Let's Talk About Chronic Hives
We've got the doctor-approved details on causes, symptoms, treatments, and a jillion other facts and tips that can make life with chronic hives (CIU) easier.by Nykia Spradley Health Writer
Whether you’ve just been diagnosed with chronic idiopathic hives (CIU) or worry you might have them, you’re probably nervous, confused—and maybe a little scared. That’s normal! Everyone featured on HealthCentral with a chronic illness has felt like you do now. But we—and they—are here for you. Read on to learn about the realities and challenges you’ll face with this condition, as well as the best treatments, helpful lifestyle changes, where and how to find your CIU community, and all the crucial information to help you not just manage this condition—but thrive with it. We’re sure you’ve got a lot of questions … and we’ve got the answers you need.
Our Pro Panel
We went to some of the nation’s top CIU experts to bring you the most scientific and up-to-date information possible.
Morgan Rabach, M.D.
Clinical Instructor in the Department of Dermatology
Mount Sinai Hospital
New York City
Purvi Parikh, M.D.
Adult and Pediatric Allergist and Immunologist
NYU Langone Health
New York City
Sheel Desai Solomon, M.D.
Each breakout of CIU will last for a minimum of six weeks, and hives can come and go for anywhere from one to five years. Even after your hives clear, it’s not unusual to experience a recurrence, months or even years later. CIU can stop spontaneously and reappear without warning. There is no pattern to it, so a recurrence after years of being in remission is not uncommon.
No. This skin condition is neither contagious nor is it dangerous. Some types of skin rashes can spread from person to person upon skin contact; CIU is not one of them. In general, CIU is more uncomfortable and distressing than anything. However, an outbreak on the tongue or throat can become more serious, so see your doctor to ensure that it doesn’t inhibit your breathing or raise your blood pressure.
Occasionally, but not usually. Unlike acute hives that are usually triggered by food, plant, or environmental allergies, CIU is not always provoked by the same thing. The exact cause of chronic hives cannot be identified, and doctors say that only a small percentage are likely due to allergies.
Not usually. With no definitive triggers to account for the majority CIU breakouts, it’s difficult to fully understand what lifestyle changes may help you avoid them. This makes prevention a bit tricky, although certain lifestyle changes may help you manage symptoms.
What Are Chronic Idiopathic Hives (CIU), Anyway?
Chronic hives—whose official medical name is chronic idiopathic urticaria (CIU)—is a painful condition characterized by pale red welts, or hives, on the skin that itch or burn.
They are generally easy to recognize by their quarter-sized shape, although they can sometimes swell to be as large as a dinner plate and may be filled with fluid.
When individual hives join together to form one large hive, it’s called a plaque. Hives can appear suddenly and anywhere on your body, including your face, lips, tongue, throat, or ears.
While hives generally aren’t considered dangerous or life-threatening, when they appear inside the mouth or near the throat and cause swelling, it can be tough to breathe. Be sure to seek medical care immediately if this happens to you.
Chronic hives can cause great discomfort, often appear without warning, usually have no known cause, and can last for weeks, months, or, in some cases, even years. (We know, we know—we shudder at the thought, too!)
According to the Journal of the American Academy of Dermatology, roughly 500,000 people in the U.S. are estimated to have CIU, the majority of whom are women aged 40 to 59 years. If you have CIU, take comfort in the fact that CIU is not in the least bit contagious. So, go ahead and hug your kids or partner, and shakes hands with your colleagues—no one is catching CIU from you.
Still, with the help of a medical pro and the right treatment plan, you can learn ways to slow down the frequency of your outbreaks—and hopefully eliminate CIU altogether. We’ll walk you through what we know about this condition, and explain how even small changes, including lifestyle fixes or doctor-prescribed medications, can help manage or prevent ongoing discomfort. We’re here to help you find the best ways to calm your skin down, fast.
What Is the Difference Between CIU and Regular Hives?
