Hives: what they are, what helps, and when they are an emergency

• Itching
• Raised red or skin-colored welts with clear edges
• Welts that grow, spread or join together
• Welts that change shape, fade and come back within minutes or hours

Many things can set off hives, such as some foods (like shellfish, fish, nuts, eggs and milk), medicines, insect bites, pollen and animal dander. Stress, cold or sun, sweating, exercise and infections can also cause them. Often, the cause is not found.

• Stay away from anything you know sets off your hives.
• Use cool compresses or take a cool shower.
• Do not wear tight clothes over the hives.
• An allergy pill (antihistamine), like cetirizine or diphenhydramine, can ease itching. Diphenhydramine can make you sleepy.

Call 911 for swelling of the face, lips, tongue, mouth or throat, trouble breathing, wheezing, a tight throat, fainting, or feeling very dizzy. These can be signs of a serious allergic reaction.

Also get emergency care for blisters, peeling or painful skin over large areas, spots that look like bruises, or sores in the mouth or eyes. These can be signs of a serious skin reaction, often to a medicine.

Get care the same day for a fever with feeling very sick, or for a spreading rash or feeling sick after starting a new medicine in the last 1 to 8 weeks.

See a doctor in person if a single welt hurts or stays in the same place for more than a day, or if your hives last more than 6 weeks or keep coming back with no clear pattern.

Hives that last more than 6 weeks are called chronic hives. Often no cause is found, and most go away within a year.

If you are in Virginia or West Virginia, you can start a visit online at any time. It is for adults and children 4 and older (with a parent or legal guardian) with a typical outbreak of hives, where each welt fades within a day. You send clear photos.

A board-certified physician reviews your answers and photos. If medicine is right for you, the doctor can send a prescription to your pharmacy. If you need to be seen in person, the doctor will tell you.

It is not for anyone with the emergency signs or the in-person reasons above.

Visits start at $59. You see the price before you pay, and you do not need insurance.