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.
Hives generally:
- Appear as small round wheals, rings or large patches and may change shape
- Itch and may be surrounded by a red flare
- Occur in batches, and often appear on the face or the extremities
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
Although chronic hives and angioedema usually aren’t life-threatening, they can be debilitating — and in some cases are a sign of an underlying health problem.
See your doctor if you have:
- Severe hives
- Hives that don’t respond to treatment
- Hives that continue to appear for more than a couple of days
Seek emergency care if you:
- Feel lightheaded
- Have difficulty breathing
- Feel your throat is swelling
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. Nonsteroidal anti-inflammatory drugs, such as ibuprofen (Advil, Motrin, others), also can worsen chronic hives.
Complications of hives and angioedema may include:
- Itching. Hives and angioedema can cause itching and discomfort.
- Difficulty breathing. In more-serious cases — when swelling occurs inside your mouth or throat — complications can include difficulty breathing, leading to a loss of consciousness. If you have a swollen throat, seek medical care immediately.
- Anaphylactic shock (anaphylaxis). This is a serious allergic reaction involving your heart or lungs that can also be associated with hives and angioedema. Your bronchial tubes narrow, it’s difficult to breathe, and your blood pressure drops, causing dizziness and perhaps loss of consciousness or even death. Anaphylactic shock occurs rapidly and requires immediate medical care.