Skip to main content

5 Potential Causes of Severe Hives

For most people, hives seem to appear suddenly. These itchy, red bumps on your skin can be jarring and uncomfortable. While m

For most people, hives seem to appear suddenly. These itchy, red bumps on your skin can be jarring and uncomfortable. While mild cases are usually harmless, severe or recurrent hives can indicate an underlying issue that requires attention.

In most instances, hives disappear as quickly as they appeared. But what about those times when they persist or become severe? In such cases, Dr. Vasif Kalfa and our team at Allergy & Asthma Clinic of Maryland in Silver Spring, Maryland, have an excellent track record of helping patients get to the bottom of — and successfully manage — severe or chronic hives. 

Here, we review five potential causes of severe hives, and explain what you can do about them.

1. Allergic reactions

One of the most common causes of severe hives is an allergic reaction. When your immune system identifies a substance as harmful — even when it's not — your body perceives it as a threat and releases histamines and other chemicals. The resulting systemic inflammation may lead to the appearance of red, itchy hives on your skin.

Common hive-inducing allergens include foods such as nuts and shellfish, medications like antibiotics and NSAIDs (nonsteroidal anti-inflammatory drugs), and stings from insects like bees and wasps. 


Dr. Kalfa often performs skin tests or blood tests to pinpoint the exact allergen causing your skin reaction. Future avoidance of any identified allergens is the best way to prevent hives. Dr. Kalfa may also prescribe an EpiPen® for emergencies, especially if your allergy is severe and poses a risk of a life-threatening allergic reaction called anaphylaxis.

2. Autoimmune disorders

Autoimmune disorders are conditions where the immune system mistakenly targets healthy cells. Conditions like lupus, rheumatoid arthritis, and thyroid disorders like Hashimoto's disease or Graves disease can trigger the immune system to release chemicals that cause inflammation and hives.

These conditions typically cause additional symptoms like fatigue, joint pain, and other types of skin rashes, which can sometimes make them easier to identify. 


Treatment of an autoimmune disorder generally consists of managing the symptoms through medications such as corticosteroids or immunosuppressive drugs, along with condition-specific approaches like dietary changes, physical therapy, or surgery.

3. Infections and viruses

While it's common knowledge that infections can make you feel sick, not many realize that they can also cause severe hives. When your body is infected with bacteria, viruses, or fungi, the immune system goes into overdrive to neutralize these pathogens. As a result, you might break out in hives.

Respiratory infections like the common cold and influenza, and bacterial infections like streptococcal pharyngitis, can all trigger hives. The same goes for gastrointestinal (GI) infections and viral fevers. 


Diagnosis usually involves identifying the underlying infection through a series of tests. Treatment aims to resolve the hives by eliminating the infection, often through antibiotics or antiviral medications.

4. Stress and emotional factors

While not fully understood, there's a known link between emotional stress and severe hives. When under stress, your body releases a flood of hormones like cortisol, which can trigger an inflammatory response resulting in severe hives.


Emotional triggers like anxiety, stress from work or personal life, and lack of sleep can be significant contributors. For people already susceptible to hives, stressful periods can worsen the condition. 


Management often includes stress-relieving techniques like deep breathing exercises, meditation, and sometimes counseling to help understand and cope with stressors better.

5. Physical factors

External factors like heat, cold, or friction can sometimes trigger severe hives. These factors are not tied to an immune response, but rather to physical stimuli. 

For instance, some people experience exercise-induced hives where increased body temperature during physical activity leads to an outbreak of hives. Similarly, tight clothing can cause pressure-induced hives.


The key to management here is understanding these physical triggers and finding ways to avoid them. Antihistamines can provide temporary relief, but avoiding the trigger altogether is often the best long-term solution.

Expert care for severe hives

Dealing with severe hives can be upsetting. While each case is unique, identifying potential causes is the first step toward effective management.  

At Allergy & Asthma Clinic of Maryland, our team of experienced allergists and immunologists offer specialized, individualized care for patients of all ages in Silver Spring, Chevy Chase, and Bethesda, Maryland, as well as the greater Washington D.C. area. To learn more or schedule a visit, call or click online today. 

You Might Also Enjoy...

Why You Shouldn’t Ignore Your Long-Lasting Cough

Why You Shouldn’t Ignore Your Long-Lasting Cough

Have you been dealing with a cough that just won’t let up? It may be more than a minor annoyance — it could be a sign of something more serious. Find out why a persistent cough isn’t something you should take lightly.
Is Your Acid Reflux the Cause of Your Chronic Cough?

Is Your Acid Reflux the Cause of Your Chronic Cough?

Your chronic cough could be a symptom of acid reflux. Discover the surprising connection between acid reflux and chronic cough, and find out how recognizing and treating the root cause can give you long-lasting relief.