Hives Symptoms: Allergy vs. Anaphylaxis?

Hives Symptoms:  First step is Diagnosing Hives vs. Anaphylaxis

Are your hives symptoms caused by an allergy or anaphylaxis
Hives symptoms: allergy vs. anaphylaxis?

About a year ago, Kristie said that she wanted to get a bee hive for the backyard.  She told me all about how we can help our garden with bees, get honey from bees, make beards from bees… and it all sounded good at first.  She even told me that she’d take CARE of the bees!

But then I realized a few things like a TV flashback:

Kristie wants bee hives
Not these hives!
  • When we got our dog, she said she’d help take care of the dog. Now I take care of the dog.
  • When we got another cat, she said she’d help with the litter box. But it’s in the garage, where spiders also live, so now I take care of the litter box.
  • When we got chickens, it was also a team effort. But now I have to go out (and walk through, ironically, bees) to check on the chickens every day.

And then it hit me:  I don’t want to take care of bees!

So at this time, we don’t have bees.  I tried to convince her to raise the nest of wasps stuck to our fireplace as her own, but somehow it isn’t the same.

If you came here to read about how to raise bee hives… wrong article.


Medical Hives:  Symptoms of Hives

There is one ACTUAL goal of this article:  to help you determine whether your symptoms of hives are due to anaphylaxis or due to “regular hives.”

  • If you have hives symptoms, then this is the article for you!
  • If you don’t have hives symptoms, but know someone who does, then this article will help you relate to them and understand what they’re going through.


Hives symptoms are FRUSTRATING for both patients and providers.  As an allergist, I specialize in hives symptoms, which means I understand what you’re going through.

I also have personal experience with the symptoms of hives… and they are MISERABLE!

I wrote this post to help guide you to getting the right answer to your hives symptoms!

Need help right now!?

I understand that many of you want answers RIGHT NOW!

If I was currently having hives, I wouldn’t want to read an article.  I’d want a solution!

If you want help right now, click this link and fill out these 5 questions and I’ll get you help immediately.

***Get Hives Help RIGHT NOW***

For everyone else, the FIRST question you need to know if you have hives is whether or not this is regular hives or potentially life-threatening anaphylaxis!

Child hives and want help right now?
CLICK HERE if you want hives help RIGHT NOW!

Overview of Hives Symptoms

Symptoms of hives are annoying to a level beyond anything that I can imagine (even worse than the vuvuzela or Raider’s fans)!  The itch is such a deep, annoying, constant itch that it could easily drive you mad!

The best description for hives symptoms:  it’s an itch so deep and annoying that you want to lift off your skin to get deep enough to relieve the itch.


Hives themselves are very common, affecting 1 in 5 (20%) of people at some point in their life.

The problem: 90% of life anaphylaxis threatening also has symptoms of hives!

What we need to figure out for you is whether or not your hives are due to anaphylaxis or if they are “regular hives.”  The cause, treatment and long term outcomes are VERY different between these causes.

The best way to determine what your cause of hives are is actually a detailed history of your hives symptoms/reaction.


History is the Key to Diagnosing Symptoms of Hives

The single most important key to a proper diagnosis is a detailed history of your hives reaction.  Ideally, before you saw any doctor you would write down and answer all these questions:

  1. Do you have any hives photos? (Take TONS of photos. This will not give me the cause of the hives but help me determine if we’re actually dealing with hives or not)
  2. How long have you had the symptoms of hives?
  3. What makes your hives symptoms better or worse?
  4. Are there any foods that trigger your hives? (If your hives symptoms just happened, write down the food/meals you ate BEFORE each episode of hives)
  5. Any new medications, vitamins or supplements OR any dose changes right before you started having hives?
  6. Have you tried any antihistamines or Benadryl/diphenhydramine and what was the response?
  7. Are there any other symptoms associated with the hives? (Such as dizziness/lightheadedness, breathing problems, GI complaints, headaches, swelling, or anything else?)


