Hives from an insect bite: what to know

A bite may cause a local bump, while hives can appear as smooth, swollen patches elsewhere or spread beyond the bite site. Individual welts may fade and reappear in different places. Itching is common, and warmth or scratching can make the skin feel more irritated. Swelling of the lips, eyelids, tongue, hands, or feet can occur with a deeper allergic reaction; see the guidance on [Angioedema](/conditions/angioedema/). A changing [Skin Rash](/symptoms/skin-rash/) is not automatically hives, so a clinician may ask when the bite happened and whether new areas developed.

Move away from the insect and gently wash the area. A cool compress may reduce itch and swelling; avoid rubbing, tight clothing, and hot showers. Do not scratch, because broken skin can become infected. A pharmacist or clinician can advise whether an oral antihistamine is suitable; read more about [Antihistamine Treatment](/treatments/medical-dermatology/oral-antihistamine-therapy/). Take a photo if the welts change quickly, and record the suspected insect, timing, and any medicine used.

Call emergency services immediately for trouble breathing, wheezing, throat tightness, difficulty swallowing, faintness, confusion, or rapidly increasing swelling of the mouth or tongue. Seek prompt medical advice for widespread welts, repeated episodes, fever, severe pain, pus, or a reaction that is not settling. Do not wait for a rash to become extensive before acting when breathing or circulation symptoms begin.

Could this be [Hives](/conditions/urticaria/) or another [Skin Rash](/symptoms/skin-rash/)? Should I use an antihistamine, and which one fits my health conditions? Do I need an emergency action plan for a future bite? What signs of [Skin Swelling](/symptoms/skin-swelling/) should prompt immediate care?