Understanding Chronic Hives – Causes, Symptoms, and Treatment Options

Chronic hives, medically referred to as chronic urticaria, are raised, red, itchy welts that appear on the skin and persist for six weeks or more. These welts, often surrounded by a ring of redness, can vary in size and shape, appearing anywhere on the body, including the face, arms, legs, and torso. While hives are typically associated with an allergic reaction, chronic hives often occur without an identifiable allergen or trigger.

This condition affects about 1% of the population, with women being twice as likely as men to develop it. For some, the condition is temporary, resolving within months or a year. For others, it can last for several years, requiring long-term management.

In severe cases, chronic hives can significantly disrupt daily life, interfering with sleep, work, and social activities due to persistent itching, discomfort, or embarrassment about their appearance.

What Causes Chronic Hives?

The causes of chronic hives are complex and often difficult to determine. Unlike acute hives, which are usually triggered by specific allergens, chronic hives are less predictable.

1. Autoimmune Conditions

Studies suggest that nearly half of chronic hives cases are autoimmune in nature. In these cases, the immune system produces antibodies that mistakenly target the body’s own tissues, leading to the release of histamine and other chemicals that cause the symptoms of hives.

Conditions like Hashimoto’s thyroiditis, lupus, or rheumatoid arthritis are often associated with autoimmune chronic urticaria.

2. Infections

Chronic bacterial infections, such as sinus infections or H. pylori (a type of stomach bacteria), can sometimes be linked to chronic hives. Viral infections like hepatitis B or C may also play a role.

3. Allergies and Sensitivities

While rare, some cases of chronic hives can be linked to food allergies, medications, or environmental allergens.

4. Physical and Environmental Triggers

For some, specific physical stimuli—like heat, cold, pressure, or sunlight—can lead to a type of chronic hives known as physical urticaria.

5. Stress

Psychological stress is a well-documented trigger for many individuals with chronic hives, potentially worsening symptoms or prolonging flare-ups.

6. Idiopathic Cases

In approximately 20-30 percent of cases, no clear cause is identified, which is termed chronic idiopathic urticaria.

Symptoms of Chronic Hives

Common symptoms include:

Welts (Wheals): Raised, red or skin-colored bumps that can be small or merge into larger plaques.
Itching: Often severe, leading to scratching that can exacerbate the condition.
Angioedema: Swelling of deeper layers of the skin, often around the eyes, lips, hands, or feet.
Persistence: Symptoms lasting six weeks or longer, with periods of improvement followed by flare-ups.

Symptoms may worsen at night, disrupting sleep, and can also be exacerbated by heat, tight clothing, or scratching.

How Is Chronic Hives Diagnosed?

A thorough diagnosis often involves a combination of medical history, physical examination, and tests to rule out other conditions.

Patient History

Your doctor will ask about the duration and pattern of your hives, possible triggers, and any associated symptoms like fever, joint pain, or weight changes.

Tests and Procedures

- Blood Tests: To rule out autoimmune diseases or infections.
- Allergy Tests: Skin prick or blood tests to identify possible allergens.
- Elimination Diets: To identify potential food triggers.
- Biopsy: In rare cases, a small skin sample may be taken to rule out other conditions like vasculitis.

Treatment Options for Chronic Hives

Managing chronic hives often requires a tailored approach, as the condition can vary significantly between individuals.

Medications

Antihistamines: Non-drowsy options like loratadine or cetirizine are first-line treatments. If symptoms persist, higher doses or combinations may be recommended.
Corticosteroids: Used for short-term relief during severe flare-ups but avoided long-term due to potential side effects.
Biologics: Omalizumab (Xolair) is an injectable medication that has been highly effective for patients with refractory chronic hives.
Immunosuppressants: In severe cases, medications like cyclosporine may be prescribed.

Lifestyle Adjustments

- Avoid known triggers, such as certain foods or extreme temperatures.
- Manage stress through techniques like mindfulness or cognitive behavioral therapy (CBT).
- Wear loose-fitting, breathable clothing to reduce irritation.