10 ways to get relief from chronic hives

Hives are itchy welts on the skin. They can be caused by:

• An allergic reaction

• A physical trigger, such as cold, heat, water, or pressure

• A medical condition, such as an infection or autoimmune disease

These welts, also called wheals, may be red, pink, white, or skin-colored. Just as they vary in color, hives come in many shapes. Some appear as tiny spots or blotches. Others look like thin, raised lines. Hives also show up on the skin in many sizes. They can be as small as a pinprick, large as a dinner plate, or any size in between.

Regardless of what hives look like, they tend to appear and clear quickly, often in less than a day. Some people may have one flare-up and never get hives again.

It’s also possible to have many flare-ups. New hives can appear the same day or the day after you see existing hives clear. If you continue to get hives daily or almost every day for 6 weeks or longer, you have chronic hives. The medical term for this condition is chronic urticaria.

When you have flare-ups for 6 weeks or longer, here’s what dermatologists recommend

1. Make an appointment to see a board-certified dermatologist. Most people who have hives are otherwise healthy, but it’s still helpful to see a dermatologist. Other skin conditions can look like hives.
   
   Your dermatologist can find or rule out possible causes, such as:

   • An infection
   • Medication
   • Medical condition, such a thyroid condition, rheumatoid arthritis, or diabetes
   To find out if a medication might be causing your hives, be sure to tell your dermatologist about all supplements and medications that you take, including those that you can buy without a prescription.
   
   If signs indicate that a medical condition may be the cause, medical testing can find or rule out these causes.
   
   While medications and medical conditions can cause hives, there are many other causes, including foods, insect bites, and pressure on the skin. That’s why it’s helpful to keep track of your flare-ups, as explained below, before you see your dermatologist.
   
   Even when a cause cannot be found, it’s still possible to get relief. Find out how two dermatologists treat patients who have a condition called chronic spontaneous urticaria (hives flare-ups continue for 6 weeks or longer).

2. Keep track of your flare-ups. While it’s not always possible to find the cause, keeping track of your flare-ups may help you figure out what triggers your hives. Some triggers that can cause long-lasting hives are shown below.

   Trigger	When hives usually appear
   Foods: Many foods can cause hives, including peanuts and other nuts, eggs, and shellfish.	Typically within 1 hour of eating the food.
   Foods (if you have latex allergy): If you already have a latex allergy, bananas, chestnuts, kiwis, or mangos can trigger hives.	Often 12 to 24 hours after you eat the food.
   Additives: Colorings and preservatives used in foods, vitamins and other supplements, spices, cosmetics, skin care products, toothpaste, or other products can trigger hives.	Usually within 12 to 24 hours.
   Medications: Many medications, including antibiotics, aspirin, and ibuprofen, can be triggers.	Can occur immediately, days, weeks, or years after you start taking a medication.
   Cold	Hives or an itchy rash can appear when you start to warm up after being in cold water or outdoors in the cold. Hives can also appear almost immediately when you go into an air-conditioned building or walk near a freezer case.
   Heat	Often develop within minutes.
   Ultraviolet light (sunlight, tanning beds)	Often within minutes.
   Vibration (very rare cause)	Itching and swelling develop when you're exposed to any vibration.
   Adrenalin: Stress, exercise, heat, and hot showers, are a few things that cause your body to release adrenalin.	Tend to appear quickly and last for 30 to 60 minutes.
   Pressure on your skin: Tight-fitting clothes, sitting, or a purse strap can apply enough pressure to cause hives.	Can occur when pressure is applied to the skin or appear hours later.
   Water (very rare cause)	Usually within 1 to 3 minutes of water touching your skin.
   Touch a plant, animal, or chemical: Stinging nettle, jellyfish, cinnamon, sorbic acid, or latex are common triggers.	Usually within minutes, hives (and sometimes difficulty breathing) occur. 

