Breaking Out in Hives: 4 Causes You Wouldn’t Expect

If you are among the majority, breaking out in hives—medically called urticaria— your skin itches, covered in red or skin-colored welts. Hives often appear when an allergen of some sort strikes: pet dander, pollen, latex are some common ones; it stimulates the body to liberate histamine into your bloodstream.

It might seem like you are breaking out in hives for no apparent reason, but there is usually an underlying cause. Environmental factors, certain health conditions, workouts, or emotional changes usually cause unexplainable hives. Here’s what you need to know about hives that happen out of nowhere.

1. The Great Outdoors

Insect bites and exposure to pollen can make you break out in hives. You may not have realized that direct sunlight, cold temperatures, or swimming in cold water can also bring on hives.

Hives caused by exposure to heat, cold, or pressure- such as from tight athletic clothing-are a type of physical urticaria because the cause is physical. This doesn’t necessarily mean you’re allergic to the elements. “It’s really more that your skin is very sensitive,” Marilyn Li, MD, a Los Angeles-based allergist and immunologist, told Health.

While avoiding those things might prevent the hives from coming back, Dr. Li said that there is always the possibility that a healthcare provider may be able to prescribe an antihistamine that will eliminate weather- or temperature-based issues. This will allow you to hike on a bright summer day, or to carry a cold beverage without the worry of an impending outbreak of hives.

2. An Underlying Disease

Chronic hives can be a harbinger of a larger issue, and extensive blood work may be necessary to determine the underlying cause.

Patients with lupus, lymphoma, thyroid disease, and hepatitis may have hives as part of the presentation of their disease, says Debra Jaliman, MD, a New York City-based dermatologist and author of Skin Rules. Since these are usually chronic hives, medications are the best source of relief.

If you have contracted a virus—including SARS-CoV-2, the virus that causes COVID-19—that can also trigger hives.

3. Your Daily Workout

While your morning jog or post-work weightlifting routine may give you a natural endorphin rush, your exercise routine may also be causing you to break out in hives.

As Dr. Jaliman points out, when the body responds to exercise, it creates acetylcholine, a chemical that can stop cells from breaking down. In some people, acetylcholine disrupts skin cells, irritating the skin and creating a rash in much the same way that histamine does, or by contributing to the release of histamine.

Dr. Li said that even sweat may trigger a breakout for those prone to hives. Sweat doesn’t cause hives but rather signifies your body’s heat is rising. Cholinergic urticaria occurs when hives arise due to a rise in body temperature.

Excess warmth on the skin, such as during a workout or a hot bath, may be enough for some to cause hives.

4. Emotionally Charged Situations

Intense emotional responses can provoke an outbreak of hives. For people who have chronic hives—or hives that persist for more than six weeks at a time—stress can lead to worsened hives and more intense itching. In addition, the relationship can occur the other way around: hives can impair emotional functioning.

Why Am I Breaking Out in Hives at Night?

You might wake up at night lying in bed trying to sleep and find you break out in hives—and dermatographism could be the cause. Also known as dermographism urticaria, dermatographism affects 2% to 5% of people but is the most common cause of physical urticaria. It occurs after skin pressure or trauma, and one potential cause of skin pressure is when your skin makes contact with bedding or sheets.

Another rather unforeseen cause of nighttime hives is related to the timing of your work shift. One study revealed that those people who worked at night were at a higher risk for chronic spontaneous urticaria. The researchers propounded the theory that circadian rhythms may bear some of the responsibility associated with this but that more research is needed.

When To See a Healthcare Provider

For those who have chronic hives from heat-induced or illness-induced activities, Dr. Li advised seeing a healthcare provider to pinpoint the symptoms and receive an antihistamine prescription. “The solutions are individualized and many times may involve just taking a little more medication,” Dr. Li said.

In most situations, hives will clear themselves within a time period, if not that extreme to be under medication or injectable. Always rush for medical care immediately should you feel like the symptoms which include;

  • Mouth, facial, or tongue swelling
  • Feelings of fainting
  • Problem in breathing shortness
  • Inability to swallow
  • Constriction of the throat
  • Wheezing

A Quick Review

Allergens often cause hives or urticaria, which are itchy red or skin-colored welts. You may not know what allergen is causing you to break out in the hives.

However, some unexpected causes include environmental temperatures, stress, health conditions such as lupus or thyroid disease, and exercise. You should see a healthcare provider if your hives do not go away or you experience other symptoms, such as throat swelling, feeling faint, or wheezing.

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