What are chronic hives?
Hives (urticaria) are red, itchy welts that result from a skin reaction. The welts vary in size and appear and fade repeatedly as the reaction runs its course.
The condition is considered chronic hives if the welts appear for more than six weeks and recur frequently over months or years. Often, the cause of chronic hives is not clear.
Chronic hives can be very uncomfortable and interfere with sleep and daily activities. For many people, antihistamines and anti-itch medications provide relief.
How common are chronic hives?
One percent or less of people have it. It’s most common in people between the ages of 20 and 40. Please discuss with your doctor for further information.
What are the symptoms of chronic hives?
The common symptoms of chronic hives are:
- Batches of red or skin-colored welts (wheals), which can appear anywhere on the body
- Welts that vary in size, change shape, and appear and fade repeatedly as the reaction runs its course
- Itching, which may be severe
- Painful swelling (angioedema) of the lips, eyelids and inside the throat
- A tendency for signs and symptoms to flare with triggers such as heat, exercise and stress
- A tendency for signs and symptoms to persist for more than six weeks and to recur frequently and unpredictably, sometimes for months or years
- Short-term (acute) hives appear suddenly and clear up within a few weeks.
There may be some symptoms not listed above. If you have any concerns about a symptom, please consult your doctor.
When should I see my doctor?
You should contact your doctor if you have any of the following:
- Severe hives
- Hives that continue to appear for several days
What causes chronic hives?
Experts don’t know. The immune system seems to play a role. Some people get chronic hives at the same time that they get other problems like thyroid disease, hormonal problems, or cancer.
What increases my risk for chronic hives?
Please discuss with your doctor for further information.
Diagnosis & treatment
The information provided is not a substitute for any medical advice. ALWAYS consult with your doctor for more information.
How is chronic hives diagnosed?
Your doctor will do a physical exam and ask you a number of questions to try to understand what might be causing your signs and symptoms. He or she may also ask you to keep a diary to keep track of:
- Your activities
- Any medications, herbal remedies or supplements you take
- What you eat and drink
- Where hives appear and how long it takes a welt to fade
- Whether your hives come with painful swelling
If your physical exam and medical history suggest your hives are caused by an underlying problem, your doctor may have you undergo testing, such as blood tests or skin tests.
How is chronic hives treated?
Your doctor will likely recommend you treat your symptoms with home remedies, such as over-the-counter antihistamines. If self-care steps don’t help, talk with your doctor about finding the prescription medication or combination of drugs that works best for you. Usually, an effective treatment can be found.
Taking nondrowsy antihistamine pills daily helps block the symptom-producing release of histamine. They have few side effects. Examples include:
- Loratadine (Claritin)
- Fexofenadine (Allegra)
- Cetirizine (Zyrtec)
- Desloratadine (Clarinex)
If the nondrowsy antihistamines don’t help you, your doctor may increase the dose or have you try the type that tends to make people drowsy and is taken at bedtime. Examples include hydroxyzine pamoate (Vistaril) and doxepin (Zonalon).
Check with your doctor before taking any of these medications if you are pregnant or breast-feeding, have a chronic medical condition, or are taking other medications.
If antihistamines alone don’t relieve your symptoms, other drugs may help. For example:
- Histamine (H-2) blockers. These medications, also called H-2 receptor antagonists, are injected or taken orally. Examples include cimetidine (Tagamet HB), ranitidine (Zantac) and famotidine (Pepcid).
- Anti-inflammation medications. Oral corticosteroids, such as prednisone, can help lessen swelling, redness and itching. These are generally for short-term control of severe hives or angioedema because they can cause serious side effects if taken for a long time.
- The tricyclic antidepressant doxepin (Zonalon), used in cream form, can help relieve itching. This drug may cause dizziness and drowsiness.
- Asthma drugs with antihistamines. Medications that interfere with the action of leukotriene modifiers may be helpful when used with antihistamines. Examples are montelukast (Singulair) and zafirlukast (Accolate).
- Man-made (monoclonal) antibodies. The drug omalizumab (Xolair) is very effective against a type of difficult-to-treat chronic hives. It’s an injectable medicine that’s usually given once a month.
- Immune-suppressing drugs. Options include cyclosporine (Gengraf, Neoral, others) and tacrolimus (Astagraft XL, Prograf, Protopic).
Lifestyle changes & home remedies
What are some lifestyle changes or home remedies that can help me manage chronic hives?
The following lifestyles and home remedies might help you cope with chronic hives:
- Wear loose, light clothing.
- Avoid scratching or using harsh soaps.
- Soothe the affected area with a bath, fan, cool cloth, lotion or anti-itch cream.
- Keep a diary of when and where hives occur, what you were doing, what you were eating, and so on. This may help you and your doctor identify triggers.
- Avoid known triggers.
- Apply sunscreen before going outside.
If you have any questions, please consult with your doctor to better understand the best solution for you.
Hello Health Group does not provide medical advice, diagnosis or treatment.
Chronic hives. http://www.mayoclinic.org/diseases-conditions/chronic-hives/home/ovc-20325284. Accessed September 20, 2017.
What Is Chronic Idiopathic Urticaria (Hives)? http://www.webmd.com/skin-problems-and-treatments/chronic-hives-17/chronic-skin-rash. Accessed September 20, 2017.
Review Date: September 21, 2017 | Last Modified: September 21, 2017