Chronic hives (urticaria)
Chronic hives (urticaria)
Chronic hives, also known as urticaria, are batches of raised, red or white itchy welts (wheals) of various sizes that appear and disappear. While most cases of hives go away within a few weeks or less, for some people they are a long-term problem. Chronic hives are defined as hives that last more than six weeks or hives that go away, but recur frequently.
In most cases of chronic hives, a cause is never clearly identified. In some cases, chronic hives may be related to an underlying autoimmune disorder, such as thyroid disease or lupus.
While the underlying cause of chronic hives is usually not identified, treatment can help with symptoms. For many people, antihistamine medications provide the best relief.
Individual hives can last from 30 minutes to 36 hours. As some hives disappear, new hives may develop.
About 40 percent of people with chronic hives also have angioedema. Signs and symptoms of angioedema include large welts or swelling of the skin that may occur around the eyes and lips, hands, feet, genitalia, and inside the throat. Swelling in the throat can obstruct breathing and requires emergency treatment. Angioedema may itch less than hives do, but can cause pain or burning.
Symptoms may not occur all the time. They may come and go with no apparent trigger. For some people, certain conditions — such as heat, exertion or stress — can make symptoms worse.
When to see a doctor
See your doctor if you have:
Seek emergency care if you:
Hives on light skin
Hives, also known as urticaria, are the result of your body's release of a natural chemical called histamine. They often appear in areas where clothes rub your skin. ...
Hives on dark skin
On dark skin, hives may be less visible but may still itch or burn. ...
Angioedema may cause large welts below the surface of the skin, particularly on the eyes and lips. Angioedema may also affect the hands, feet and throat. ...
Chronic hives are an inflammation of the skin triggered when certain cells (mast cells) release histamine and other chemicals into your bloodstream, causing small blood vessels to leak. The exact cause of chronic hives isn't well understood — and triggers can be difficult to pinpoint. Chronic hives are thought to be caused by an immune system (autoimmune) disorder and may be linked to another health problem, such as thyroid disease or lupus.
Rarely, a reaction to medication, food, food additives, insects, parasites or infection is identified as an underlying cause of chronic hives. But in most cases, the cause of chronic hives is never identified, even after testing and monitoring symptoms. Heat, cold, pressure, sunlight or other environmental stimuli may worsen chronic hives. Certain pain medications, such as aspirin, ibuprofen (Advil, Motrin, others) and naproxen sodium (Aleve, Anaprox, others), also can worsen chronic hives.
Complications of hives and angioedema may include:
Preparing for your appointment
You'll probably first visit your family doctor or a general practitioner. However, you may then be referred to a doctor who specializes in allergic disease.
Because appointments can be brief, and there's often a lot of ground to cover, it's a good idea to be well prepared for your appointment. Here's some information to help you get ready for your appointment, and what to expect from your doctor.
What you can do
Your time with your doctor is limited, so preparing a list of questions ahead of time will help you make the most of your time together. List your questions from most important to least important in case time runs out. For chronic hives, some basic questions to ask your doctor include:
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment.
What to expect from your doctor
What you can do in the meantime
Tests and diagnosis
Physical exam and medical history
Treatments and drugs
Finding an effective treatment for chronic hives can be challenging. In cases in which a trigger is identified — such as a reaction to a certain food, medication or physical stimulus — treatment includes avoiding the trigger. If your chronic hives are caused by an underlying health condition, they may improve when the underlying condition is treated.
Symptoms can be treated effectively in most people with over-the-counter or prescription medications. Work with your doctor to find the medication — or combination of medications — that works best for you. If the first medication you try doesn't relieve your symptoms, talk to your doctor about trying something else.
Second-generation, newer antihistamines. Your doctor may have you start with newer, nonsedating or low-sedating antihistamines because they are generally as effective and better tolerated than first-generation antihistamines. Examples include:
First-generation, older antihistamines. If a nonsedating antihistamine doesn't work, your doctor may recommend taking a first-generation antihistamine. These antihistamines can make you drowsy and impair your ability to drive or perform other tasks that require physical coordination. For that reason, your doctor may recommend that you take this type of antihistamine before bedtime and switch to a second-generation drug during the daytime. This class of antihistamines includes:
Check with your doctor before taking any of these medications if you're pregnant or breast-feeding, have a chronic medical condition, or are taking any other medications.
Other medications are still being studied to determine whether they may be useful for treating chronic hives. These include:
The following precautions may help prevent hives and angioedema:
Last Updated: 2011-09-17
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