Signs, Emergencies and When Stronger Treatment Is Needed
Hives can be severe in two different ways: as a medical emergency caused by a serious allergic reaction, or as long-lasting, intense symptoms that disrupt sleep, work and quality of life. Knowing which situation you are in determines what to do next.
Emergency Signs
Severe hives with trouble breathing, throat tightness, wheezing, swelling of the face or tongue, dizziness, or repeated vomiting suggest anaphylaxis and need emergency care. See also are hives dangerous.
Severe Chronic Hives
Doctors rate severity with a seven-day urticaria activity score (UAS7). Scores of 28 to 42 are considered severe, 16 to 27 moderate and 7 to 15 mild; 6 or less indicates well-controlled disease. Signs that hives are not controlled include daily welts, nightly waking, missed work and constant itching.
Treatment for Severe Hives
If standard antihistamine doses do not control hives, the doctor may increase them (up to four times) and then add omalizumab, dupilumab or remibrutinib in eligible adults. Short courses of oral steroids may be used for severe flares but are not for long-term use. Read about chronic hives treatment and Xolair for hives.
When to Call 911
Call 911 right away if hives or swelling occur with difficulty breathing or swallowing, a tight or closing throat, a swollen tongue, lips or face, wheezing, faintness, or a sudden feeling of impending doom. Use an epinephrine auto-injector first if one has been prescribed to you, then call for emergency help.
When to See a Doctor
See a doctor if your symptoms last more than a few days, keep coming back, cover large areas, or interfere with sleep or daily life. Dr. Tiffany Young and the Hives Treatment Center in San Francisco provide online and in-person care for severe hives.
Frequently Asked Questions About Severe Hives
Can hives be life-threatening?
Hives alone rarely are, but hives with breathing difficulty or swelling of the throat can be.
Should I go to the ER for widespread hives?
Go if you have breathing symptoms or feel faint; otherwise see a doctor promptly.
Can severe hives be controlled?
Yes, most people improve with stepwise treatment.
Get Relief for Your Hives
Uncontrolled hives are treatable, and you do not have to just endure them. Visit our hives treatment page to see the latest treatment options for your outbreak.
This information is for educational purposes only and is not a substitute for professional medical advice, diagnosis or treatment. If you think you are having a medical emergency, call 911.
