Overview

Hives (urticaria) are red, itchy welts that result from a skin reaction. The welts vary in size and appear and fade repeatedly as the reaction runs its course.

The condition is considered chronic hives if the welts appear for more than six weeks and recur frequently over months or years. Often, the cause of chronic hives is not clear.

Chronic hives can be very uncomfortable and interfere with sleep and daily activities. For many people, antihistamines and anti-itch medications provide relief.

Symptoms

Signs and symptoms of chronic hives include:

  • Batches of red or skin-colored welts (wheals), which can appear anywhere on the body
  • Welts that vary in size, change shape, and appear and fade repeatedly as the reaction runs its course
  • Itching, which may be severe
  • Painful swelling (angioedema) of the lips, eyelids and inside the throat
  • A tendency for signs and symptoms to flare with triggers such as heat, exercise and stress
  • A tendency for signs and symptoms to persist for more than six weeks and to recur frequently and unpredictably, sometimes for months or years

Short-term (acute) hives appear suddenly and clear up within a few weeks.

When to see a doctor

See your doctor if you have severe hives or hives that continue to appear for several days.

Seek emergency medical care

Chronic hives don't put you at any sudden risk of a serious allergic reaction (anaphylaxis). If you do experience hives as part of a serious allergic reaction, seek emergency care. Signs and symptoms of anaphylaxis include dizziness, trouble breathing, and swelling of your lips, eyelids and tongue.

Causes

The welts that come with hives arise when certain cells release histamine and other chemicals into your bloodstream.

Doctors often can't identify the reason for chronic hives or why acute hives sometimes turn into a long-term problem. The skin reaction may be triggered by:

  • Pain medications
  • Insects or parasites
  • Infection
  • Scratching
  • Heat or cold
  • Stress
  • Sunlight
  • Exercise
  • Alcohol or food
  • Pressure on the skin, as from a tight waistband

In some cases, chronic hives may be related to an underlying illness, such as a thyroid disease or, rarely, cancer.

Complications

Chronic hives don't put you at any sudden risk of a serious allergic reaction (anaphylaxis). But if you do experience hives as part of a serious allergic reaction, seek emergency care. Signs and symptoms of anaphylaxis include dizziness, trouble breathing, and swelling of your lips, eyelids and tongue.

July 06, 2017
References
  1. Hives. American Academy of Dermatology. http://www.aad.org/dermatology-a-to-z/diseases-and-treatments/e---h/hives. Accessed April 25, 2017.
  2. Hives (urticaria). American College of Allergy, Asthma and Immunology. http://www.acaai.org/allergist/allergies/Types/skin-allergies/hives/Pages/default.aspx. Accessed April 25, 2017.
  3. Khan DA. Chronic urticaria: Standard management and patient education. http://www.uptodate.com/home. Accessed April 25, 2017.
  4. Goldsmith LA, et al., eds. Urticaria and angioedema. In: Fitzpatrick's Dermatology in General Medicine. 8th ed. New York, N.Y.: The McGraw-Hill Companies; 2012. http://accessmedicine.mhmedical.com. Accessed April 25, 2017.
  5. Khan DA. Chronic urticaria: Treatment of refractory symptoms. https://www.uptodate.com/home. Accessed April 25, 2017.
  6. Bernstein JA, et al., eds. The diagnosis and management of acute and chronic urticarial: 2014 update. Journal of Allergy and Clinical Immunology. 2014;133:1270.
  7. Darlenski R, et al. Chronic urticaria as a systemic disease. Clinics in Dermatology. 2014;32:420.
  8. Casale TB. Omalizumab for chronic urticaria. Journal of Allergy and Clinical Immunology: In Practice. 2014;2:118.