Chronic Hives

Diagnosis

To diagnose chronic hives, your healthcare professional will discuss your symptoms and examine your skin. One key feature of chronic hives is that the welts come and go unpredictably, with each lasting less than 24 hours. You may be asked to keep a diary to track:

• Your daily activities

• Any medicines, herbal remedies, or supplements you take

• What you eat and drink

• Where hives appear, how long they last, and whether they leave marks or bruises

• Whether your hives occur with painful swelling

Blood tests may be recommended to identify possible causes. In some cases, a skin biopsy — the removal of a small tissue sample for lab testing — may be needed to confirm the diagnosis.

Treatment

Treatment for chronic hives usually begins with nonprescription antihistamines to relieve itching. If these are not effective, prescription-strength medications may be suggested, such as:

• Montelukast (Singulair)

• Doxepin (Silenor, Zonalon)

• Ranitidine

• Omalizumab (Xolair)

For severe or resistant cases, medicines that help calm the immune system may be prescribed. These can include cyclosporine, tacrolimus, hydroxychloroquine, or mycophenolate.

Self-care

Chronic hives can last for months or years and may interfere with daily life. The following self-care strategies can help manage symptoms:

• Avoid triggers: Common triggers include certain foods, medications, pollen, pet dander, latex, and insect stings. Stress or fatigue may also contribute.

• Use nonprescription antihistamines: Options that don’t cause drowsiness include loratadine, famotidine, cimetidine, nizatidine, and cetirizine. If itching worsens at night, a sedating antihistamine such as diphenhydramine may help. Always check with your healthcare professional before using these medicines, especially if you’re pregnant, breastfeeding, or taking other medications.

• Apply cold: Use a cool washcloth or ice cube on the itchy area for relief.

• Take a cool shower or bath: Adding baking soda or oatmeal powder to the water can help soothe the skin.

• Use an anti-itch cream or lotion: Products containing menthol can provide a cooling, soothing effect.

• Wear loose cotton clothing: Avoid tight, rough, or wool fabrics that can irritate the skin.

• Protect your skin from the sun: Apply sunscreen at least 30 minutes before going outdoors and seek shade when possible.

• Track your symptoms: Keeping a symptom diary can help identify potential triggers and patterns to guide your treatment plan.