Finding the Right Treatment for Hives

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9 Potential Causes of Chronic Hives

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  • If you suffer from chronic hives, you may be taking one or more medications to treat the itch. Itchy red welts are the defining hallmark of most cases of this skin condition, also known as chronic urticaria. Chronic hives, as opposed to acute hives, last six weeks or longer. And although it’s typically fairly simple to identify the triggers of acute hives, chronic hives are a bit tougher to figure out. Experts don’t yet know the underlying cause of chronic hives, but studies are showing links between chronic conditions and environmental factors. Here’s what we know so far.

  • 1
    Stress
    portrait of stressed woman

    Researchers suggest stress may play a role in chronic urticaria. They aren’t ready to proclaim that stress definitely triggers your case of chronic hives, but if your stress level is through the roof, it could exacerbate your hives–or possibly make them last longer.

  • 2
    Temperature
    Young Asian American man wiping sweat off forehead with towel under direct sunshine

    Changes in temperature trigger the welts to develop in some people who have a version of chronic hives called physical urticaria. Some are more susceptible to the cold, while heat is more of a trigger for others. And when your own temperature goes up, your sweat might even trigger the hives to develop.

  • 3
    Physical Contact
    woman itching her arm

    Rubbing, scratching, pressure, and constriction can all trigger hives in people with physical urticaria. Sun exposure can also trigger hives.

  • 4
    Thyroid Disease
    Doctor examining man's neck

    Autoimmune thyroid disease has been linked to some cases of chronic hives. Scientists are still researching the possible mechanism, and there are lots of theories under review. But if you have chronic hives with no other known cause, it might be worth asking your allergist or dermatologist about getting tested for thyroid disease. It’s possible you could have the elevated antithyroid antibodies associated with certain thyroid disorders like Hashimoto’s disease.

  • 5
    Liver Disease
    doctor examining patient's stomach

    Hepatitis B, which is a type of liver disease, has been associated with chronic urticaria. However, many people with hepatitis C also develop an acute form of hives, so researchers are looking at the possibility of a relationship between cases of hepatitis C and chronic hives, too.

  • 6
    Cancer
    cancer patient sitting by window in head wrap

    It’s definitely rare, but a few cases of cancer have been linked to chronic hives. And at least one large population-based study suggests  people with chronic hives may be at increased risk for developing certain kinds of cancer, like cancer of the blood or lymph nodes. However, experts caution that more research is needed.

  • 7
    Celiac Disease
    young woman sitting on couching with stomach pain

    Because it’s not annoying enough to have to cope with abdominal pain, bloating, diarrhea, and the other typical symptoms of celiac disease, you may also have to cope with an itchy red rash. Chronic hives are already associated with some other autoimmune conditions, and celiac disease is considered an “immune-mediated disease.”

  • 8
    Lupus
    black woman in thought

    As we’ve already noted, some autoimmune diseases have been linked to some cases of chronic hives. Add lupus to the list. Again, it’s not common, but some people develop autoimmune urticaria as an early symptom of lupus.

  • 9
    Unknown Causes
    gettyimages 168360236

    This is the catch-all category, but for good reason. Far and away, most cases of chronic hives can’t be traced back to a specific cause. Chronic hives that don’t have a known cause are called chronic idiopathic urticaria. Idiopathic literally means “cause unknown.” As many as 80% of cases of chronic hives fit into this category. But researchers are working hard to determine the root of chronic hives, and today we have more treatment options than ever before, thanks to this work.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2019 Feb 19
  1. Chen Y, et al. Cancer Risk in Patients With Chronic
    Urticaria: A Population-Based Cohort Study. JAMA Dermatology.
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    https://jamanetwork.com/journals/jamadermatology/fullarticle/1105196
  2. Chronic hives: Diagnosis and treatment. Mayo Clinic.
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  3. Chronic hives: Symptoms and causes. Mayo Clinic.
    https://www.mayoclinic.org/diseases-conditions/chronic-hives/symptoms-causes/syc-20352719
  4. Diakow MN. Chronic Urticaria Treatment & Management.
    Medscape. July 31, 2018.
    https://emedicine.medscape.com/article/1050052-treatment
  5. Griffin PM, et al. Chronic urticaria following acute
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    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4544675/
  6. Ludvigsson JF, et al. Does urticaria risk increase in
    patients with celiac disease? A large population-based cohort study. European
    Journal of  Dermatology. 2013 Sep-Oct;
    23(5): 681–687. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3896876/
  7. Lupus-Specific Skin Disease and Skin Problems. The Johns
    Hopkins Lupus Center. Johns Hopkins Medicine.
    https://www.hopkinslupus.org/lupus-info/lupus-affects-body/skin-lupus/
  8. Saini S. Patient education: Hives (urticaria) (Beyond the
    Basics). UpToDate. May 1, 2018. https://www.uptodate.com/contents/hives-urticaria-beyond-the-basics
  9. Selvendran SS and Aggarwal
    N. Chronic urticaria and thyroid autoimmunity: a perplexing association. Oxford
    Medical Case Reports. 2018 Feb; 2018(2): omx099.
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5822693/
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