Chronic Hives: Everything You Need to Know

by Eileen Bailey Health Writer

What are hives (urticaria)?

Urticaria, which is the scientific name for hives, is an outbreak of red, swollen, and itchy welts that form on the skin according to the American Academy of Dermatology. Hives appear suddenly and can appear anywhere on the body, including the face, lips, and throat.

Woman with hives itching her arm.
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What makes hives a chronic condition?

For some people, hives just don’t go away — or they recur frequently. Hives that last more than six weeks are considered chronic according to the American Academy of Dermatology. Although chronic hives are not life-threatening or contagious, the condition can cause distress, discomfort, and pain.

Man discussing chronic hives with his doctor.
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When should I contact a doctor?

If your hives don’t respond to over-the-counter treatments or do not go away within a few days, contact your doctor. In addition, if you experience dizziness, fainting, difficulty breathing, tightness in your throat, tongue or face swelling or wheezing with your hives, you should seek immediate medical attention according to Mt. Sinai Medical Center.

Woman holding up a shrimp, a potential trigger of chronic hives.
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What causes chronic hives?

Acute hives, which occur after a trigger, such as an allergy to shellfish, happen anywhere from a few hours to a few days after exposure to the trigger and usually disappear within 24 hours. For chronic hives, the answer isn’t so easy. There isn’t any known cause for about 95 percent of chronic hives according to the American Osteopathic College of Dermatology. About one-half of people with chronic idiopathic urticaria also have autoimmune problems.

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How is chronic hives diagnosed?

You may talk with your family doctor and an allergist according to the American College of Allergy Asthma and Immunology. Once illnesses that can cause hives have been ruled out, the doctor will perform a physical examination and ask questions about contact with substances that may have led to an allergic reaction. Your doctors may also do allergy tests, blood work or a skin biopsy according to the American Academy of Dermatology.

Squeezing pain ointment out of a tube to ease the symptoms of chronic hives.
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How are hives managed?

The best treatment for urticaria is to identify and avoid the trigger, if triggers are known. Over the counter anti-itch creams and antihistamines can also help control the itch and swelling.

Antihistamine injection to treat chronic hives.
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Which hive medications work best?

In most cases of chronic hives when the cause is unknown, medications such as antihistamines, corticosteroids, dapsone, or omalizumab can be used to control symptoms and help prevent breakouts according to the American Academy of Dermatology.

Woman with throat swelling as a side effect of chronic hives medication.
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What are other potential medical complications?

About 50 percent of people with chronic idiopathic urticaria have angioedema, a rapid and potentially dangerous swelling around the mouth, throat, tongue, and eyes according to an article published in the Journal of Allergy & Therapy. If you experience symptoms of angioedema, seek immediate medical assistance. If you have chronic idiopathic urticaria you might be more at risk for other immune disorders, such as thyroid, lupus, celiac disease, type 1 diabetes, rheumatoid arthritis, Sjogrens disorder according to a report in NEJM Journal Watch.

Acupuncture treatment to prevent a chronic hives flare-up.
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What are some ways I can prevent flare-ups?

In her article, chronic hives patient advocate Marisa Zeppieri-Caruana provides a comprehensive list of practical suggestions to manage hives, including medical related tips (working with the right allergist and learning about different treatments); alternative medicine-related tips, such as acupuncture and vitamin D supplements; and self-care strategies, such as stress-reducing techniques.

Father and son looking into a telescope.
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What does the future look like when you have chronic hives?

About 35 percent of people with chronic hives became symptom free within a year of the first appearance of hives according to report completed by Paul Schaefer, MD. PhD. Almost 30 percent more experienced some reduction of symptoms. For those with chronic idiopathic urticaria, 48 percent had a spontaneous remission.

Eileen Bailey
Meet Our Writer
Eileen Bailey

Eileen Bailey is an award-winning author of six books on health and parenting topics and freelance writer specializing in health topics including ADHD, Anxiety, Sexual Health, Skin Care, Psoriasis and Skin Cancer. Her wish is to provide readers with relevant and practical information on health conditions to help them make informed decisions regarding their health care.