatment and may need to be taken regularly, sometimes at doses recommended by a clinician. If antihistamines do not fully control urticaria, additional treatments are available – for example, Omalizumab is an effective injectable option, although most patients will not need it. Remibrutinib, is a new treatment option for appropriate adult patients with chronic spontaneous urticaria whose symptoms are not adequately controlled by antihistamines. Remibrutinib is an oral medication taken as a 25mg film-coated tablet and we are delighted to be able to now offer this at Allergy London.
It is important to remember that finding another medical condition alongside urticaria does not necessarily mean that the condition caused the hives, or that treating it will make the hives disappear.
Allergist for Hives / Urticaria
Many GPs can effectively diagnose and manage hives with antihistamines. However, seeking specialist advice from an experienced allergist / GP with specific expertise with hives (urticaria) can help provide appropriate, individualised care when symptoms persist or recur, are difficult to manage, the diagnosis is uncertain, further investigation is needed, or treatment requires review.
At Allergy London, we provide a dedicated service for adults (and children) with urticaria /hives. We are a leading multi location specialist allergy practice (London and Elstree), led by renowned allergists Professor Adam Fox OBE, (Professor of Paediatric Allergy), and Professor Stephen Till, (Professor of Adult Allergy). Our team also includes highly experienced GPs with a specialist interest in allergy, providing expert, personalised care for both adults and children with hives / urticaria.
Our trusted team of doctors have extensive experience and expertise in the assessment and management of hives (urticaria) in adults and children and other allergic conditions. We take the time to listen to your concerns, understand the pattern of your symptoms and recommend appropriate investigations and treatment where required.
Our specialists are supported by a wider clinical team of nurses and healthcare partners.
Urticaria – Types and Key Things to Know
Urticaria (hives) causes raised, itchy areas of skin that can appear and disappear. Urticaria can sometimes occur alongside angioedema, which causes deeper swelling beneath the skin. Depending on the symptoms and their severity, further medical assessment and treatment may be needed.
Spontaneous Urticaria
When hives repeatedly appear without an obvious trigger, this is known as spontaneous urticaria.
- Acute spontaneous urticaria: Hives last for less than six weeks. They may sometimes occur during or following an infection or vaccination.
- Chronic spontaneous urticaria: Hives continue or repeatedly occur for more than six weeks.
Idiopathic urticaria is a term used when hives occur without an identifiable cause. The hives may repeatedly appear and disappear over an extended period, sometimes lasting for several weeks or longer, even when antihistamines are being taken regularly.
Some people with chronic urticaria also develop dermographism, where scratching, rubbing or applying pressure to the skin produces raised, itchy lines or wheals.
Less common forms of urticaria can be triggered by physical factors such as cold, pressure or vibration.
Hives that continue or recur for six weeks or longer are considered chronic, and although blood tests may sometimes be used to look for associated conditions such as thyroid or coeliac disease, in many cases no specific underlying cause is found.
Hives and Food Allergies
Where there is a food allergy, hives can occur and are usually a sign of a mild allergic reaction. When a particular food is responsible, hives usually develop in close relation to eating or being exposed to that food. Avoiding the suspected food and taking an antihistamine may help the symptoms settle.
However, hives that repeatedly appear and disappear on different parts of the body over a prolonged period, without a consistent or identifiable trigger, are more suggestive of spontaneous urticaria than an ongoing food allergy.
A useful distinction is the timing and pattern of symptoms:
- Food allergy: Hives typically occur soon after exposure to a particular food and may occur alongside other allergic symptoms. The symptoms usually settle after the exposure has stopped and with appropriate treatment.
- Spontaneous/idiopathic urticaria: Hives can continue to appear and disappear over days, weeks or longer without a clear trigger. Symptoms may continue despite regular antihistamine treatment.
Important: If hives are accompanied by signs of a severe allergic reaction (anaphylaxis), use your adrenaline device promptly (this includes if you are unsure whether the reaction is severe enough to require adrenaline), and ensure someone has called 999, as this is an urgent medical emergency.
When to Seek Specialist Help for Urticaria/ Hives
Seeking specialist advice and care from a private allergy clinic for Urticaria / Hives may be helpful if:
- your hives persist or repeatedly return;
- you have a food allergy and would like to seek advice about hives
- your symptoms are difficult to control;
- the diagnosis is uncertain;
- you would like further investigation into possible causes or associated conditions; or
- your current treatment needs to be reviewed or optimised.
Hives can be acute, lasting for days or weeks, or chronic, when symptoms continue or recur for six weeks or longer.
If symptoms persist without an obvious allergic cause, a doctor will take a detailed medical history and, where appropriate, arrange blood tests to look for associated conditions. These may include thyroid disease, coeliac disease and, much less commonly, certain immune-system abnormalities.
In many people with chronic urticaria, however, investigations do not identify a specific underlying cause.
If Blood Tests are Taken, What Happens When when the Results Come Back?
If no underlying condition is identified, your doctor will usually discuss the diagnosis with you and advise you on the most appropriate treatment, including which medication you should continue taking.
If the results identify another condition that requires further assessment, you may be advised to see an appropriate specialist.
Your test results and relevant medical information may also be passed back to your GP, who can advise you on the next steps and arrange any further referrals that may be required.
Make an Appointment
At Allergy London, our dedicated team provides specialist care for children and adults with hives (urticaria).
Our experienced clinicians specialise in the assessment and management of urticaria and related allergic conditions, with a strong focus on clinical excellence and personalised care. We take the time to listen to your concerns, understand your symptoms and how they affect your daily life, and recommend appropriate investigations and treatment options based on your individual needs.
Our specialists work closely with an experienced team of nurses and healthcare partners to provide comprehensive, coordinated care throughout your journey with us.
Adults
- Professor Stephen Till
- Dr David Mass
Children
- Professor Adam Fox OBE
- Dr David Mass
Contact our Team
To make an appointment, please contact our team in the first instance:
Email: info@allergylondon.com
Telephone: 020 3758 9160
At Allergy London, we see children and adults with a wide range of allergic conditions at leading specialist hospitals and clinics across London and Elstree.
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