Fact sheet

Hives and Swelling

Itchy raised welts that wander around, each lasting less than a day, sometimes with deeper swelling (angioedema). Most follow a virus or have no clear cause and fade within weeks.

The hives ladder

Start at the bottom, climb only if you need to. Hives most days for more than 6 weeks is chronic hives, which is rarely an allergy and usually needs a daily antihistamine at least.

  1. Step 1 · Self-careCool down and dodge triggersCool showers or packs, loose clothes, and less heat, alcohol and spicy food during a flare.
    Works
    Not tested in trials; eases itch and may cut flares, but won’t stop hives on its own
    Cost
    Free
    How long
    Straight away
    Watch for
    Aspirin and anti-inflammatories can make hives worse. Paracetamol is fine for pain.

    Scratching feels great for four seconds, then makes it worse for an hour.

  2. Step 2 · PharmacyNon-drowsy antihistamine (cetirizine, loratadine or fexofenadine)The main treatment. For hives that keep returning, take it every day, not just when itchy.
    Works
    Settles most short-lived hives; fully controls fewer than half of people with chronic hives at the usual dose
    Cost
    About $10–25 for a month’s supply
    How long
    Works within an hour or two; take daily while hives continue
    Watch for
    Mild drowsiness (more with cetirizine), dry mouth. The old drowsy antihistamines aren’t needed.

    Taking it only when itchy is like shutting the gate after the horse has bolted. Daily works better.

  3. Step 3 · PharmacyHigher antihistamine dose, on medical adviceIf the usual dose isn’t enough, a doctor may advise up to 4 times the usual daily dose.
    Works
    About 6 in 10 not controlled on the usual dose respond to a higher dose (combined trials)
    Cost
    About $30–60 a month
    How long
    2–4 weeks to judge
    Watch for
    More drowsiness. Only go above the label dose with medical advice.

    Same tablet, more of them, with a doctor holding the map.

  4. Step 4 · PrescriptionMontelukast, or a short course of steroid tabletsMontelukast is sometimes added for chronic hives. Prednisolone is for a severe flare only.
    Works
    Montelukast: small, inconsistent benefit in trials; steroids calm a severe flare fast
    Cost
    Montelukast private script about $20–40 a month; prednisolone under the $25 PBS co-payment, about $10–15
    How long
    Steroids for a few days only
    Watch for
    Montelukast: rarely, serious mood or behaviour changes (including suicidal thoughts) or nightmares; stop and see your doctor. Steroids: poor sleep, mood swings, high sugar; repeated courses cause real harm.

    Steroids are a fire extinguisher, not a sprinkler system.

  5. Step 5 · SpecialistOmalizumab injectionsFor chronic hives not controlled by high-dose antihistamines, from an immunologist or dermatologist.
    Works
    About half to 2 in 3 get good control; about 1 in 3 become hive-free (vs under 1 in 10 on a dummy treatment)
    Cost
    $25 per script on the PBS if criteria are met ($7.70 concession), plus specialist fees
    How long
    Monthly injection; judged at 3–6 months
    Watch for
    Injection-site reactions, headache. Rare allergic reactions, so early doses are given in clinic.

    The big gun for chronic hives, and it actually hits the target.

Costs are rough Australian prices in October 2026 and vary by pharmacy and clinic. PBS co-payment: $25, or $7.70 with a concession card. Results are typical figures from trials: your skin didn’t read the trials.

Save your money

Popular, heavily marketed or often asked about, but the evidence is weak or says no.

What you can do

See your GP if

Call 000 for swelling of the tongue or throat, trouble breathing or swallowing, a hoarse voice, wheeze, dizziness or collapse. Use an adrenaline autoinjector first if you have one, and lie down rather than stand.

Common questions

What causes hives?

Most cases follow a viral infection or have no clear cause, and settle within days to weeks. Hives most days for more than 6 weeks (chronic hives) is rarely due to allergy.

Which antihistamine is best for hives?

A non-drowsy one such as cetirizine, loratadine or fexofenadine. For hives that keep coming back, take it every day. Only take a higher dose on medical advice; specialist injections (omalizumab) help if that isn’t enough.

Do I need allergy tests for hives?

For chronic hives, allergy tests and strict diets rarely find a cause. Only have them with medical advice.

When are hives an emergency?

Call 000 for swelling of the tongue or throat, trouble breathing or swallowing, a hoarse voice, wheeze, dizziness or collapse. Use an adrenaline autoinjector first if you have one.

How long do hives last?

Each welt usually fades within 24 hours, though new ones can keep appearing. Most bouts of hives settle within days to a few weeks. Hives lasting more than 6 weeks are called chronic hives and often settle by themselves within 1 to 5 years.

Are hives contagious?

No. Hives are a reaction in the skin and can’t be passed on, even when an infection such as a cold triggered them.

Can stress cause hives?

Stress doesn’t usually cause hives on its own, but it can trigger or worsen flares, especially in chronic hives. Heat, tight clothing, alcohol, anti-inflammatories and infections are other common triggers.

Helpful resources

Evidence and more information

Updated 28 October 2026. General education, not personal medical advice. Treatment depends on your situation, so talk to your GP or pharmacist.

Related

maladywise.com/hives/