Chronic Hives (Chronic Idiopathic Urticaria): Causes & Treatment

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Chronic hives (chronic urticaria) are red, itchy skin welts that last more than six weeks. Many people have these welts every day for a year or longer. People with certain autoimmune diseases are more prone to chronic hives. But often, the cause of chronic hives is unknown. Antihistamines, steroids and immunosuppressants can soothe the hives.

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Chronic hives are itchy, raised, red bumps or welts that appear on your skin at least twice per week. These welts, also called wheals, are chronic when they last more than six weeks.

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You may hear this condition called chronic idiopathic urticaria:

• Chronic: A symptom or condition that persists even with treatment.
• Idiopathic: The symptom or condition occurs for no known reason. It comes on suddenly.
• Urticaria: The medical term for hives, pronounced ur-tik-CARE-ee-uh.

Hives (urticaria) and angioedema (swelling) can occur together. Hives are raised red bumps or splotches on your skin. Angioedema (swelling) may occur in deep layers of tissue. This swelling can affect your face, lips, throat, hands, feet and genitals.

Chronic hives are different than acute hives:

• Acute hives start to fade within 24 hours (although new hives may replace them). They are gone within six weeks. A recent viral infection often causes acute hives.
• Chronic hives are visible at least twice per week for more than six weeks. Some chronic hives last for months or years. The cause is often unknown.

Up to 5% of people develop chronic hives. The condition can affect anyone, but is more common in women ages 30 to 50.

For most people with chronic hives, there’s no known cause. Rarely, medication allergies or food allergies cause chronic hives. The most common allergic cause is something you consume on a regular basis. Other types of allergies may also bring on chronic hives.

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Some people develop chronic hives when their body changes temperature rapidly due to heat, cold or physical activity. Pressure on your skin from tight clothing may also cause the condition.

About 1 in 5 people who develop chronic hives also have an autoimmune disease, such as:

• Celiac disease.
• Dermatomyositis.
• Diabetes.
• Lupus.
• Polymyositis.
• Rheumatoid arthritis.
• Thyroid disease.
• Vitiligo.

Other conditions that may cause chronic hives include:

• Asthma.
• Infections like H. pylori bacterial infections and sinus infections (sinusitis).
• Liver disease.
• Lymphomas, including Hodgkin lymphoma and non-Hodgkin’s lymphoma.
• Vasculitis.

Hives can appear anywhere on your body and look different on each person. Hives can have different shapes and sizes. They may be as small as a pinprick or larger than a softball.

Chronic hive symptoms include:

• Red, raised welts or bumps on your skin that may hurt or sting.
• Blanching (the center of the hive turns white when you press it).
• Itchy skin (pruritus).
• Swelling (angioedema).

Healthcare providers who diagnose and treat chronic hives include:

• Allergists.
• Dermatologists.
• Primary care physicians.

Your healthcare provider can diagnose chronic hives by examining your skin and learning more about your symptoms.

Diagnostic tests for chronic hives can pinpoint or rule out causes. You may get one or more of these tests:

• Allergy test to see if an allergen is causing a reaction.
• Blood test to check for high levels of antibodies, proteins that help your body fight off bacteria, allergens and other substances.
• Urine test to look for bacterial infections.
• Skin biopsy procedure to confirm the diagnosis and evaluate for other causes.

Treatments for chronic hives include:

• Allergy medications: Daily over-the-counter (OTC) or prescription allergy medications like antihistamines relieve itching and reduce or prevent allergic reactions.
• Allergy shots: A monthly injection of a drug called omalizumab (Xolair®) blocks your body’s production of immunoglobin E (IgE). People with severe allergies can make too much IgE, leading to problems like chronic hives and asthma.
• Steroids: Corticosteroids like prednisone (Deltasone®, Rayos®) can ease symptoms that don’t respond to allergy medicines.
• Hydroxychloroquine: A study found that 8 in 10 people with autoimmune disease-induced chronic hives got symptom relief after taking hydroxychloroquine (Plaquenil®), an antimalarial drug, for three or more months.
• Cyclosporine: This immunosuppressant is highly effective at clearing up severe chronic hives. But it can cause serious side effects when taken for too long.