Physically, they aren’t different—it’s more about how often they appear and reappear, and how long they last. As the “chronic” in their name suggests, CIU lasts six weeks or more. (If you’re wondering about “idiopathic,” it means no known cause, and “urticaria”—pronounced “ur-ti-kair-ee-uh”—is just a fancy, scientific way of saying, yup, hives.)
So, chronic idiopathic hives are just that—long-lasting, with no known trigger.
Regular hives—also called acute hives—last for shorter periods of time (generally no more than 24 hours, although they can sometimes linger for weeks during some attacks).
Unlike chronic hives, the acute sort usually appear when you experience an allergic reaction after coming into contact with a trigger, which can include things like:
Anything your body’s immune system rejects as foreign
Sometimes, it can also be things like:
While 20% of people occasionally get hives, only 1% experiences CIU, which can occur at any age, although doctors typically see this condition most often in women, and sometimes in older children (adolescents and up) and men, too.
Again, while the occasional, run-of-the-mill case of hives might last for a few hours or a few days, CIU breakouts are characterized by 24-hour cycles of hives appearing on the skin, fading later in the day or at night, and then reemerging the next morning. This daily recurring pattern lasts for six weeks or more.
More than half of CIU cases resolve spontaneously within one to two years. Five years after the first appearance of CIU, 80% to 90% of people are completely in the clear.
However, with this condition, there is always a chance of recurrence—it’s not uncommon for people with CIU to experience another flareup months or even years down the line, without warning. According to a study published in the Journal of Allergy and Immunology: In Practice, recurring CIU (called RCU) occur in about 13% of people who experience another breakout six or more months after their first bout with CIU has fully resolved.
The good news? Most people with CIU do see their symptoms clear. Over time, certain treatments can help your immune system become less reactive and calm down your allergy mast cells, which trigger hives in the first place. What are allergy mast cells, you ask? Read on.
What Causes Chronic Hives?
Your body’s immune system is there to protect you from what it perceives to be foreign invaders that might do you harm. Rightly or wrongly, when it thinks harm is being done, the immune system sets off a cascade of reactions in your body.
It starts by activating antibodies that attach themselves to allergy mast cells in your body, telling the mast cells to release a chemical called histamine. In turn, histamine triggers an inflammatory response in your body to try and flush out the foreign invader.
Here’s how a histamine reaction typically unfolds:
You’re exposed to an allergen (i.e., a “foreign invader”).
The immune system reacts. It sends a chemical signal to your allergy mast cells that are found in your skin, as well as in your mouth, lungs, nose, gut, and blood.
This signal is like an SOS that says: “Release histamines!” (Again, histamines are stored in the allergy mast cells.)
Histamines then increase blood flow to the affected area of your body—causing inflammation.
That inflammation eggs on your immune system even more—it wants to fix the problem, so it sends in additional cells to do the job.
Symptoms of Histamine Release
The release of histamine does more than just cause inflammation. It triggers a cascade of events, including muscle contractions and blood vessel dilation. You might also experience any of these symptoms:
A “tight” feeling in your throat
Hives: the red, itchy, swollen, (and sadly, all-too-familiar) welts on your skin
Swelling may occur, too—think of this symptom as internal hives that are just deeper in your mucosal surfaces, rather than on the surface of your skin. Usually, swelling is not dangerous, but, again, if you feel your tongue and throat swell, it could inhibit your breathing.
It’s important that you see a board-certified allergist to figure out the cause of swelling—and consider carrying an Epipen (an epinephrine injection, which is used in emergencies to treat allergic reactions) as a precaution at all times.
On rare occasions, blisters may occur along with your hives. If you spot something like this on your skin, see your doctor immediately. Hives with blisters can signal infection, irritation from scratching, or even a life-threatening allergic reaction such as DRESS syndrome (a serious reaction to a medication that requires emergency medical attention) or Steven Johnson syndrome (a severe skin reaction with flu-like symptoms, also requiring urgent care).
CIU May Be an Autoimmune Condition
While acute hives are generally the result of a reaction to a specific allergen, chronic hives typically appear with no known trigger: In seven out of 10 cases, the cause is a complete mystery. (In a small percentage of CIU cases, allergens may play a role.)
