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10 ways to get relief from chronic hives

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Find a Dermatologist

You can search by location, condition, and procedure to find the dermatologist thats right for you.

What is a dermatologist?

A dermatologist is a medical doctor who specializes in treating the skin, hair, and nails. Dermatologists care for people of all ages.

Chronic hives

Diagnosis

To diagnose chronic hives, your health care provider will likely talk with you about your symptoms and look at your skin. One of the telling features of chronic hives is that the welts come and go at random. You might be asked to keep a diary to keep track of:

• Your activities
• Any medications, herbal remedies or supplements you take
• What you eat and drink
• Where hives appear and how long it takes a welt to fade and whether it leaves behind a bruise or other mark
• Whether your hives come with painful swelling

You may also need blood tests to determine the cause of your symptoms. An accurate diagnosis will guide your treatment options. If needed to clarify the diagnosis, your doctor might take a skin sample (biopsy) to examine under a microscope.

Treatment

Treatment for chronic hives often starts with nonprescription anti-itch drugs (antihistamines). If these don't help, your health care provider might suggest that you try one or more of these treatments:

Prescription anti-itch drugs. The usual treatment for chronic hives is prescription antihistamine pills that don't make you drowsy. These drugs ease itching, swelling and other allergy symptoms. Daily use of these drugs helps block the symptom-producing release of histamine. Examples include:

• Cetirizine
• Desloratadine (Clarinex)
• Fexofenadine

These medications have few side effects. If the nondrowsy antihistamines don't help you, your health care provider may increase the dose or add another type of antihistamine.

Check with your health care provider before taking any of these medications if you're pregnant or breastfeeding, have a long-term medical condition, or take other medications.

Other medications

If the first-choice drugs don't ease your symptoms, other drugs may help. For example:

• Famotidine (Pepcid AC)
• Montelukast (Singulair)
• Doxepin (Silenor, Zonalon)
• Cimetidine (Tagamet HB)
• Nizatidine (Axid AR)
• Ranitidine (Zantac)
• Omalizumab (Xolair)

For chronic hives that resist these treatments, your health care provider might prescribe a drug that can calm an overactive immune system. Examples are cyclosporine (Gengraf, Neoral, Sandimmune), tacrolimus (Prograf, Protopic, others), hydroxychloroquine (Plaquenil) and mycophenolate (Cellcept, Myfortic).

Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition.

Lifestyle and home remedies

Chronic hives can go on for months and years. They can interfere with sleep, work and other activities. The following self-care tips may help you manage your condition:

• Avoid triggers. These can include foods, medications, pollen, pet dander, latex and insect stings. If you think a medication caused your welts, stop using it and contact your primary care provider. Some studies suggest that stress or fatigue can trigger hives.
• Use a nonprescription anti-itch drug. A nonprescription anti-itch (antihistamine) pill that doesn't cause drowsiness may help ease itching. Examples include loratadine (Alavert, Claritin, others) and cetirizine (Zyrtec Allergy).
• Apply cold. Soothe the skin by covering the itchy area with a cold washcloth or rubbing an ice cube over it for a few minutes.
• Take a comfortably cool shower or bath. Some people might relieve itching in the short term by taking a cool shower or bath. Try sprinkling the bath water with baking soda or oatmeal powder (Aveeno, others).
• Apply an anti-itch cream or lotion. Try a cream with menthol for a soothing effect.
• Wear loose, smooth-textured cotton clothing. Avoid wearing clothing that's rough, tight, scratchy or made from wool.
• Protect your skin from the sun. Liberally apply sunscreen about a half hour before going outdoors. When outdoors, seek shade to help relieve discomfort.
• Track your symptoms. Keep a diary of when and where hives occur, what you were doing, what you were eating, and so on. This may help you and your health care provider identify triggers.

Preparing for your appointment

You'll likely start by seeing your primary care provider. Or you may be referred to an allergy specialist or a doctor who specializes in the diagnosis and treatment of skin conditions (dermatologist).

What you can do

Here are some tips to help you get ready for your appointment.

• List your symptoms, when they occurred and how long they lasted.
• List any medications you're taking, including vitamins, herbs and supplements. Even better, take the original bottles and a list of the doses and directions.
• List questions to ask your doctor.