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You can try these steps at home to ease itchy skin and soothe inflammation:

• Apply an OTC anti-itch cream.
• Place cool compresses on the hives several times a day (unless cool temperatures make hives worse).
• Take a cool bath or shower.
• Use hypoallergenic lotions and creams to moisturize dry skin.
• Wear loose-fitting clothes made with soft fabric that won’t irritate your skin.

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For half of people with chronic hives, the hives go away (often without treatment) within a year. Treatments can ease symptoms of long-lasting hives.

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The unpredictability of chronic hive flares can take a toll on your mental health. Learn tips to help manage the impact.

Call your healthcare provider if you experience:

• Hives or swelling that lasts more than a week.
• Infected-looking bumps (red, swollen or pus-filled).
• Recurring hives that come back every few months.
• Severely itchy skin.

You may want to ask your healthcare provider:

• What is causing the chronic hives?
• When should the chronic hives go away?
• Should I get an allergy test?
• What’s the best treatment for chronic hives?
• What’s the best treatment to reduce itching?
• Should I look out for signs of complications?

Stress and anxiety can worsen skin diseases. Anti-anxiety medicines may help. You may also benefit from stress-relieving therapies like mindfulness or meditation.

Chronic hives (chronic urticaria) can be itchy and uncomfortable. You may become self-conscious about your appearance. Most of the time, providers can’t pinpoint the cause of chronic hives. However, treatments like antihistamines, steroids and even immunosuppressants can help. You can also take steps at home to ease itching and swelling. For many people, chronic hives eventually go away, although it may take a year or longer.

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Cleveland Clinic’s health articles are based on evidence-backed information and review by medical professionals to ensure accuracy, reliability and up-to-date clinical standards.

Cleveland Clinic’s health articles are based on evidence-backed information and review by medical professionals to ensure accuracy, reliability and up-to-date clinical standards.

• American Academy of Dermatology. 10 Ways to Get Relief from Chronic Hives (https://www.aad.org/public/diseases/a-z/hives-chronic-relief). Accessed 5/2/2022.
• American Academy of Dermatology. Hives: Overview (https://www.aad.org/public/diseases/a-z/hives-overview). Accessed 5/2/2022.
• American College of Allergy, Asthma and Immunology. Hives (Urticaria) (https://acaai.org/allergies/types-allergies/hives-urticaria). Accessed 5/2/2022.
• American Osteopathic College of Dermatology. Urticaria (https://www.aocd.org/page/Urticaria). Accessed 5/2/2022.
• Bracken SJ Abraham S, MacLeod AS. Autoimmune theories of chronic spontaneous urticaria (https://pubmed.ncbi.nlm.nih.gov/30984191/). Front Immunol. 2019 March 29;10:627. Accessed 5/2/2022.
• Chen Y, Wu C, Shen J, Chen T, Chang Y. Cancer risk in patients with chronic urticaria: A population-based cohort study (https://jamanetwork.com/journals/jamadermatology/fullarticle/1105196). Arch Dermatol. 2012;148(1):103–108. Accessed 5/2/2022.
• Khan S. Urticaria in patients with diabetes: Adverse drug reaction or relapse of underlying autoimmune urticaria? (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6607826/) Indian J Med Res. 2019;149(3):423-425. Accessed 5/2/2022.
• Merck Manual (Consumer Version). Hives (https://www.merckmanuals.com/home/skin-disorders/itching-and-dermatitis/hives). Accessed 5/2/2022.
• Sachdeva S, Gupta V, Amin SS, Tahseen M. Chronic urticaria. Indian J Dermatol. 2011;56(6):622-628. Accessed 5/2/2022.

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