If you’re dealing with chronic hives — distinguished from other cases of hives only in the fact that they continue to recur for at least six weeks — you likely already know they can cause significant disruptions in your life. Challenging your sleep and your social life, chronic hives can be menacing. Here, experts share some tips about managing chronic hives and other complications hives might create. Hives are considered acute if they completely disappear (and don’t come back) within six weeks. Chronic hives are those that last (or keep coming back) for longer than six weeks. Up to 1.8 percent of the global population are affected by chronic hives at some point in their lives. (1) How long it takes chronic hives to go away is unknown. “They can last months to years and, for some individuals, even decades,” says Sarina Elmariah, MD, PhD, a board-certified dermatologist at Massachusetts General Hospital in Boston. Unfortunately, the longer you have chronic hives (which are also referred to as “chronic urticaria” — “urticaria” being the medical term for hives), the less likely it is they’ll go away for good. “Usually within a year of being in the chronic phase, only 50 percent of hives cases will be resolved,” says Adam Friedman, MD, a professor and the chair of dermatology at the George Washington University School of Medicine and Health Sciences in Washington, DC. Why such a long and sometimes unsuccessful battle? Namely, because it’s difficult to pinpoint an exact cause. (3) “For chronic hives, half of them are idiopathic, meaning they have no known cause,” says Meghan Feely, MD, a board-certified dermatologist in private practice in New York City and New Jersey and a media expert for the American Academy of Dermatology. RELATED: Common Allergy Triggers and Symptoms Autoimmune issues and long-standing infections are known to be associated with chronic hives (and such a relationship does not appear to exist between autoimmune diseases or ongoing infections and acute hives). “Autoimmune urticaria is characterized by autoantibodies that release histamine,” a chemical produced by your body that helps fight foreign invaders and is responsible for hives and their itching, Feely says. Autoimmune disorders like lupus, rheumatoid arthritis, type 1 diabetes, thyroid disease, and celiac disease are all thought to be causes of recurring hives, which are often chronic in nature, Dr. Elmariah says. For individuals with these conditions who have chronic hives, the hives are just one of the many symptoms they’re dealing with. Your doctor can help identify any underlying medical issue behind the hives that may require treatment, Friedman says. And your doctor can also help you manage the problem for better day-to-day living, he adds. When you do see a doctor, come with a full history of your hives, including when they first started, how often you get them, if there’s anything that seems to trigger them, what medication you’ve already tried — and how well these worked. As with acute hives, you can expect your doctor to start treatment by recommending that you take an antihistamine, most likely a prescription one. The good news is that about 50 percent of chronic hives that have no apparent causes will respond to antihistamines. (4) If you’re in that other 50 percent and you’re not responding to antihistamines, doctors can also move to a new generation of biologic medications like omalizumab (Xolair), a treatment approved by the U.S. Food and Drug Administration (FDA) for chronic hives. The medication is injected under your skin, and success rates with this medication are much higher in treatment-resistant cases. Some doctors may even prescribe corticosteroids like prednisone (Deltasone), although these are usually just to provide short-term relief and aren’t recommended as a long-term strategy. (4) Your doctor will also most likely test for autoimmune issues. They don’t do this with acute hives, because it’s more likely that chronic hives are a result of an autoimmune problem than acute hives, Elmariah says. Tests include a blood test that looks for certain autoimmune markers. Fortunately, even though the struggle may be long, all hope is not lost in the quest to put chronic hives to bed. The American Academy of Allergy, Asthma, and Immunology reports that in about one-half of patients, the hives will be resolved in one to two years, while 80 to 90 percent of hives sufferers will see visible improvement within five years. (4) Besides physical discomfort and itchiness during the day, hives can interrupt sleep, making sufferers even more irritable and grumpy, Elmariah says. That change in mood can affect your interactions with other people, especially friends and family. Work and school performance may also suffer. And for some people, these symptoms may lead to withdrawal from social interactions, which may further worsen mood and emotional health. RELATED: What Happens to Your Mind and Body When You Don’t Sleep About one in every seven people with hives will deal with psychological conditions such as anxiety, depression, and stress. One study found that number to be much higher, with 48 percent of patients with chronic hives reporting feelings of depression and the same amount dealing with anxiety. If you’re feeling this way, it’s important to speak with friends and family about what you’re going through and tell your doctor, too. They may be able to prescribe a medication to help you cope. (5) Swelling in the eyes, lips, hands, feet, or genitals can be a sign you’re experiencing angioedema, which is a complication that occurs when fluid buildup in the skin causes deep swelling. Angioedema is generally treated with a combination of antihistamines and oral corticosteroids with the goal of decreasing swelling. (6) Finally, while hives don’t put you at an increased risk of anaphylaxis, which is the name for a life-threatening allergic reaction, they are one of the first signs that such a reaction may be taking place. (6,7,8) In addition to the skin changes, you might notice swelling on the body, lightheadedness, abdominal pain, feeling faint, and shortness of breath. (6) Consider these symptoms an emergency, and call 911 as soon as possible. During the attack, you’ll likely be treated with epinephrine, oxygen, antihistamines, cortisone (Cortone Acetate), and a beta-agonist to help you breathe and reduce your body’s allergic response. (9) In most cases, the best way to protect yourself against anaphylaxis is to avoid the trigger altogether and carry an adrenaline autoinjector, such as an EpiPen, so you can administer epinephrine in case of an emergency. (9) RELATED: FDA Approves Generic Version of EpiPen With additional reporting by Moira Lawler.