3. Take photos of your hives. When you see your dermatologist, you may not have hives. Taking pictures can help your dermatologist make sure you have hives.

4. Relieve the itch at home. Itch is common in people who have chronic hives. Here are some ways to get temporary relief:

   • Avoid overheating.
   • Wear loose-fitting, cotton clothes.
   • Apply a cool compress (unless cold triggers your hives). To make a cold compress, you can apply a clean, cool and damp washcloth or a clean washcloth in which ice cubes are wrapped. Place the cool compress on your itchy skin several times a day.
   • Use anti-itch medication that you can buy without a prescription, such as an anti-itch lotion that contains pramoxine.
   • Prevent dry skin by using a fragrance-free moisturizer several times a day.

   The pressure of a purse strap can cause chronic hives where the strap rests on your skin.

   

5. Stay calm. Stress can trigger hives. If you feel stressed often, healthy ways to reduce your stress include exercising, meditating, and practicing mindfulness.

6. Know that treatment can be effective when the cause(s) of your hives remains unknown. It’s helpful to find out what’s causing your hives, but sometimes, a cause cannot be found. About 50% of people who have chronic hives never find out what’s causing their flare-ups.
   
   Even when you cannot find the cause, treatment can help you clear your skin and prevent new flare-ups.

7. Follow your treatment plan. For treatment to be effective, it’s essential to follow the treatment plan your dermatologist creates for you.
   
   Treatment may fail to work when you take medication less often than prescribed. For example, if your dermatologist prescribes a daily oral antihistamine and you only take it when you have a flare-up, you may continue to get hives.

8. Tell your dermatologist if treatment fails to work. If you are following your treatment plan exactly as instructed, you may still have flare-ups. Hives can be stubborn, but treatment can still work.
   
   To give you relief, your dermatologist may:

   • Increase the dose of a medication.
   • Add another medication to your treatment plan.
   • Prescribe a different medication.
   Before changing your treatment plan, be sure you’ve followed the original treatment plan.

9. Understand that extensive allergy testing often does not find a specific cause or allergen. Many people believe that their hives would go away if they could just find out what’s causing the flare-ups. Even when the cause remains unknown, treatment can clear your skin and keep it clear.

10. Know that chronic hives may go away on their own. About half the people who have chronic hives will stop having flare-ups within 1 year.

With so many possible causes, it’s easy to feel overwhelmed. The good news is that treatment can keep hives under control. Sometimes, it just takes time to find the treatment that works for you.

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Related AAD resources

• Chronic spontaneous urticaria: Effective treatment available

• Hives: Symptoms, causes, and treatment

• Welts on skin due to cold temperature could be hives

Images

• Images 1, 2: Reproduced with permission from ©DermNet www.dermnetnz.org 2024.

• Image 3, 4: Getty Images

References
American Academy of Dermatology. “Basic Dermatology Curriculum: Urticaria.” Module last accessed December 14, 2018.

Antia C, Baquerizo K, et al. “Urticaria: A comprehensive review, Epidemiology, diagnosis, and work-up.” J Am Acad Dermatol. 2018;79:599-614.

Antia C, Baquerizo K, et al. “Urticaria: A comprehensive review, Treatment of chronic urticaria, special populations, and disease outcomes.” J Am Acad Dermatol. 2018;79:617-33.

Gratten CEH, Black AK. “Urticaria and angioedema.” In: Bolognia JL, et al. Dermatology. (second edition). Mosby Elsevier, Spain, 2008: 261-75.

Kaplan AP. “Urticaria and angioedema.” Fitzpatrick’s Dermatology in General Medicine (seventh edition). McGraw Hill Medical, New York, 2008: 330-43.

Written by:
Paula Ludmann, MS

Reviewed by:
Elaine T. Kaye, MD, FAAD
William Warren Kwan, MD, FAAD
Elan M. Newman, MD, FAAD
Brittany Oliver, MD, FAAD

Last updated: 12/18/24