When hives appear and reappear over the course of six weeks or more, they’re considered chronic. When the cause is unknown, they’re called idiopathic.
Urticaria is the medical term for hives. These are itchy raised bumps or welts on your skin. Your dermatologist may call them wheals.
Hives can be very uncomfortable, interfering with sleep and normal daily activity.
Idiopathic means the cause is undetermined. Before classifying hives as idiopathic, your doctor will check for the presence of an allergy, autoimmunity, or infection. About
Chronic hives don’t pose an immediate risk, but the sudden appearance of hives can be a sign of an allergic reaction that could lead to anaphylactic shock. This serious condition can close off the throat and lead to strangulation. If you have an EpiPen (a device that injects epinephrine), use it and seek emergency care right away if this happens to you.
- raised or swollen welts on your skin (hives or wheals) that appear and reappear over the course of 6 weeks
- itching that is sometimes severe
- swelling of the lips, eyelids, or throat (angioedema)
Your hives may change size, fade, and reappear. Heat, exercise, or stress may aggravate your symptoms.
Chronic idiopathic urticaria isn’t an allergy and isn’t contagious. It’s probably caused by a combination of factors.
These may include environmental irritants, your immune system, and genetics. It can also be a response to a bacterial, fungal, or viral infection.
Chronic idiopathic urticaria activates the immune response system. It also affects your
Any of these things may
- pain medications
- infection
- insects or parasites
- scratching
- heat or cold
- stress
- sunlight
- exercise
- alcohol or food
- pressure on your skin from tight clothing
Chronic urticaria
Anti-TPO antibodies may also indicate the presence of an autoimmune thyroid disease, such as Graves’ disease or Hashimoto’s thyroiditis. Your doctor will look for this if your blood test shows raised levels of anti-TPO.
Is chronic urticaria an autoimmune disease?
Research suggests that about half of chronic hives cases are associated with an autoimmune trigger.
Your doctor will ask about your medical history and perform a physical exam. This can include evaluating your hives and any other symptoms and asking about your history of allergies or autoimmune diseases.
The doctor may mark your lesions and monitor their resolution within
Your doctor may also ask you to keep a diary to record what you eat or drink to see if food might be a trigger. Some people have common food allergies to eggs, shellfish, peanuts, and other nuts. Spoiled fish can contain a high level of histamines, which may cause hives.
Food additives and salicylic acid (found in aspirin) have also been shown to trigger hives in some people. In addition, aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) may also trigger hives in some cases.
Your doctor will ask you questions to try to narrow down the cause. Other tests may be needed if allergy, reaction to medication, or immune factors are ruled out.
Over-the-counter (OTC) antihistamines are usually the first-line treatment for chronic hives.
Non-drowsy antihistamines with few side effects include:
- cetirizine (Zyrtec)
- loratadine (Claritin)
- fexofenadine (Allegra)
- levocetirizine (Xyzal)
If your hives don’t clear up with OTC antihistamines, your doctor may try
- H1 and H2 blockers: These drugs block the production of histamines, which can cause hives or the overproduction of stomach acids. Common versions are cimetidine (Tagamet HB) and famotidine (Pepcid).
- Short-term oral corticosteroids, such as prednisone: These are especially useful for reducing the swelling around eyes, lips, or throat that can accompany hives.
- Tricyclic antidepressants: This can include doxepin (Zonalon), which is available as an oral or topical medication.
- Immune suppressants: These include cyclosporine (Gengraf, Neoral), tacrolimus (Astagraft XL, Prograf), mycophenolic acid (CellCept), and methotrexate.
- Monoclonal antibodies: Omalizumab (Xolair) is an expensive, newer drug that has proved very effective against chronic idiopathic urticaria. It’s typically injected once per month.
On average, chronic hives resolve themselves within 3 to 5 years. In the first 12 months, there is a reported remission rate of up to
Those who have thyroid disease or angioedema are more likely to have them longer.
That said, chronic hives aren’t life threatening. Treatment with antihistamines or other medications will usually clear it up. But it may reappear when treatment is stopped.
If you have a severe case of hives or if they last for several days, you should see your doctor.