For chronic hives, questions you may want to ask include:

• What is likely causing my symptoms?
• How long will hives last?
• What kinds of tests do I need? Do these tests require any special preparation?
• What treatments are available, and which do you suggest?
• What are the alternatives to the primary approach that you're suggesting?
• Do these treatments have any side effects?
• Do I need prescription medication, or can I use nonprescription drugs to treat the condition?
• Does the medicine you're prescribing have a generic version?

What to expect from your doctor

Your health care provider is likely to ask you a few questions, such as:

• When did you first have symptoms?
• What did your skin reaction look like when it first appeared?
• Have your symptoms changed over time?
• Have you noticed anything that makes your symptoms worse or better?
• Do your skin lesions mainly itch, or do they burn or sting?
• Do your skin lesions go away completely without leaving a bruise or a mark?
• Do you have any known allergies?
• Have you ever had a similar skin reaction before?
• Have you tried a new food for the first time, changed laundry products or adopted a new pet?
• What prescriptions, nonprescription medications and supplements are you taking?
• Have you started taking any new medications or started a new course of a medication you've taken before?
• Has your overall health changed recently? Have you had any fevers or have you lost weight?
• Has anyone else in your family ever had this kind of skin reaction? Do other family members have any known allergies?
• What at-home treatments have you used?

How long can hives last?

Hives can appear and disappear quickly, with each hive only lasting around 23 hours. However, depending on the cause, they may reappear and continue affecting someone for days, weeks, or longer.

People can have acute hives, which occurs due to a specific trigger and resolves within 6 weeks. Alternatively, they can have chronic hives, which recur at least twice per week for longer than 6 weeks.

This article looks at how long hives last, factors that influence their duration, and treatment.

Each hive lasts only 23 hours, but for some people, they continue to appear and disappear for longer. The duration of hives can depend on whether they are acute or chronic.

Acute hives appear quickly and do not last long. Doctors classify hives as acute if the overall duration is less than 6 weeks.

However, around 25% of people go on to develop chronic hives. This is when hives regularly reappear over 6 weeks or more.

For many individuals, chronic hives eventually clear on their own, but this can take months. According to the American Academy of Dermatology Association (AAD), around half of people with chronic hives spontaneously recover within 1 year.

Acute hives often occur in response to an allergen or irritant. When the immune system perceives a substance as a threat, it releases histamine and other chemicals. This causes tiny blood vessels under someones skin to leak fluid, which accumulates and causes the bump.

Some common substances that can result in hives include:

• food allergens, such as milk, eggs, tree nuts, peanuts, or shellfish
• contact allergens, such as latex or animal dander
• insect bites or stings
• medications

Any drug can cause hives, but some of the medications most commonly associated with this symptom include:

Acute hives can also occur in response to viral infections, parasitic infections, or during times of stress.

According to a 2018 review, doctors are unsure of the cause of acute hives in around 50% of individuals. These cases are known as acute spontaneous urticaria (ASU).

Chronic hives may have the same cause as acute hives, but with symptoms lasting longer than 6 weeks. However, chronic hives are often not due to an allergen and instead have a physical cause.

There are two subcategories of chronic hives: inducible urticaria and chronic idiopathic urticaria.

Chronic idiopathic hives

Chronic idiopathic urticaria has no clear cause and is the most common form of chronic hives. Researchers are working to understand why this type of hives occurs, but a leading theory links it with autoimmunity.

Autoimmunity occurs when a persons immune system mistakenly attacks healthy tissue, and several autoimmune conditions are associated with chronic hives. The most common is thyroid disease, which is present in 9.8% of cases.

This suggests that the hives may result from someones immune system not functioning as it should. Other conditions that can occur alongside chronic hives include type 1 diabetes, lupus, and rheumatoid arthritis.

Infections can also be associated with the onset of chronic hives. This includes bacterial, viral, and parasitic infections. Again, this may result from autoimmunity an infection may trigger a change in how the persons immune system works.

Inducible hives

Inducible or physical urticaria is less common than chronic idiopathic urticaria. With this subtype, it is possible to purposely induce the hives by a person exposing their skin to certain triggers, which could include:

• Scratching or pressure: The most common type of inducible hives is known as dermatographia. This condition involves developing hives as a response to scratching or drawing on the skin.
• Cold: Cold hives occur on someones skin or mouth after exposure to cold temperatures. Triggers include consuming iced drinks, touching cold water, or going outside in cold weather.
• Heat: Cholinergic hives occurs when an individuals body becomes hot or sweaty. Hot baths, exercise, and spicy food can be triggers.
• UV light: Solar hives occur in response to UV light from the sun and certain light bulbs, such as those in tanning beds.
• Water: Some people develop hives if their skin comes into contact with water. This is known as aquagenic urticaria and is very rare.

