Chronic Hives

Chronic hives or chronic urticaria is a skin rash that appears as dark red, raised, itchy bumps on the skin. Chronic hives are defined by recurrent episodes occurring at least twice a week for six weeks.

Chronic hives are not very common, and about 5% of people may have them in their lifetime. 

The condition is usually more prevalent in women than in men.

Hives or urticaria (pronounced ur-tik-CARE-ee-uh) are itchy, raised, rash-like welts on the skin. Although no specific cause is known for them, hives may be triggered by allergic reactions to food or medicines. They usually tend to subside on their own.

When hives come back again and again almost every day for six weeks and frequently recur over months or years, it’s called Chronic Idiopathic Urticaria (CIU) or chronic hives.

Chronic means that the condition repeatedly appears, even with treatment, and idiopathic means the condition comes on suddenly, with no known reason.

Symptoms of CIU or chronic hives include:

• The appearance of red or skin-colored welts anywhere on the body.
• Welts that vary in size, change in shape and fade or appear repeatedly as the reaction runs its course.
• Severe itching in the affected area(s).
• Painful swelling of the lips, eyelids, and inside the throat.
• The condition may worsen with exposure to heat, exercise, and stress.

If your symptoms persist for more than six weeks and recur frequently and unpredictably, you may have chronic hives. Sometimes the condition can continue for months or even years.

Chronic hives do not put you at sudden risk of a severe allergic reaction (anaphylaxis). However, seek emergency care if you experience hives as part of a severe allergic reaction. 

Signs and symptoms of anaphylaxis can include dizziness, trouble breathing, and swelling of your lips, eyelids, and tongue.

Patients with certain autoimmune diseases may be more prone to chronic hives. 

However, in most cases, the cause of chronic hives is unknown, and it may be difficult to identify why it turns into a long-term problem.

Chronic hives may be triggered by:

• Pain medications
• Insects or parasites
• Infection
• Scratching
• Heat or cold
• Stress
• Sunlight
• Exercise
• Alcohol or food
• Pressure on the skin, such as from a tight waistband

In some cases, chronic hives could also be related to an underlying illness, such as thyroid problems or, in rare cases, cancer.

See your doctor if you believe your persistent problem with skin rash may be chronic hives. During your consultation, your doctor will likely want to know about your symptoms and ask about one or more of the following details.

• When and where do hives appear?
• How long does an episode last?
• Do you have any identified triggers?
• Do the hives cause any swelling?
• Do you have any other symptoms?
• Whether you changed (or started) any medicines before the episode(s)?

Diagnostic tests will then be used to identify triggers for the skin condition. One or more of the following tests may be ordered to confirm or rule out various other causes.

• Allergy tests are helpful to see if the condition is an allergic reaction triggered by any foods or pets.
• Blood tests check for high levels of antibodies (proteins) that help your body fight off bacteria, allergens, and other substances.
• Urine tests check for infections.
• Tests to check for other illnesses or conditions that could be causing the hives, like an overactive or under-active thyroid gland.

If no other cause for your recurrent skin problem can be identified, you’ll likely be diagnosed with chronic hives.

While there is no known cure for chronic hives, they don't last forever. Most people have them off and on for one to five years, and it may last longer for a small number of people. Thankfully, chronic hives are not contagious even though they are itchy and painful.

Unfortunately, chronic hives can be very uncomfortable and tend to interfere with sleep and daily activities. Most patients find relief from the use of antihistamines and anti-itch medication. Other forms of treatment can include:

• Over-the-counter (OTC) allergy medication.
• Allergy shots may be taken monthly.
• Corticosteroids are recommended if allergy medication doesn’t work.
• Immunosuppressants, such as cyclosporine, can also be highly effective at clearing up chronic hives; however, they may cause severe long-term side effects.

While at home, you can try some of the following alternatives to soothe your skin and control inflammation:

• Use an OTC anti-itch cream on the affected area(s).
• If cool temperatures do not worsen the hives, try taking a cool bath or shower or use a cool compress on the affected area(s).
• Wear soft fabrics to minimize irritation to your skin.
• Use loose-fitting clothes.
• Use hypo-allergenic lotions and creams to moisturize dry skin.

If you suspect your skin rash is a chronic hives problem, please call West Hills Allergy & Asthma Associates for a consultation with Dr. Rene Anderson-Cowell. You can call us at (503) 297-4779 or request an appointment online.