Hives that come and go daily: Causes and treatment

Hives are itchy, raised bumps on the skin. Some people get a flare-up of hives that go away on their own. However, when a person has hives that come and go daily, they may have chronic hives.

Doctors diagnose chronic hives in people who experience them for at least 6 weeks. Each hive typically lasts for 24 hours before disappearing. Usually, the condition does not have an identifiable cause, but sometimes, it does.

Some people experience chronic hives due to an underlying condition. Therefore, it is important for individuals to speak with a doctor about hives that keep returning.

Keep reading to learn more about the symptoms, causes, diagnosis, and treatment of hives that come and go daily.

Chronic hives is a condition that causes hives that keep coming back. Each one lasts less than 24 hours, and as old hives fade, new ones appear.

Unlike acute hives, which come on suddenly and fade quickly, chronic hives can occur almost daily for 6 weeks or more. In some cases, symptoms can hinder daily activities and impair sleep.

Chronic hives looks identical to acute hives. The only difference is that the symptoms come and go instead of flaring up and then resolving.

Hives are itchy, raised welts on the skin that may be red or the same color as a person's skin. They turn white when a person presses on them. Hives can develop anywhere on the body, move around, and change shape. They can also appear and disappear suddenly.

Hives usually do not break the skin, but they may cause bleeding if a person scratches them.

There can be several causes of chronic hives, but the trigger is unknown in the majority of cases.

Chronic idiopathic urticaria

The medical name for chronic hives that have no clear trigger is chronic idiopathic urticaria.

According to the American Osteopathic College of Dermatology (AOCD), the immune system is overactive in about half of people who have chronic idiopathic urticaria. Doctors consider these cases autoimmune, as they stem from the immune system attacking healthy tissues.

However, a 2021 research article notes that certain bacteria, viruses, or parasites are also associated with cases of chronic hives. Researchers have not proven that these organisms cause the hives, but they may trigger the immune system, which could lead to hives as part of its response to the infection.

Bacterial infections associated with chronic hives include:

Viral infections associated with the condition include:

Parasitic infections associated with chronic hives include:

Autoimmune conditions

Some cases of chronic hives may stem from an underlying autoimmune disease. Research has found that 9.8% of people with chronic hives also have autoimmune hypothyroidism. Other conditions associated with chronic hives include:

Physical stimuli

A small percentage of chronic hives cases stem from physical stimulation. This is known as physical urticaria. The most common trigger is scratching or rubbing the skin firmly.

Other physical triggers may include:

exercise
cold temperatures
hot temperatures
sunlight
vibration
pressure

Allergies

As with acute hives, chronic hives can also occur due to an allergy. However, unlike acute hives, this is a rare cause for chronic hives.

Some common allergens that can trigger hives include:

certain foods
food additives and preservatives
latex
medications

Reactions to medications can happen at any time after someone starts taking one. Some common triggers include:

Diagnosing chronic hives may begin with consulting a primary care physician, an allergist, or a dermatologist. They will examine the hives and ask the person questions to rule out common causes, such as a medication reaction.

Depending on the circumstances, the doctor may order diagnostic tests. This could include allergy testing or blood tests to detect inflammation markers or celiac disease.

If the hives are not always apparent, it may help for a person to take photographs to show a doctor at the appointment. Keeping a diary of when the hives appear and any possible contributing factors may also help. People can track:

food they eat
medication they take
exposure to physical stimuli, such as the sun, friction, or pressure on the skin

In cases where there is no clear cause, treatment focuses on controlling the hives. A 2021 review article lists the following treatment options:

Second-generation H1-antihistamines: This is the first-line treatment for chronic hives, and includes drugs such as cetirizine and loratadine. Routine use of first-generation H1 antihistamines, such as diphenhydramine (Benadryl), is not recommended by doctors due to side effects.
Omalizumab (Xolair): If a person is unresponsive to the first-line treatment, practitioners may add this drug for a second-line treatment. It is a monoclonal antibody, which blocks the action of substances in the body that produce hives.
Cyclosporine (Gengraf): Doctors may prescribe this when someone does not respond to a combination of an H1-antihistamine and omalizumab.
Corticosteroids: Short-term use of these anti-inflammatory drugs may be an option to alleviate flare-ups of chronic hives.

In cases where the hives have a known trigger, avoiding the trigger is another important part of treatment.

Chronic hives can go away. A prospective cohort study found that 35% of participants with chronic hives had no symptoms after 1 year, and another 29% experienced a reduction in symptoms during this time.

Among individuals with idiopathic chronic hives, 48% experienced remission within 3 years. However, only 16% of those with physical hives experienced remission within 3 years.

If a person has flare-ups of hives for 6 weeks or longer, the American Academy of Dermatology Association recommends visiting a board-certified allergist, dermatologist, or primary care doctor.

If someone experiences severe hives inside their mouth or airways that affect breathing, call 911 or the number of the nearest emergency department. This could be a sign of a severe allergic reaction, or anaphylaxis, which can make it hard to breathe.

Symptoms of anaphylaxis include:

fast or shallow breathing
a fast heartbeat
wheezing
lightheadedness
clammy skin
anxiety or confusion
loss of consciousness

Hives that come and go daily for at least 6 weeks may meet the criteria for chronic hives. Most cases do not have an identifiable cause, but it is associated with an infection, autoimmune condition, allergy, or physical cause in some people.

Physical hives can occur due to exercise, vibration, or exposure to hot or cold temperatures. However, chronic idiopathic urticaria is more common.

Doctors treat this condition with medications to control the symptoms. Evidence indicates that after 1 year, a sizable proportion of people with chronic hives experience remission or a reduction in symptoms.

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