When Hives Don't Go Away

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woman with rash on arm or shoulder

For many, allergic reactions cause symptoms like a runny nose or watery eyes. Others experience hives, a common skin reaction involving red, itchy, rash-like marks. Hives usually go away on their own within a few days to a week. But for some, hives become a chronic, or long-term, issue.

If you develop hives and they last longer than six weeks, you may have a condition known as chronic hives. Also called chronic idiopathic urticaria (CIU), this condition causes unpleasant symptoms that may interfere with your daily activities. Fortunately, there are many treatment options available, and if one doesn’t work, your doctor can help you find effective relief using other methods.

What are chronic hives?

Chronic hives, or CIU, are hives that don’t go away after six weeks or longer and frequently reoccur. Like acute, or short-term, hives, chronic hives cause itchy red welts on the surface of the skin. Some hives may even connect, forming larger, more uncomfortable welts.

Most people experience multiple symptoms when living with chronic hives. Your symptoms may include:

  • Red welts appearing anywhere on your body

  • Welts that vary in shape, color, or size

  • Mild to severe itching

  • Angioedema, a condition characterized by painful swelling in the throat and on the eyelids and lips

  • Welts that persist for more than six weeks or that frequently reform on the body

What causes chronic hives?

Unfortunately, the exact cause of chronic hives is unknown. However, doctors do know that hives seem to form in response to certain triggers. These triggers may be allergens in the environment, or they may be related to other factors like the consumption of alcohol or certain foods. Hives may be triggered by:

  • Bites from insects or parasites

  • Certain medications, like nonsteroidal anti-inflammatory drugs (NSAIDs)

  • Exercise

  • Exposure to sunlight, heat, or cold

  • Infections

  • Putting pressure on the skin or scratching existing welts

  • Stress

In all cases, the red welts that appear after exposure to a trigger form because certain cells release a chemical called histamine into the bloodstream. Histamine causes itching, redness, and swelling.

How are chronic hives diagnosed?

To diagnose your condition, your doctor will ask you several questions about your past medical history, current health, and any known allergies you may have. Additionally, your doctor may suggest keeping a food, activity, and medication diary for a week or two. This diary can help determine potential triggers, especially if you keep careful notes about what you eat and do, and whether those choices resulted in hives. Your doctor may also recommend blood or skin tests to see if any underlying causes may contribute to hives.  

What are my treatment options?

Many people find relief from the symptoms of chronic hives by taking an antihistamine medication once every day. Your doctor may recommend a non-drowsy antihistamine to help block cells from releasing histamine into your bloodstream.

For some, antihistamines by themselves aren’t enough to control chronic hives. Fortunately, other medications may help relieve symptoms. In addition to an antihistamine, your doctor may suggest:

  • Anti-inflammatory medications: If you suffer from angioedema or your hives are especially severe, anti-inflammatories, like certain steroids, may help control your symptoms.

  • Histamine (H-2) blockers: These drugs block the production of histamine in your body.

  • Immunosuppressants: Your doctor may prescribe immunosuppressants, which reduce the activity of your body’s immune system.

Your specific treatment will depend on the severity of your hives, your past medical history, and any other medical conditions you may have.

Should I worry about a severe allergic reaction?

Chronic hives are usually not associated with any serious allergic reactions. These emergencies, also called anaphylaxis, are dangerous, potentially life-threatening allergic reactions requiring medical treatment. Hives resulting from anaphylaxis often occur with other symptoms, such as difficulty breathing, dizziness, and swollen eyelids, lips, and tongue. If you experience any of these symptoms along with hives, call 911 immediately.

Chronic hives can be difficult to live with, but there are effective treatment options to help manage symptoms. Identifying and avoiding triggers is also key to managing chronic hives. And after making a positive diagnosis, your doctor will suggest one or several treatments that may be beneficial to you.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2019 Jan 22
  1. Chronic hives. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/chronic-hives/symptoms-causes/syc-20352719
  2. Hives That Won’t Go Away: The Basics of CIU. Asthma and
    Allergy Foundation of America. https://community.aafa.org/blog/chronic-idiopathic-urticaria-hives-that-won-t-go-away-ciu
  3. Hives. American Academy of Dermatology. https://www.aad.org/public/diseases/itchy-skin/hives#overview
  4. Hives. University of Texas at Austin. https://www.healthyhorns.utexas.edu/HT/HT_hives.html
  5. Evaluating
    and managing chronic idiopathic urticaria in adults. Journal of the American
    Academy of PAs. https://journals.lww.com/jaapa/Fulltext/2018/07000/Evaluating_and_managing_chronic_idiopathic.3.aspx
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