Doctors diagnose hives by performing a physical examination. There is no test to determine whether the persons hives are acute or chronic, so they will use the length of time they recur to do this.

The doctor may also ask an individual:

• when the rash began
• the shape, size, and distribution of the rash
• where on the body they first noticed the rash
• if they have had any insect bites
• if they live or work with common hive triggers, such as chemicals, animals, or latex gloves
• if they have bone or joint pain, fever, or abdominal pain
• if anyone in their family experiences hives
• if they take any medications or supplements

The doctor may use a skin prick test and serum-specific IgE test to check if the acute hives result from a specific substance, such as food, dust mites, or chemicals. Alternatively, they may refer someone to an allergy clinic for these tests.

However, in cases of chronic hives, allergy testing is rarely useful. A doctor may check for other underlying health conditions by performing additional tests, such as:

The most suitable treatment depends on whether the person has acute hives or chronic hives.

Acute hives

Doctors typically recommend second-generation antihistamines as the first-line treatment for acute hives, such as:

• loratadine (Claritin)
• desloratadine (Clarinex)
• fexofenadine (Allegra)
• cetirizine (Zyrtec)
• levocetirizine (Xyzal)

They may prescribe a standard dose or increase by up to 4 times if the individual does not respond.

If these medications do not improve symptoms, the doctor may recommend an additional antihistamine, such as cimetidine (Tagamet), famotidine (Pepcid), or ranitidine (Zantac). They may recommend a 310-day course of corticosteroids to help control the symptoms in severe cases.

The doctor may prescribe an epinephrine auto-injector if they think the individual is at risk of anaphylaxis, which is a severe allergic reaction that restricts breathing. This provides emergency medicine to treat anaphylaxis quickly.

The doctor will then reassess the individual in 26 weeks.

Chronic hives

Doctors may recommend a four-step treatment plan for chronic hives. This approach involves using an antihistamine daily, which may be up to 4 times the regular dosage depending on how the individual responds.If necessary, they may prescribe a second antihistamine or another medication, such as montelukast (Singulair). With persistent hives, they may suggest a high potency antihistamine, such as hydroxyzine or doxepin.

The final step is for a doctor to refer the individual to a specialist for immunomodulatory therapy. This may involve taking medications such as omalizumab (Xolair) or cyclosporine (Sandimmune).

Once symptoms are under control, a doctor may gradually reduce the dosage of these medications. If the hives have an identifiable cause, such as cold or heat exposure, adopting changes to avoid the triggers wherever possible is also important.

The AAD suggests the following methods for people to reduce irritation and itchiness in hives:

• applying topical anti-itch medications, such as calamine lotion
• wearing loose-fitting clothing
• moisturizing with fragrance-free lotion to prevent dry skin
• using cold compresses several times per day

However, it is important for individuals to try to determine whether the hives have a specific trigger, in addition to relieving symptoms. If someone has cold hives, for example, a cold compress may make them worse.

Therefore, it is a good idea for people to keep a symptom diary, recording when the hives occur and any factors that might have contributed. Symptom diaries are also useful to refer to at medical appointments. A person can take note of:

• the date and time the hives appear
• what they were doing just before they developed
• what they have had to eat or drink

If any common factors emerge when the hives occur, a person can try to temporarily avoid these to see if it helps. It is important for people to do this with the guidance of a doctor, allergist, or dietitian if someone has food-related hives.

Learn more about remedies and treatments for hives here.

Hives do not last long, taking only 23 hours to fade. However, more can appear, which makes the symptoms last longer. Acute hives can develop and resolve on their own within 6 weeks, while chronic hives can last much longer.

Doctors treat acute and chronic hives differently, so it is advisable for people to speak with a medical professional about this symptom, especially if the hives last longer than 6 weeks.

If hives or swelling occur in the mouth and airways, making it difficult to breathe, dial 911 or the number of the nearest emergency department immediately.