Scientists do have some theories, though: Research indicates that about half of people with CIU may have an overactive immune system—and this is where things gets interesting, since we know how hives appearing on your body is the result of an autoimmune response.
There is also a connection between CIU and other autoimmune conditions. It’s estimated that as many as 10% to 50% of people with CIU also have Hashimoto’s thyroiditis, a thyroid disorder.
People with CIU also have increased risk for:
In addition, there are other chronic disorders—including certain lymphomas and multiple myeloma cancers—that can create a chronic release of histamine from allergy mast cells. (Your doctor can rule this out with special tests.)
Luckily, an association between CIU and cancer is extremely rare and shouldn’t be your first (or, even your 50th) concern. In fact, many doctors don’t recommend cancer screening in those with CIU unless there’s another clear reason to do so—that’s how uncommon it is.
How Is CIU Diagnosed?
The process is pretty straightforward—simple, even—although everyone is different, so the details are driven by age, specific symptoms, health history, and risk factors.
Generally, after your physician takes a thorough medical history and conducts a physical examination, he or she may do bloodwork—a complete blood cell count, or CBC, to rule out parasitic infections or reaction to medication—plus an allergy test, if needed, where your skin (usually on your back or your arm) is exposed to a wide range of potential food and environmental allergens to observe any noticeable reactions.
In many cases, no additional testing is required, if visual signs of hives on your body are classic (meaning those obvious, red welts).
What Is the Treatment for CIU?
Your doctor will work with you to get your CIU under control through the use of medication and possibly some lifestyle changes.
Some medications your doctor may prescribe include:
Antihistamines: Taking OTC antihistamine pills daily helps block the release of histamine, which in turn lessens your symptoms. Some common ones you’ll find in your drugstore are Allegra (fexofenadine), Claritin (loratadine), and Zyrtec (cetirizine). They have few side effects—but if you’ve got a busy day ahead, make sure you get the non-drowsy versions!
If OTC antihistamines alone don’t alleviate your symptoms, your doctor might suggest that you try:
Histamine blockers: These are also called H-2 receptor antagonists, and you can take them orally, or they can be given as a shot. They work by preventing the binding of histamines to receptors within the body, inhibiting or lessening symptoms. Examples include Pepcid (famotidine), Tagamet HB (cimetidine), and Zantac (ranitidine).
Anti-inflammation meds: Oral corticosteroids can help decrease swelling, redness, and itching. You may be given a short course of 3 to 5 days to help get hives under control but avoid long-term use. If you take them for an extended period (usually months), they can cause serious side effects such as hypertension, fragile bones, weight gain, blurred vision, increased thirst, and fluid retention. A common corticosteroid is called prednisone. It works by slowing down your immune system and how quickly your body responds to injury and illness. In the case of CIU, your system is inexplicably in overdrive, so calming it down is usually the quickest way to get hives in check.
Monoclonal antibodies: These work by unbinding allergy antibodies from allergy mast cells in the body, which then stop releasing as much histamine, making you less reactive over time. The drug Xolair (omalizumab) can be very effective against chronic hives. It's an injectable medicine, usually given once a month until hives subside. Although side effects aren’t common, there’s a possibility of joint pain, a mild rash where it was injected, and dizziness. Some research indicates that a recurrence of CIU is more likely to occur after omalizumab is used.
Immunosuppressants: Use of these medications, like the drug Gengraf (cyclosporine), are only recommended for people with severe CIU who have cannot tolerate high doses of oral antihistamines and do not respond to conventional treatments. They work by hindering your immune response to reduce or stop symptoms. Cyclosporine is taken by mouth and should be used for to 12 months. Possible side effects include an increased risk for infection. Some research also shows an increased risk for RCU.
Chronic hives can make it hard to sleep or work, or—let’s face it—do much of anything while your skin itches and stings for long periods of time. Here are some ideas to help you cope with the condition—and live your best life—while you’re combatting a breakout.
