Learn how this long-lasting skin condition that causes painful, itchy, recurring welts is diagnosed and what treatments may offer relief.
Hives — also called urticaria (ur-tih-KAR-e-uh) — is a skin reaction that causes itchy welts. Chronic hives are welts that last for more than six weeks and return often over months or years. Often, the cause of chronic hives isn't clear.
The welts often start as itchy patches that turn into swollen welts that vary in size. These welts appear and fade at random as the reaction runs its course.
Chronic hives can be very uncomfortable and interfere with sleep and daily activities. For many people, anti-itch medications (antihistamines) provide relief.
Illustration of hives on different skin colors. Hives can cause swollen, itchy welts. Hives is also called urticaria.
Symptoms of chronic hives include:
See your health care provider if you have severe hives or hives that last for more than a few days.
Chronic hives do not put you at sudden risk of a serious allergic reaction (anaphylaxis). If you get hives as part of a severe allergic reaction, seek emergency care. Symptoms of anaphylaxis include dizziness, trouble breathing, and swelling of the tongue, lips, mouth or throat.
The welts that come with hives are caused by the release of immune system chemicals, such as histamine, into your bloodstream. It's often not known why chronic hives happen or why short-term hives sometimes turn into a long-term problem.
The skin reaction may be triggered by:
Chronic hives don't put you at sudden risk of a serious allergic reaction (anaphylaxis). If you do get hives as part of a severe allergic reaction, seek emergency care. Symptoms of anaphylaxis include dizziness, trouble breathing, and swelling of the tongue, lips, mouth or throat.
To lower your likelihood of experiencing hives or angioedema, take the following precautions:
To diagnose chronic hives, your health care provider will likely talk with you about your symptoms and look at your skin. One of the telling features of chronic hives is that the welts come and go at random. You might be asked to keep a diary to keep track of:
You may also need blood tests to determine the cause of your symptoms. An accurate diagnosis will guide your treatment options. If needed to clarify the diagnosis, your doctor might take a skin sample (biopsy) to examine under a microscope.
Treatment for chronic hives often starts with nonprescription anti-itch drugs (antihistamines). If these don't help, your health care provider might suggest that you try one or more of these treatments:
Prescription anti-itch drugs. The usual treatment for chronic hives is prescription antihistamine pills that don't make you drowsy. These drugs ease itching, swelling and other allergy symptoms. Daily use of these drugs helps block the symptom-producing release of histamine. Examples include:
These medications have few side effects. If the nondrowsy antihistamines don't help you, your health care provider may increase the dose or add another type of antihistamine.
Check with your health care provider before taking any of these medications if you're pregnant or breastfeeding, have a long-term medical condition, or take other medications.
If the first-choice drugs don't ease your symptoms, other drugs may help. For example:
For chronic hives that resist these treatments, your health care provider might prescribe a drug that can calm an overactive immune system. Examples are cyclosporine (Gengraf, Neoral, Sandimmune), tacrolimus (Prograf, Protopic, others), hydroxychloroquine (Plaquenil) and mycophenolate (Cellcept, Myfortic).
Chronic hives can go on for months and years. They can interfere with sleep, work and other activities. The following self-care tips may help you manage your condition:
You'll likely start by seeing your primary care provider. Or you may be referred to an allergy specialist or a doctor who specializes in the diagnosis and treatment of skin conditions (dermatologist).
Here are some tips to help you get ready for your appointment.
For chronic hives, questions you may want to ask include:
Your health care provider is likely to ask you a few questions, such as: