Medical dermatology

Hives / Urticaria

Q: Will my hives go away on their own?

Acute hives often resolve within days to weeks once the trigger is removed. Chronic urticaria typically requires ongoing treatment but goes into remission in most patients within 1–5 years.

Q: Is Xolair (omalizumab) safe for urticaria?

Omalizumab is FDA-approved for chronic spontaneous urticaria and has a well-established safety profile. It is given as a monthly injection and significantly reduces or eliminates hives in most patients.

Itchy welts appearing and disappearing on the skin — our dermatologists diagnose triggers and provide lasting relief for acute and chronic urticaria.

Acute vs. Chronic Urticaria

Acute urticaria — lasts < 6 weeks. Common triggers: foods (shellfish, peanuts, tree nuts), medications (NSAIDs, penicillin), infections, insect stings.

Chronic spontaneous urticaria (CSU) — lasts ≥ 6 weeks, often without identifiable trigger. Autoimmune mechanisms play a role in ~45% of patients.

Physical urticarias — triggered by pressure, cold, heat, vibration, or exercise.

Diagnostic Workup

Detailed history and trigger diary
Skin prick tests / specific IgE when food/drug allergy suspected
Labs: CBC, CMP, thyroid antibodies, CRP, ANA for chronic cases

Treatment Options

| Severity | Approach | |---|---| | Mild–Moderate | Non-sedating H1-antihistamines (cetirizine, loratadine, fexofenadine) | | Moderate–Severe | Updosing antihistamines; short oral corticosteroid bursts | | Chronic refractory | Omalizumab (Xolair) injections monthly |

Angioedema

Deeper swelling (angioedema) of lips, tongue, or throat can accompany urticaria and may be an emergency — seek immediate care if airway involvement is suspected.

Frequently asked questions

Will my hives go away on their own?

Acute hives often resolve within days to weeks once the trigger is removed. Chronic urticaria typically requires ongoing treatment but goes into remission in most patients within 1–5 years.

Is Xolair (omalizumab) safe for urticaria?

Omalizumab is FDA-approved for chronic spontaneous urticaria and has a well-established safety profile. It is given as a monthly injection and significantly reduces or eliminates hives in most patients.

Most insurance plans cover medical dermatology procedures. Contact us to verify your benefits.

Trusted sources

This page is educational. Specific treatment decisions are made during your visit with Dr. Puyana.

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