Some people experience a flare-up of hives that goes away on its own. Other people may have hives that come and go daily.
Hives are itchy, raised bumps on the skin. Doctors diagnose chronic hives in people who experience them for at least 6 weeks. Each hive typically lasts for 24 hours before disappearing. Usually, the condition does not have an identifiable cause, but sometimes it does.
Some people experience chronic hives due to an underlying condition. Therefore, it is important for individuals to speak with a doctor about hives that keep returning.
Keep reading to learn more about the symptoms, causes, diagnosis, and treatment of hives that come and go daily.
Chronic hives is a condition that causes hives that keep coming back. Each one lasts less than 24 hours but, as old hives fade, new ones appear. If this continues for 6 weeks or longer, a doctor will diagnose chronic hives. Acute hives lasts less than 6 weeks.
The symptoms of both acute and chronic hives are the same. A person will have welts that come and go. In some cases, symptoms can hinder daily activities and impair sleep.
Chronic hives look identical to acute hives. In both cases, they can flare up and resolve, but chronic hives keep coming back for 6 weeks or longer and typically occur daily.
Hives are itchy, raised welts on the skin that may be red or the same color as a person’s skin. Hives can develop anywhere on the body, move around, and change shape. They can also appear and disappear suddenly.
Hives usually do not break the skin, but bleeding can occur if a person scratches them.
Chronic hives can happen for various reasons. In most cases, however, it is not possible to identify the trigger.
Chronic idiopathic urticaria
The medical name for chronic hives that have no clear trigger is chronic idiopathic urticaria.
According to the American Osteopathic College of Dermatology (AOCD), the immune system is overactive in about half of people who have chronic idiopathic urticaria. Doctors consider these cases autoimmune, as they stem from the immune system attacking healthy tissues.
Bacterial infections associated with chronic hives include:
- Helicobacter pylori
- Mycoplasma pneumoniae
Viral infections associated with the condition include:
Parasitic infections associated with chronic hives include:
- Entamoeba spp.
- Giardia lamblia
- Anisakis simplex
Some cases of chronic hives may stem from an underlying autoimmune disease.
Conditions associated with chronic hives include:
Chronic hives can stem from physical stimulation, such as scratching or rubbing the skin. This is known as physical urticaria or dermatographism. The most common trigger is scratching or rubbing the skin firmly. The hives are not always itchy.
Other physical triggers may include:
- cold temperatures
- hot temperatures
As with acute hives, chronic hives can also occur due to an allergy. However, unlike acute hives, this is a
Some common allergens that can trigger hives include:
- certain foods
- food additives and preservatives
Diagnosing chronic hives may begin with consulting a primary care physician, an allergist, or a dermatologist. They will examine the hives and ask the person questions to rule out common causes, such as a medication reaction.
A doctor may order diagnostic tests to check for other conditions that could be causing symptoms. This could include allergy testing, blood tests to detect inflammation markers, or tests for celiac disease or thyroid problems.
If the hives are not always apparent, it may help for a person to take photographs to show a doctor at the appointment. Keeping a diary of when the hives appear and any possible contributing factors may also help. People can track:
- food they eat
- medication they take
- exposure to physical stimuli, such as the sun, friction, or pressure on the skin
In cases where there is no clear cause, treatment focuses on managing the hives.
A doctor may recommend the
- Second-generation H1-antihistamines: This is the first-line treatment for chronic hives, and includes drugs such as cetirizine and loratadine. Routine use of first-generation H1 antihistamines, such as diphenhydramine (Benadryl), is not recommended by doctors due to sedating side effects.
- Omalizumab (Xolair): If symptoms do not respond to the first-line treatment, practitioners may add Xolair for a second-line treatment. It is a monoclonal antibody, which blocks the action of substances in the body that produce hives.
- Cyclosporine (Gengraf): Doctors may prescribe this when someone does not respond to a combination of an H1-antihistamine and omalizumab.
- Corticosteroids: Short-term use of these anti-inflammatory drugs may be an option to alleviate flare-ups of chronic hives. They are not suitable for long term use due to the risk of cataracts and other possible adverse effects.
If a person knows the trigger, avoiding it can help manage symptoms.
Chronic hives can go away. One study found that 35% of participants with chronic hives had no symptoms after 1 year, and another 29% experienced a reduction in symptoms during this time.
Among individuals with idiopathic chronic hives, 48% experienced remission within 3 years. However, only 16% of those with physical hives experienced remission within 3 years.
If a person has flare-ups of hives for 6 weeks or longer, the American Academy of Dermatology recommends visiting a board-certified allergist, dermatologist, or primary care doctor.
If someone experiences severe hives inside their mouth or airways that affect breathing, call 911 or the number of the nearest emergency department. This could be a sign of a severe allergic reaction, or anaphylaxis, which can make it hard to breathe and can be life threatening.
Anaphylaxis: Symptoms and what to do
Anaphylaxis is a severe allergic reaction that can be life threatening. The symptoms develop suddenly and include:
- swelling of the face or mouth
- fast, shallow breathing
- a fast heart rate
- clammy skin
- anxiety or confusion
- blue or white lips
- fainting or loss of consciousness
If someone has these symptoms:
- Check whether they are carrying an epinephrine pen. If they are, follow the instructions on the side of the pen to use it.
- Dial 911 or the number of the nearest emergency department.
- Lay the person down from a standing position. If they have vomited, turn them onto their side.
- Stay with them until the emergency services arrive.
Some people may need more than one epinephrine injection. If the symptoms do not improve in 5–15 minutes, or they come back, use a second pen if the person has one.
Here are some questions people often ask about chronic hives.
Why am I getting chronic hives?
In many cases, it is not clear what is causing hives. However, they may be linked to allergies and some immune conditions, such as lupus and celiac disease. Physical stimuli — for instance, heat, pressure and vibration — may also contribute.
Will chronic hives ever go away?
Chronic hives can go away over time, or symptoms may improve. However this does not happen for everyone. If hives go away, they can also come back in some cases.
How can I get rid of chronic hives?
It might not be possible to get rid of chronic hives, but treatment options such as antihistamines, corticosteroids, and other drugs can help manage symptoms.
Hives that come and go daily for at least 6 weeks are chronic hives. Most cases do not have an identifiable cause, but it is associated with an infection, autoimmune condition, allergy, or physical cause in some people.
Physical hives can occur due to exercise, vibration, or exposure to hot or cold temperatures. However, chronic idiopathic urticaria — when there is no known cause — is more common.
Chronic hives can affect a person’s quality of life, but doctors can prescribe medications to help manage the symptoms.