Although in the vast majority of cases, it can be justifiably said that hives are a genuine, authentic skin disease, in a few cases it should not be taken lightly. However, in a few cases, hives should not be taken lightly, as they are not just a skin disease, but may be a skin manifestation of an underlying visceral disease, and should be recognized in a timely manner to avoid misdiagnosis or underdiagnosis. Therefore, it is very important to recognize that urticaria is sometimes more than a skin disease and not to be careless. Urticaria can occur in 7%-9% of SLE cases, and 40% of them are the earliest symptoms of the disease or develop before 1 year of the disease, mostly as urticaria-like vasculitis. Urticaria can occur months before young rheumatoid arthritis (Still’s disease), and 25% of young rheumatoid arthritis patients have a non-itchy rash spreading throughout the body, while the early lesions are urticaria. 1.7% of early rheumatic fever patients also have an urticaria-like rash, and urticaria-like vasculitis is a characteristic lesion in the acute phase of polymyositis. He Huiying, Department of Dermatology, Zhejiang Hospital of Traditional Chinese Medicine 20% of cold urticaria is associated with cryoglobulinemia or myeloma. Cryoglobulinemia can be of unknown cause, but many are associated with connective tissue disorders, multiple myeloma, chronic lymphatic leukemia, and infectious mononuclear cell hyperplasia. Urticaria is very closely related to gastrointestinal disorders. Urticaria can be accompanied by gastrointestinal symptoms, and gastrointestinal discomfort and bloating are often considered to be a precursor to urticaria. Altered gastric acidity, small bowel lesions and colitis can all cause urticaria, and the gastric emptying time is greatly reduced in patients with chronic urticaria compared to normal individuals. Chronic cholecystitis is thought to trigger chronic urticaria. In a control group of middle-aged women, 60% of chronic urticaria was controlled after removal of the gallbladder, while only 12% of chronic urticaria improved in the group without gallbladder removal. Acute urticaria can also be triggered by acute gastroenteritis. In recent years, the organic link between chronic urticaria and thyroid disease has been more clearly recognized. According to statistics, 6% of thyroid disorders can be associated with chronic urticaria, and if thyroid disorders are controlled, chronic urticaria will be reduced at the same time. Patients with thyroid disease accompanied by chronic urticaria usually have a 30% positive rate of anti-microsomal antibodies (titer ≥1:1600), while patients with thyroid disease without chronic urticaria only have a 5.6% positive rate. Allergy to insulin occurs in 16% to 50% of diabetic patients, especially in the injection site to produce wind damage, and more than 25% of those allergic to insulin will also be allergic to penicillin. In conclusion, chronic urticaria is inextricably linked to visceral diseases, either explicitly or implicitly, and should be carefully questioned when taking a medical history in order to find clues.