These are the first round of questions needed to determine if your hives are potentially life-threatening anaphylaxis or more regular hives.

If you have symptoms of hives, take a moment to write down these questions for your doctor.  Or, if you want a faster answer, take this quiz and I’ll give you a good direction on your hives!


Hives as a part of Anaphylaxis

If you are actually having potentially life-threatening anaphylaxis, I would expect there to be hives symptoms 90% of the time.  However, you should ALSO have another system affected at the same time.


Symptoms of hives are a part of anaphylaxis
Signs and Symptoms of Anaphylaxis

Signs of anaphylaxis/Symptoms of anaphylaxis:

Having 2 or more of these suggests anaphylaxis:

  • Hives (90%) of the time
  • Swelling (of the face/tongue, hands or feet)
  • Dizziness/lightheadedness
  • GI upset (nausea, vomiting, diarrhea or abdominal pain)
  • Difficulty breathing or shortness of breath
  • Heart racing or chest pains
  • Feeling of “impending doom”


Note:  If you only have hives and swelling together that doesn’t necessarily mean a diagnosis of anaphylaxis.  But I’d need to know more about the swelling to know for sure.


Most common causes of hives as a part of anaphylaxis:

  • Food allergy/anaphylaxis
  • Medication allergy/anaphylaxis
  • Insect sting allergy/anaphylaxis
  • Idiopathic anaphylaxis


Hives Symptoms NOT due to anaphylaxis

If you’re having hives and not anaphylaxis, then you are part of the 20% of people who will have an episode of hives at least once in their life.

I’m writing a series of posts to go into greater detail on the different types of hives and how to feel better.

Again, if you don’t want to wait for these posts (I know I wouldn’t) then click here and I can get you your answer right away.


For now, the first step is to make sure you are not dealing with anaphylaxis!

Signs and Symptoms of Hives NOT due to anaphylaxis

Hives can be caused by anaphylaxis or other causes
Itching is common with any type of hives!

Having hives AND swelling are common together

  • Hives
  • Swelling (of the face/tongue, hands or feet)


Note:  If you only have hives and swelling, this could be anaphylaxis.   But I’d need to know more about the swelling to know for sure.

You should have NONE of these:

  • Dizziness/lightheadedness
  • GI upset (nausea, vomiting, diarrhea or abdominal pain)
  • Difficulty breathing or shortness of breath
  • Heart racing or chest pains
  • Feeling of “impending doom”


Most common causes of hives symptoms NOT due to anaphylaxis

  • Colds/Flus or bacterial infections are the #1 cause!
  • Contact hives (due to touching pets, pollen or chemicals)
  • Physical causes of hives
    • Stress induced hives
    • Exercise induced hives
    • Heat or cold induced hives
    • Water induced hives
    • Vibration induced hives
    • Weight (pressure) induced hives
  • Idiopathic hives (80% of the cause of hives lasting > 6 weeks)
  • Internal causes (some chronic medical problems)


What about lab or allergy testing?

As I mentioned above, the key to a diagnosis of hives is HISTORY and not testing!

I’m creating a post specifically addressing the testing for hives but if you want to know about testing before that post then click here and I’ll be able to answer your questions.

Goal of Step 1

At this point, if you have hives (or know someone who had) the ONLY goal is to determine if the hives are more likely due to anaphylaxis or more likely regular hives.  That is IT!


  1. If you feel that your hives are concerning for anaphylaxis, I would recommend you see your primary care provider and possibly an allergist to get the right diagnosis and treatment.
  2. If you feel that your hives are not concerning for anaphylaxis, then the next step is to get you feeling better
    • You can fill out the questions above and take them to your primary care provider
    • You can read more about hives in my future posts
    • Or you can ask me and I’ll try to give you a good diagnosis and treatment answer


PS – “Hives symptoms” is a boring title

I want to give credit to Kristie, who wrote a much better title for this article (in exchange for letting me talk s#%t about her in the introduction.

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