Even Anne Hathaway gets nervous before a big interview, and her skin doesn’t let her hide it. In 2016, the actress posted an Instagram photo of the large, blotchy red patches spreading across her chest just before an appearance on The Ellen DeGeneres Show, jokingly dubbing them her “Ellen DeGeneres nerves.” Five years later, the hives made a cameo on Late Night with Seth Meyers, and fans took to Twitter (now X) to thank the actress for being so open about a reaction many of them know all too well.
“Anne Hathaway talking about breaking in hives when public speaking!!!!” one person exclaimed on the platform. “I am FINALLY SEEN.” It’s a common feeling: Stress hives don’t get talked about nearly as often as they happen. So why do they show up, and how can you prevent them or clear them up fast? We tapped three experts—two board-certified dermatologists and a board-certified allergist-immunologist—to find out.
Featured Experts
- Daniel Schlessinger, MD is a board-certified dermatologist in Omaha, NE
- Joel Schlessinger, MD is a board-certified dermatologist in Omaha, NE
- Kara Wada, MD is a board-certified allergist and immunologist in Columbus, OH
What Causes Stress Hives?
At first glance, stress hives are exactly what they sound like. “Stress hives occur when an emotional stressor causes mast cells to release histamine, producing raised, itchy welts,” explains Omaha, NE dermatologist Daniel Schlessinger, MD.
But stress is rarely the whole story. “Stress does not usually cause hives on its own, but I think of it as lighter fluid,” says Columbus, OH allergist-immunologist Kara Wada, MD. When you’re under pressure, she explains, nerves in the skin release chemical messengers and the skin produces its own stress hormone, both of which make mast cells quicker to fire. And even everyday stressors count: In studies, Dr. Wada says, things as ordinary as video games, phone use and traffic noise made skin reactions bigger, while laughter, music and affection helped calm them down.
As for why some people break out before a big presentation while others stay perfectly calm-skinned, Dr. Daniel Schlessinger says genetics and other triggers, like allergies, can play a role. Dr. Wada adds that people’s nerves and mast cells simply respond differently.
Stress Hives vs. Allergic Hives
The tricky part? You can’t tell stress hives and allergic hives apart just by looking at them. So how do you know which one you’re dealing with? According to Dr. Wada, it comes down to a careful look at your history. “We have to act a bit like detectives and ask when the symptoms are occurring and what they might be occurring in relationship to,” she says. True allergic hives, she explains, show up quickly, usually within an hour of a specific exposure, and they happen every time you eat that food, take that medication or get stung by that insect.
Stress hives, on the other hand, tend to flare during stressful moments (like, in Hathaway’s case, an appearance on Ellen). According to Dr. Wada, stress acts less like an allergy and more like a trigger that makes people who are already prone to hives more likely to break out.
Annoyingly, you can have both stress hives and allergic hives, so allergy testing won’t always give you the full picture. If you suspect a specific trigger, like a certain food or medication, targeted testing can help confirm it. But when there’s no clear culprit, Dr. Wada says broad allergy panels aren’t recommended: They haven’t been shown to improve outcomes and often lead to false leads.
How to Get Rid of Stress Hives Fast
You’ve got options when it comes to clearing up stress hives. “Everyone thinks about Benadryl first, but we have much better options nowadays that don’t cause drowsiness, such as Zyrtec, Xyzal or Claritin,” Dr. Daniel Schlessinger explains. Cool compresses or a cold shower can also calm things down, as can steering clear of heat, alcohol and scratching. For extra relief, he suggests a product like his own FixMySkin 1% Hydrocortisone Healing Balm ($23).
The good news is that flare-ups are usually short-lived. “A stress-related episode may resolve within hours or a few days, although new welts can continue appearing if the trigger persists,” Dr. Daniel Schlessinger says. Each individual welt, he adds, typically moves around, changes shape and disappears within 24 hours without leaving a mark.
How to Prevent Stress Hives
If you know your skin tends to act up before high-pressure moments, Omaha, NE dermatologist Joel Schlessinger, MD suggests asking your doctor whether taking a non-sedating antihistamine in advance makes sense for you.
If so, timing matters. These medications generally start working within one to three hours, so according to Dr. Wada, “taking a dose a few hours beforehand, or the night before a next-morning event, is a reasonable approach.” As she puts it, “it’s like we’re trying to keep the horses in the barn rather than chase after them once they’ve escaped.”
For people who break out often, daily use may be more reliable than taking one here and there. And if you’re worried about taking an antihistamine every day, Dr. Wada notes that non-sedating options have a much better safety profile for long-term use than older ones like Benadryl and are generally well tolerated.
Your everyday habits matter too. Consistent sleep, regular exercise and stress-management techniques like paced breathing may make flares less likely, “particularly when practiced routinely rather than only moments before an event,” Dr. Joel Schlessinger adds.
Keeping your body cool can also help, as heat and friction may amplify hives. That means wearing loose clothing and skipping hot showers and alcohol. For some people, Dr. Wada says, physical factors like sweat and pressure can even trigger hives on their own. And while gentle, fragrance-free skin care can reduce background irritation, Dr. Joel Schlessinger is realistic about its limits: “No topical product can reliably prevent a histamine-driven outbreak.”
When to See a Doctor
Some signs mean it’s time to get checked out. According to Dr. Daniel Schlessinger, a rash that stays in the same place for more than 24 hours, or that scales, blisters, bruises or becomes painful, may be something more serious and should be evaluated by a board-certified dermatologist. You should also see a doctor for severe or frequently recurring episodes. Swelling of the lips, tongue or throat, difficulty breathing, dizziness or fainting require emergency treatment.
If hives last or keep coming back for more than six weeks, they’re considered chronic hives, though Dr. Wada notes that fewer than 40 percent of cases get there. When they do, they can persist for years before clearing up or going into remission. Luckily, there’s more help available than over-the-counter pills. A doctor may increase your antihistamine dose (up to four times the standard amount under supervision) and there are FDA-approved prescription treatments for chronic hives, including the injections Xolair (omalizumab) and Dupixent (dupilumab) and an oral medication called Rhapsido (remibrutinib).
The takeaway: The next time your skin flares before a big moment, remember that you’re in good company, and that a little planning can help keep your nerves from showing.
