Once in a while, you may get hives, a super-itchy, red skin rash that crops up out of nowhere. In fact, up to 20% of people will get hives at some point in their lives. Your doctor will refer to them by their medical name, urticaria. You might also hear them called welts. 

But about 30% of people get hives that keep coming back, again and again. The welts can stick around for weeks or even years. Hives become chronic when the outbreaks last for more than 6 weeks. 

Chronic hives can:

  • Crop up on your skin anywhere on your body.
  • Itch, sting, or burn.
  • Come in different sizes or change shape.
  • Appear suddenly and move around, disappear, or reappear over short periods of time.
  • Look like reddish or skin-colored bumps.
  • Affect women more often than men.
  • Cause your eyelids, lips, or throat to swell. This is called angioedema.
  • Flare up as a response to a trigger, which isn’t always known.

Allergies

Allergic hives happen when your body senses a trigger and releases histamines into your bloodstream. Those triggers could include:

  • Foods like nuts, chocolate, fish, eggs, or milk
  • Insect bites or stings
  • Alcoholic drinks
  • Medications 
  • Latex 
  • Pet fur or dander
  • Pollen
  • Plants

Health Issues

Health Issues

About 5% of chronic hives are caused by a health issue such as:

  • Autoimmune diseases like lupus, juvenile rheumatoid arthritis, or thyroid disease
  • Infections like hepatitis or herpes
  • Liver problems
  • Thyroid problems
  • Stress
  • Cancer, but this is rare

Things in the World Around You

Things you encounter every day can irritate your skin and cause a reaction. Common culprits include:

  • Extreme heat or cold
  • Sunlight
  • Water
  • Pressure, like a too-tight waistband
  • Exercise
  • Scratching or rubbing your skin
  • Vibrations
  • Friction

Idiopathic Hives: When The Trigger Isn’t Clear

About 95% of people who get chronic hives can’t pinpoint the cause. Your doctor might call this idiopathic urticaria. That just means your hives have no known triggers that you can avoid to prevent flare-ups.

Don’t worry. You can still treat idiopathic chronic hives when they happen.

How Are Chronic Hives Diagnosed?

To diagnose chronic hives, the doctor will look at your skin. They’ll ask questions about your symptoms to try to find what’s causing hives.

What can you do before your appointment?

  • Write down what happens just before you break out in hives: foods you eat, any medicines you take, your activities, or changes in the temperature. 
  •  Keep track of how often you get hives and how long they last.
  • Take some snaps of your hives with your phone during a flare.

The doctor may also give you blood tests or skin tests to help diagnose the cause of your hives, like another health issue. 

Even if you can’t find the cause, you can treat chronic hives.

Allergy Medications for Chronic Hives

The doctor may suggest that you treat hives on your own with over-the-counter antihistamines. You can try nondrowsy allergy medicines like cetirizine (Zyrtec), desloratadine (Clarinex), fexofenadine (Allegra), or loratadine (Claritin).

Diphenhydramine (Benadryl) treats hives too, but it can make you sleepy. Take it before you go to bed at night.

What If Allergy Medications Don’t Help?

What If Allergy Medications Don’t Help?

If antihistamines don’t treat your outbreaks, other drugs may do the trick. The doctor might have you try:

  •  H2 blockers, or medications that are also used to treat heartburn, like famotidine (Pepcid) or cimetidine (Tagamet)
  • Anti-inflammatory drugs, such as steroids like prednisone. These are used short-term only for severe hives outbreaks.
  • Antidepressant skin creams like doxepin (Zonalon) that treat itching.
  • Asthma drugs that contain antihistamines.
  • Monoclonal antibodies, such as omalizumab (Xolair), a monthly shot to treat chronic hives.
  • Immunosuppressants like cyclosporine or tacrolimus.

Easy Steps to Prevent Chronic Hives

Simple changes to your daily routine may prevent your hives flares:

  • Exercise daily to work off your stress.
  • Wear loose-fitting, cotton clothing to stay cool.
  • Use a sunscreen with zinc oxide (it’s less likely to cause allergy troubles) before you go outside if sunlight triggers your hives.
  • If heat’s your trigger, wrap ice cubes in a damp cloth. Press it to your skin where you get hives. 
  • Don’t scratch itchy hives if you can help it.
  • Skip harsh soaps or body washes.
  • Stay away from perfume, cologne, or scented bath and laundry products.
  • Avoid any triggers you can identify.