Eat a Healthy, Balanced Diet
Unless you know you have a food allergy, it’s best to eat a wide variety of whole foods. What to watch out for? Although research is sparse, some experts suggest avoiding highly inflammatory foods such as those with artificial colorings, preservatives, alcohol, dairy, and spices. Other studies connect the wheat intolerance that comes with celiac disease (an autoimmune disorder) with higher rates of CIU.
Take Care of Your Skin
While skin care can’t prevent an outbreak of CIU, it can make you feel better if you’re having one. Use gentle, hypoallergenic soaps, shampoos, and even laundry detergents—you want them to be as gentle as possible on sensitive skin. Apply anti-itch lotions and creams, and always wear sunscreen (yes, even in winter). Wearing loose-fitting clothing may also help prevent the irritation of fabric chafing against your hives.
Be Careful With Body Temperature
Intense exercise raises your body temperature and increases blood flow, potentially triggering a histamine reaction and the appearance of hives. Hives from heat are known as cholinergic urticaria, and this condition means that you are super-sensitive to heat, or to the response of sweating. Changes in temperatures—hot or cold—can trigger CIU, too, so be careful with piping hot showers and baths or “icing” your body after a workout.
Take Precautions With Sex
Much like exercise, sex increases blood flow and body heat, too, potentially leading to temporary inflammation and histamine release. If you have CIU and a latex allergy, sex with a condom can make things worse—consider using non-latex condoms in polyurethane or lambskin.
Understand Pregnancy Risks
Everything about pregnancy is unpredictable—and that’s especially true for chronic hives, which may be linked to hormonal influences on allergy mast cells. Doctors say that one-third of people with CIU report that their symptoms improve during pregnancy, one-third report that symptoms get worse, and one-third say their symptoms remain the same.
Dealing with CIU for an extended period of time can be debilitating and stressful. In fact, research shows how the emotional strain of dealing with this condition can harm quality of life, making it comparable to people undergoing open heart surgery, with significant impact on work, school, relationships, depression, anxiety, and self-esteem. If you have CIU, a treatment plan that includes your emotional well-being is essential. Talking with others who have successfully managed this condition may help improve your outlook, too.
Remember, you’re not alone! Half-a-million Americans are going through exactly what you’re facing right now. If you’ve developed hives that occur, retreat, reappear daily, and last for longer than six weeks, it’s time to find a dermatologist, allergist, or CIU specialist. Ask your primary care physician for a referral, or check out these resources from the Asthma and Allergy Foundation of America. With the right treatments and lifestyle choices, your skin can be free and clear once again.
Where Can I Find CIU Communities?
Sometimes just talking to others with CIU is a source of comfort. These online communities and support groups may help bring some calm to life with chronic hives.
Top Chronic Hives Instagrammers
Follow because: In case it’s not obvious at first glance, “Bri” is a plant-based junkie. She’s also a diehard Medical Medium fan. (If you’re here and haven’t heard of Medical Medium, make that your next Google stop, one tab over—but don’t leave this page just yet, because there’s more you should know. #wedigress) What’s more, she credits her healing to her dedication for that veggie life. Aside from gorgeous spreads and awesome recipes, she shares insight as to why she eats, what she eats, and what it does for her. She’s an open Instagram-book, and we’re reading it.
Follow because: She’s kind of the opposite of Bri—she shows the highlight reel of life that’s not bogged down by chronic hives. She takes fashion risks, travels, and shows you how full of a life you can live, even when you have a flare and can’t wear your favorite lipstick because it irritates your lips. The posts sprinkled in about living with hives are what will keep you hooked, because every now and then you’ll see, oh, she’s just like me, but she’s living—and I should, too.
Morgan Boerup, @itsjustmyocd
Follow because: On the Instagram surface, she’s a fearless and raw advocate for OCD and its accompanying conditions: anxiety and depression. On the human surface, she battles urticaria, and she talks about the struggle (and endless pursuit) to find the right docs, plus how to have a successful marriage through all the suck of chronic illnesses. Her journey to find peace pushes you along to yours, too.
