Chronic hives (urticaria) causes itchy, raised welts that last for at least six weeks. Because symptoms are persistent, knowing how to manage chronic hives is essential for maintaining quality of life. Medications, identifying triggers, and other changes can help you take control of flares.
The most important part of managing chronic hives is working with a doctor to establish a structured medication plan.
Usually, treatment plans start with non-drowsy, second-generation antihistamines such as cetirizine (Zyrtec), loratadine (Claritin), or fexofenadine (Allegra). These drugs block histamine, a substance in the body responsible for allergy symptoms like swelling.
If standard doses don’t work, your doctor may increase the amount of antihistamines you take. Or, they may prescribe other medications that target the immune response directly, such as omalizumab (Xolair), dupilumab (Dupixent), or cyclosporin. The Food and Drug Administration also recently approved another drug for chronic hives called remibrutinib, which aims to reduce symptoms by blocking a specific type of protein in the body.
The majority of chronic hives cases don’t have any identifiable external trigger—research suggests that, in many cases, these long-lasting hives are caused by autoimmune issues, or the body attacking itself.
But for some people with chronic hives, certain physical factors can make symptoms much worse. Temperature swings, from a hot shower or very cold air, may intensify or cause the formation of new welts. The same can be true for tight waistbands, bra straps, or heavy bags that press into the skin.
Pay attention to what, if anything, makes your symptoms worse. Then adjust your habits to the best of your ability to avoid a flare in symptoms.
When you’re in the middle of a flare, keeping your skin temperature down can provide immediate relief.
Turn on air conditioning to keep your home cool, and wear loose-fitting, breathable clothing made of fabrics like cotton to prevent irritation and overheating. You can also apply cool washcloths to your skin to soothe burning sensations.
To further calm your skin, reach for anti-itch lotions containing menthol or aloe vera.
There is a strong connection between your nervous system and your skin. Stress can cause your body to release chemicals that disrupt your nervous system, which in turn worsen inflammation and sometimes causes hives.
Stress-relief practices like meditation, deep breathing, walking, or cognitive behavioral therapy may be able to help people calm their nervous system and manage their symptoms. Getting enough rest is also crucial.
While food rarely triggers chronic hives, you may find that making certain tweaks to your diet could help reduce symptom severity.
Some foods naturally contain higher levels of the chemical histamine, or they can trigger your body to release more. There are many foods that are considered high in histamines, but some include:
- Fermented foods
- Pork and chicken
- Vegetables like spinach and tomatoes
- Alcohol
- Fruits such as lemons, oranges, bananas, and strawberries
- Fish like tuna or mackerel
Though more research is needed, some research suggests that avoiding high-histamine foods could help reduce chronic hives’ severity.
You can keep a food diary to see if certain foods seem to worsen your hives. However, it’s best to speak with a healthcare professional before overhauling your diet. A registered dietitian can create a plan that eliminates problem foods while keeping your diet nutritionally complete.
In order for you and your doctor to be on the same page about your symptoms and how you’re responding to treatments, it’s helpful to keep a chronic hives diary.
Take photos of your skin during a flare (or just periodically) to track your hives’ severity and appearance. Your doctor may also ask you to monitor your symptoms every day for a set period of time by filling out questionnaires like the Urticaria Activity Score. Completed either on paper or in an app, these questionnaires ask you to track how many hives you have, how large they are, their intensity, and other metrics.
Though chronic hives isn’t life-threatening, it can take a significant toll on your quality of life. To find solutions that successfully reduce your symptoms, make sure to:
- Start a symptom diary: Track when your hives appear, how severe they are, and what they look like. Note your stress levels, the foods you ate, the activities you did, and any new products you used. This can help identify patterns.
- Talk to your doctor about treatment options: Be honest about how well your current treatment is controlling your symptoms, and ask about whether there are different antihistamines or drugs that might work better for you.
- Consider seeing a specialist: In addition to your primary care doctor, you may need to work with a dermatologist, allergist, psychiatrist, and/or immunologist to manage your chronic hives. Specialists have more experience managing difficult cases.
- Make stress management a priority: Dealing with chronic hives can be very challenging, so it’s important to find ways to reduce stress and calm your nervous system. Try deep breathing, yoga, meditation, music therapy, or other stress relief techniques to find one that may reduce the frequency of your flare-ups.
