Hives and angioedema: Understanding the difference

Last updated Oct. 6, 2025, by Agata Boxe
Fact-checked by Joana Carvalho, PhD

Hives, or urticaria, are raised welts that can appear anywhere on the body. They often accompany, and can be mistaken for, a type of swelling called angioedema.

While they often occur together, angioedema and hives can occur separately. Learning about their causes, the differences between the two conditions, and available treatments can help you better manage the symptoms.

Hives vs. angioedema

The main difference between hives and angioedema is that hives affect the skin’s surface, whereas swelling from angioedema occurs within the skin’s deeper layers and underlying tissues.

Both hives and angioedema can be classified into several types and can have different causes or no clear cause.

What are hives (urticaria)?

Hives are raised welts on the skin, and about 20% of people develop them at some point.

The three main types of hives are acute, chronic, and inducible.

Acute urticaria lasts less than six weeks and can be triggered by viral infections, foods, medications, insect stings or bites, stress, or latex.
Chronic urticaria lasts six weeks or more, and its cause is usually unknown.
Inducible urticaria is triggered by physical factors like pressure, heat, or cold.

Inducible hives are broken down further and named based on their cause:

Dermatographism, or skin writing, is when hives appear after the skin is lightly scratched or pressed, like when a belt rubs or presses against the skin.
Solar urticaria is caused by exposure to sunlight.
Cold-induced urticaria occurs following exposure to cold.
Aquagenic urticaria occurs after contact with water.
Cholinergic urticaria is caused by an elevation in body temperature, which can occur after physical exertion or exposure to heat.

What is angioedema?

Angioedema is not merely a skin reaction but swelling that affects the deeper layers of the skin and the tissues beneath it. It can occur in any part of the body, but it most commonly affects the eyes, lips, hands, feet, and genitals.

There are several types of angioedema:

Acute allergic angioedema is usually accompanied by hives and is caused by allergic reactions to triggers, including certain foods, medications, latex, and animal dander. In response, the immune system releases histamine, causing blood vessels to expand and the affected areas to swell.
Idiopathic angioedema does not have a known cause but may coincide with hives.
Hereditary angioedema (HAE) is a rare genetic condition that causes recurrent episodes of severe swelling, usually without hives. It can be triggered by stress (called a stress-induced angioedema attack).
Acquired angioedema (AAE) is a rare condition usually caused by another illness, like cancer or an autoimmune disease. It can affect any body part, but most commonly the face, limbs, or genitals, and it does not typically present with hives.

Another type of angioedema is drug-induced nonallergic angioedema. This type does not involve hives and is most often caused by angiotensin-converting enzyme inhibitors, also called ACE inhibitors, which are blood pressure medications.

As many as 2.5% of people who take ACE inhibitors develop drug-induced nonallergic angioedema, with Black individuals being more likely to develop it than those who are white.

Other medications that can cause this type of angioedema including:

Angiotensin-2 receptor blockers (used to lower blood pressure)
Nonsteroidal anti-inflammatory drugs (to relieve inflammation and pain)
SSRIs (to treat depression and other mental health conditions)
Statins (to reduce cholesterol)
Proton pump inhibitors (to help with acid reflux)

Overlapping triggers and mechanisms

Some types of urticaria and angioedema share the same triggers and mechanisms, which is why they can occur together. For example, certain foods and insect venom can trigger both conditions.

However, not all cases of hives or angioedema are linked to a specific trigger or a histamine response. Sometimes, the cause or mechanism is unknown.

A healthcare provider can help determine what may be causing your symptoms.

Diagnosing hives and angioedema

The process of diagnosing angioedema and hives will depend on your exact symptoms and other factors. Your doctor may be able to diagnose these conditions by reviewing your medical history, examining your skin, and conducting certain assessments, such as skin tests for allergies. Blood tests and other diagnostic procedures may also be recommended.

While many cases of hives and angioedema go away on their own, some situations need immediate medical attention, like mouth or throat swelling, which can make breathing difficult.

Anaphylactic shock is a life-threatening allergic reaction with symptoms that include trouble breathing, dizziness, fainting, and vomiting. If you think you are experiencing an anaphylactic shock, call 911 or go immediately to the emergency room.

Additionally, if your hives are painful and severe, last longer than a week, and are accompanied by other symptoms like abdominal pain, urgent medical care is needed.

Management and treatment

A healthcare provider can determine the best treatment for your symptoms. The approach will depend on whether you have hives, angioedema, or both.

Hives (acute or chronic) are often treated with antihistamines, but your doctor may suggest other options based on your specific diagnosis.

The treatment of angioedema is more complex and depends on its type and cause (if known).

For example, antihistamines and epinephrine can help if angioedema is caused by histamine release, but they won’t work for other types, such as bradykinin-mediated angioedema.

Bradykinin-mediated angioedema, such as HAE or AAE, requires a different treatment approach, which may include injectable therapies for swelling attacks.

Your doctor can also recommend long-term management strategies if your condition is chronic. When allergens like food or drinks trigger hives or angioedema, avoiding the trigger is key, along with any other treatments your doctor suggests.

Angioedema News is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.