Top Chronic Hives-Related Podcasts
The Healthy Skin Show. Host Jennifer Fugo, M.S., is on a mission to invade doctors’ offices ... kind of. She brings you the things that you didn’t have time to talk about at the doc (or they didn’t have time to tell you), things you were too shy to bring up in the exam room, or things that sprang up after you left—and now you’ve got to know. Her podcasts bring you alternative solutions to stop chronic rashes and rebuild healthy skin.
The Balanced Blonde: Soul on Fire. While this podcast doesn’t constantly throw hives in your face (no pun intended, or ever wanted), it’s hosted by Jordan Younger, who deals with chronic hives by way of Lyme disease. And because Jordan is all about health and wellness, she’s certainly not going to bring you anything on her podcast that would harm her—or you (and your hives).
Top Chronic Hives Support Groups and Nonprofits
American College of Allergy, Asthma, & Immunology. Resources—check. Patient support groups and success stories—check and check. But the coolest part of this professional medical association is its 6,000+ allergist-immunologists and allied health professionals on board who are ready to answer your questions. No kidding, they have an “Ask the Allergist” section on their site that drills deep into questions about chronic hives. Oh, and they’re the leading voice for allergists advocating on the Hill on behalf of patients. NBD.
Asthma and Allergy Foundation of America (AAFA). They’ve been around the block for a minute or two—serving the asthma and allergy communities as the leading patient organization since 1953. Also home to the oldest asthma and allergy patient group in the world. They advocate, educate, and they’re really just ... there for you.
Chronic Urticaria Support Group on Facebook. This group has gathered on Facebook since 2012, and their tight-knit, private access ensures that everyone who’s there is like you—and can ultimately help you. You’ll answer three questions to get behind the private gate, and from there you’ll be connected with nearly 5,000 likewise individuals with chronic hives. Post and ask away.
- About CIU: The American Osteopathic College of Dermatology. (n.d.) “Urticaria.” aocd.org/page/Urticaria
- CIU Symptoms: American Academy of Allery, Asthma & Immunology. (n.d.). “Hives (Urticaria) and Angioedema Overview.” aaaai.org/conditions-and-treatments/library/allergy-library/hives-angioedema
- Recurring CIU: Journal of Allergy and Immunology: In Practice. (2018.) “Recurrence of Chronic Urticaria: Incidence and Associated Factors.” jaci-inpractice.org/article/S2213-2198(17)30537-8/abstract
- Diagnosis and Treatment (1): World Allergy Organization Journal. (2012.) “Diagnosis and Treatment of Urticaria and Angioedema: A Worldwide Perspective.” waojournal.biomedcentral.com/articles/10.1097/WOX.0b013e3182758d6c
- Diagnosis and Treatment (2): American Academy of Dermatology. (n.d.). “Ten Ways to Get Relief From Chronic Hives.” aad.org/diseases/a-z/hives-chronic-relief
- Diagnosis and Treatment (3): Indian Journal of Dermatology. (2009.) “Chronic Urticaria and Treatment Options.” ncbi.nlm.nih.gov/pmc/articles/PMC2807703/
- Diagnosis and Treatment (4): Advances in Dermatology and Allergology. (2018.) “Stress, Itch, and Quality of Life in Chronic Urticaria Females.” ncbi.nlm.nih.gov/pmc/articles/PMC5949545/
- CIU and Thyroid Disorders: Annals of Dermatology. (2016.) “Effect of Levothyroxine Treatment on Clinical Symptoms in Hypothyroid Patients with Chronic Urticaria and Thyroid Autoimmunity” ncbi.nlm.nih.gov/pmc/articles/PMC4828383/
- Chronic Hives and Celiac Disease: European Journal of Dermatology. (2014.) “Does urticaria risk increase in patients with celiac disease? A large population-based cohort study.” ncbi.nlm.nih.gov/pmc/articles/PMC3896876/