Chronic Hives

Urticaria, often known as hives, is a skin response that results in itchy welts. Hives that persist longer than six weeks and frequently recur over the course of months or years are referred to as chronic hives. The root reason for persistent hives is frequently unclear.

The welts frequently begin as itchy areas that develop into swollen, variable-sized welts. The welts develop and disappear at random as the response progresses.

Hives that last a long time can be quite unpleasant and disrupt sleep and daily activities. Many patients get relief with anti-itch drugs (antihistamines).

Chronic Hives: Causes

Hives result in the release of immune system chemicals like histamine into your circulation, which results in welts. The causes of chronic hives are frequently unknown, as are the reasons why short-term hives may develop into long-term issues.

The following may cause the cutaneous reaction −

  • Warmth or cold

  • Vibrations such as those brought on by running or using lawnmowers.

  • Skin pressure, such as that caused by a tight waistline.

  • Diseases include cancer, infection, allergies, and thyroid disease

  • In sunlight

Chronic Hives: Symptoms

The major symptoms include −

  • Clusters of welts (wheals) that can appear anywhere on the body Depending on your skin tone, these welts may be red, purple, or skin-colored.

  • Size and shape variable, repeatedly appearing and fading welds.

  • Itching, or pruritus, may be very bad.

  • Angioedema, painful swelling around the lips, cheeks, or eyes

  • Heat, activity, or stress-related flares Symptoms that last longer than six weeks and return frequently and anytime, occasionally for months or years

Three hallmarks of the urticarial plaque are distinctive redness, blistering, and itching. An occasional burning feeling might be present. Everywhere in the body, lesions might develop and disappear completely within around 2-3 hours. Sometimes, this spontaneous recuperation might extend up to a day.

Angioedema causes a quick onset of skin swelling, particularly in places like the lip mucosa and eyelid mucosae. Instead of pruritus, pain, and a burning feeling may be more prominent. In around 72 hours, the lesions spontaneously regress.

Erythema and edema known as dermographism appear 10 to 20 minutes after mechanically traumatizing the skin. About half of the population may have this condition, and if the area is itchy, the condition is known as dermatographic urticaria.

When to Visit a Doctor?

If you have severe hives or hives that last for more than a few days, consult your doctor.

You are not suddenly in danger of a major allergic response if you have chronic hives (anaphylaxis). Get immediate attention if you experience severe allergic reaction-related hives. Dizziness, difficulty breathing, and swelling of the tongue, lips, mouth, or throat are all signs of anaphylaxis.

Chronic Hives: Risk Factors

The major risk factors include −

  • Atopy

  • Air toxicity

  • Women's gender

  • Certain foods

  • Medications

  • Jobs involving a lot of latex touch or a lot of skin friction

  • A good family history

  • Bee and insect stings

Chronic Hives: Diagnosis

Based on clinical signs and anamnesis, the diagnosis is quite straightforward. Urticaria pigmentosa, urticarial vasculitis, viral rashes, connective tissue disorders, photosensitive diseases, and several syndromic illnesses are occasionally also mistaken for it.

To determine the cause of the urticaria, it is crucial to acquire a thorough history from the patient. The patient should be questioned regarding the beginning, growth, localization of lesions, overall symptoms, dietary habits, stress levels, and regular or irregular drug usage. Routine laboratory studies and allergy tests are not necessary in cases with acute urticaria. There is no need for laboratory investigations if there is no evidence to establish a diagnosis.

Your healthcare professional will probably ask you about your symptoms and examine your skin to determine whether you have persistent hives. The fact that the welts appear and disappear at random is one of the telltale signs of persistent hives.

You could be requested to keep a journal to document −

  • Your pursuits

  • Whatever prescription drugs you use, herbal supplements, or

  • What you consume and ingest

  • Where hives occur, how long it takes for a welt to go away, and if a bruise or other mark is left behind

  • No matter whether your hives cause excruciating swelling

Blood tests can also be required to identify the source of your symptoms. Your treatment choices will be influenced by an appropriate diagnosis.

Chronic Hives: Treatment

Non-prescription anti-itch medications are frequently the first step in treating persistent hives (antihistamines). Your doctor could advise you to try one or more of the following therapies if these don't work −

Prescribed anti-itch medications. Antihistamines with no drowsiness on prescription are typically used to treat persistent hives. These medicines reduce allergic symptoms including itchiness and swelling. Regular usage of these medications aids in preventing the production of histamine that causes symptoms. Examples include −

  • Cetirizine

  • Desloratadine

  • Fexofenadine

There are not many negative effects of these drugs. Your healthcare professional may raise the dose or add another type of antihistamine if the nondrowsy antihistamines don't assist you.

If you are pregnant, nursing, have a chronic medical condition or use any other medicine, see your doctor before taking any of them.

  • Apply ice. Using an ice cube or covering the irritated region with a cool washcloth will help to soothe the skin.

  • Take a shower that is comfortably chilly. In the short term, having a chilly shower or bath might help some itchy people. Try adding some baking soda or oatmeal powder to the bath water.

  • Use an itching-relieving ointment or lotion. For a calming effect, try a menthol-containing lotion.

  • Wear loose, cotton garments with a soft feel. Wearing clothes that are tight, scratchy, abrasive, or made of wool is not recommended.

  • Sun protection for your skin. Apply sunscreen liberally for approximately 30 minutes before heading outside. While outside, look for shade to help you feel more comfortable.

Chronic Hives: Prevention

Precautions to take to reduce your risk of developing hives or angioedema include −

  • Abstain from recognized triggers. Try to avoid the chemical if you know what causes your hives.

  • Take a shower and freshen up. Take a bath or wash and change into fresh clothing if you have previously had hives after coming into touch with pollen or animals.


Chronic urticaria is a very prevalent illness, and the majority of cases are idiopathic and lack a clear allergic trigger. Up to 30–40% of cases have been shown to have autoimmune origins. In chronic situations, it's crucial to seek physical urticarias such as pressure urticaria.

Food avoidance should not usually be advised without the proper testing for food allergies. If necessary, long-acting, non-sedating antihistamines can be used in safe and efficient amounts even greater than those recommended.

Many people with chronic urticaria experience detrimental effects on their quality of life. A specific focus is needed on psychological stresses since they might have a significant impact on this illness.

Dr. Durgesh Kumar Sinha
Dr. Durgesh Kumar Sinha


Updated on: 30-Mar-2023


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