Patient education: Chronic hives (The Basics)

What are chronic hives? — Hives are patches of skin that are usually very itchy (picture 1). The skin looks puffy or raised compared with the rest of the skin.

Hives can appear anywhere on the body. Sometimes, individual hives start small and get bigger over hours, then gradually fade away. They can appear clustered together or scattered around the body (picture 2). New hives appear as others go away.

The medical term for hives is "urticaria." "Chronic" means long term. People who have chronic hives have them on most days for 6 weeks or more.

Chronic hives are different from hives that happen suddenly and last only a short time. Hives that only last hours or a few days might be caused by an allergy or infection. Sometimes, sudden hives means that the person is having a life-threatening allergic reaction. When this happens, they have other symptoms with the hives, such as trouble breathing or passing out.

Chronic hives are not caused by allergies or infections, and are not life-threatening. But they are very itchy and can make it hard to concentrate or sleep. In most people, chronic hives go away over time, but sometimes, they can last for years. There is no cure for chronic hives, but medicines can help ease symptoms.

What are the symptoms of chronic hives? — People with chronic hives have puffy, raised areas on their skin. Hives might look reddish in color on light-colored skin, and can be pale in the middle. The color changes can be hard to see on darker skin (picture 3). They are usually very itchy, especially at night.

The hives will come and go, but certain things can make symptoms worse. These include:

●Heat, such as hot showers or hot, humid weather

●Tight clothes, waistbands, or clothing straps

●NSAID medicines, including aspirin, ibuprofen (sample brand names: Advil, Motrin), and naproxen (sample brand name: Aleve)

●Alcohol

●Stress

●Certain foods, such as spicy foods

●Having a cold

●Not getting enough sleep

●Certain times in the menstrual cycle (usually just before and during the monthly period)

Chronic hives are not caused by food allergies, but some people find that their hives get worse after they eat certain foods.

Many people with chronic hives also get a condition called "angioedema." Angioedema causes puffiness and swelling of the tissues under the skin (picture 4). Parts of the body that are often affected include the lips, cheeks, eyelids, hands, feet, and genitals.

Will I need tests? — Probably not. Your doctor or nurse should be able to tell if you have chronic hives by learning about your symptoms and doing an exam.

They might order blood tests to make sure that another condition isn't causing your symptoms.

How are chronic hives treated? — Chronic hives usually go away over time. Many people get better within a year, but the condition can last a few years. To help with symptoms, doctors can prescribe different medicines. Most people need to take more than 1 medicine every day to control their symptoms. Medicines can include:

●Antihistamines – These are the same medicines people commonly take for allergies. They can help with itching and shrink the size of your hives. They work better if you take them on a regular schedule.

●Steroid pills – Your doctor might prescribe steroids for a short time to help get your symptoms under control. They help reduce itching and swelling.

If these medicines don't help enough to ease your symptoms, tell your doctor or nurse. There are other medicines or treatments that might help. Over-the-counter creams or lotions might help with itching temporarily, but they aren't recommended for treating chronic hives.

Is there anything I can do on my own to feel better? — Yes. Try to avoid the things that commonly make chronic hives worse. For example, avoid taking NSAIDs or drinking alcohol. Avoid hot showers or tight-fitting clothes that rub or pinch your skin. Try to get plenty of sleep each night.

If your hives get worse when you eat certain foods, try to avoid those foods. But if you are avoiding a lot of foods, tell your doctor or nurse.

More on this topic

Patient education: Hives (The Basics)
Patient education: Angioedema (The Basics)
Patient education: Nonsteroidal antiinflammatory drugs (NSAIDs) (The Basics)
Patient education: Inducible hives (The Basics)
Patient education: Itchy skin (The Basics)

Patient education: Hives (urticaria) (Beyond the Basics)
Patient education: Nonsteroidal antiinflammatory drugs (NSAIDs) (Beyond the Basics)