Everything You Need to Know About Managing Chronic Hives and Other Hives Complications

If you’re dealing with chronic hives — distinguished from other cases of hives only in the fact that they continue to recur for at least six weeks — you likely already know they can cause significant disruptions in your life. Challenging your sleep and your social life, chronic hives can be menacing. Here, experts share some tips about managing chronic hives and other complications hives might lead to.

Chronic Hives Are Distinct Because They Come Back Again and Again

Hives essentially fall into two categories: acute (which are more common) and chronic. The main difference is the length of time you’re dealing with them.

Hives are considered acute if they completely disappear (and don’t come back) within six weeks. Chronic hives are those that last (or keep coming back) for longer than six weeks. (1) Between 0.5 percent and 5 percent of the population are affected by chronic hives at some point in their lives. (2)

How long it takes chronic hives to go away is unknown. “They can last months to years and, for some individuals, even decades,” says Sarina Elmariah, MD, PhD, a board-certified dermatologist at Massachusetts General Hospital in Boston.

Unfortunately, the longer you have chronic hives (which are also referred to as “chronic urticaria” — “urticaria” being the medical term for hives), the less likely it is they’ll go away for good. “Usually within a year of being in the chronic phase, only 50 percent of hives cases will be resolved,” says Adam Friedman, MD, a professor and the interim chair of dermatology at the George Washington University School of Medicine and Health Sciences in Washington, DC.

Why such a long and sometimes unsuccessful battle? Namely because it’s difficult to pinpoint an exact cause. (3) “For chronic hives, half of them are idiopathic, meaning they have no known cause,” says Meghan Feely, MD, a board-certified dermatologist in private practice in New York City and New Jersey and a media expert for the American Academy of Dermatology.

Chronic Hives Are Caused by Acute Hives Triggers, Along With a Few Others

Autoimmune issues and long-standing infections are known to be associated with chronic hives (and such a relationship does not appear to exist between autoimmune diseases or ongoing infections and acute hives). “Autoimmune urticaria is characterized by autoantibodies that release histamine," a chemical produced by your body that helps fight foreign invaders and is responsible for hives and their itching, Feely says.

Autoimmune disorders like lupus, rheumatoid arthritis, type 1 diabetes, thyroid disease, and celiac disease are all thought to be causes of recurring hives, which are often chronic in nature, Dr. Elmariah says. For individuals with these conditions who have chronic hives, the hives are just one of the many symptoms they’re dealing with.

Sometimes Doctors Can Prescribe Medication or Over-the-Counter Drugs to Help With Chronic Hives

If you’ve been suffering with hives for six weeks or longer, it’s time to seek help. That may seem like a long time to just ignore a medical problem, but Dr. Friedman says it’s not uncommon for people to wait up to a year to ask him about their hives.

Your doctor can help identify any underlying medical issue behind the hives that may require treatment, Friedman says. And your doctor can also help you manage the problem for better day-to-day living, he adds.

When you do see a doctor, come with a full history of your hives, including when they first started, how often you get them, if there’s anything that seems to trigger them, what medication you’ve already tried — and how well these worked.

As with acute hives, you can expect your doctor to start treatment by recommending that you take an antihistamine, most likely a prescription one. The good news is that about 50 percent of chronic hives that have no apparent causes will respond to antihistamines. (4)

If you’re in that other 50 percent and you’re not responding to antihistamines, doctors can also move to omalizumab, a treatment approved by the U.S. Food and Drug Administration (FDA) for chronic hives. The medication is injected under your skin, and success rates with this medication rise to 65 percent. Some doctors may even prescribe corticosteroids, like prednisone, although these are usually just to provide short-term relief and aren’t recommended as a long-term strategy. (4)

Your doctor will also most likely test for autoimmune issues. They don’t do this with acute hives, because it’s more likely that chronic hives are a result of an autoimmune problem than acute hives, Elmariah says. Tests include a blood test that looks for certain autoimmune markers.

Fortunately, even though the struggle may be long, all hope is not lost in the quest to put chronic hives to bed. The American Academy of Allergy, Asthma, and Immunology reports that in about one-half of patients, the hives will be resolved in one to two years, while 80 to 90 percent of hives sufferers will see visible improvement within five years. (4)

Medication That Can Help Chronic Hives

Some medication that helps hives works by blocking the immune response that causes the welts in the first place.

Complications of Chronic Hives

Hives can irritate more than just your skin. “Chronic hives can have a substantial negative impact on quality of life for people,” Friedman says. Dealing with any long-term condition or illness is challenging, and the itchy skin that comes with hives can be especially difficult to live with. (5)

About one in every seven people with hives will deal with a psychological problem such as anxiety, depression, and stress. (5) One study found that number to be much higher, with 48 percent of patients with chronic hives reporting feelings of depression and the same amount dealing with anxiety. (2) If you’re feeling this way, it’s important to speak with friends and family about what you’re going through, and tell your doctor, too. He or she may be able to prescribe a medication to help you cope. (5)

It’s Rare, but Acute and Chronic Hives Can Both Lead to Life-Threatening Complications

In the majority of cases, acute hives will go away on their own and do not pose a serious threat to your health. But sometimes, acute hives can be the sign of a more threatening problem.

Swelling in the eyes, lips, hands, feet, or genitals can be a sign you’re experiencing angioedema, which is a complication that occurs when fluid buildup in the skin causes deep swelling. Angioedema is generally treated with a combination of antihistamines and oral corticosteroids with the goal of bringing the swelling down. (5)

Finally, while hives don’t put you at an increased risk of anaphylaxis, which is the name for a life-threatening allergic reaction, they are one of the first signs that such a reaction may be taking place. (5,6,7) In addition to the skin changes, you might notice swelling on the body, light-headedness, abdominal pain, unconsciousness, and shortness of breath. (5) Consider these symptoms an emergency, and call 911 as soon as possible.

During the attack, you’ll likely be treated with epinephrine, oxygen, antihistamines, cortisone, and a beta-agonist to help you breathe and reduce your body’s allergic response. (8) In most cases, the best way to protect yourself against anaphylaxis is to avoid the trigger altogether and carry an EpiPen so you can administer epinephrine in case of an emergency. (8)

With additional reporting by Moira Lawler.

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