Chronic Urticaria (Hives)

Urticaria — also called hives — is a raised, itchy rash that appears when cells in the skin release histamine. Individual patches usually come and go within 24 hours, though new ones can keep forming. When hives occur on most days for more than six weeks, it is called chronic urticaria.

What it looks and feels like

• Raised weals (bumps) that can be small or join into larger areas
• Itching, sometimes intense, that is often worse in the evening
• Patches that fade in one place and appear in another
• In some people, deeper swelling of the lips, eyelids or hands (angioedema)

Why it happens

In most cases of chronic urticaria no external allergen is found. It is frequently linked to the immune system reacting against the person’s own tissues, and it can be made worse by heat, pressure on the skin, infection, certain painkillers, stress and tiredness. Because a food or drug “allergy” is a common assumption but an uncommon cause, careful assessment matters.

How it is assessed

History

We ask how long each patch lasts, what the pattern is through the day and week, whether there is swelling, and what medicines and supplements you take.

Targeted testing

Blood tests may be used to look for markers of inflammation or autoimmunity. The autologous serum skin test is sometimes used to see whether the skin reacts to a person’s own serum. Broad allergy panels are generally not helpful for chronic urticaria and are avoided unless the history points to a specific trigger.

Treatment

The usual first step is a regular, often higher-than-standard dose of a non-drowsy antihistamine, taken every day rather than only when the rash appears. If symptoms continue, additional options that a specialist may consider include other antihistamines, a short course of other medication, or, for difficult cases, treatments such as autologous serum therapy or biologic medication. The aim is to keep the itching under control while the condition settles, which it often does over months to a few years.

• Take antihistamines consistently, as advised
• Keep cool; avoid very hot showers and tight clothing over affected areas
• Note and avoid painkillers that clearly worsen the rash, and tell your clinician
• Manage sleep and stress where you can

When to book an appointment

See us if hives are lasting beyond six weeks, disturbing sleep, not responding to standard antihistamine doses, or are accompanied by swelling of the lips or tongue. Swelling that affects breathing or swallowing needs emergency care.

This page is general information and not a substitute for a consultation. Symptoms overlap between conditions, so a clinician's assessment is the reliable way to know what is going on and what will help in your case.