The immune system protects the body from germs and other foreign invaders. Sometimes it makes a mistake and confuses its own tissues with something dangerous. This mistake is known as autoimmunity, and it’s the cause behind autoimmune disorders.

People with autoimmune diseases are more likely to develop chronic urticaria (hives) — itchy bumps on the skin that come and go. Research suggests that in up to 50 percent of people with chronic spontaneous urticaria (CSU) — the most common type of chronic hives — the cause is autoimmune. But the connection between chronic hives and autoimmune diseases is a little more complex than that. In this article, you’ll learn how they are connected and what that means for treatment and management.

Can Autoimmune Reactions Trigger Chronic Hives?

Autoimmune reactions may explain why chronic hives develop even if there is no clear cause. Normally, your body’s immune system protects you against germs and helps you heal after infections and injuries. A healthy immune system can tell the difference between what belongs in your body and what doesn’t. But in autoimmune diseases, the immune system makes mistakes and attacks the body’s cells, thinking they don’t belong.

A key part of this process involves autoantibodies: proteins that the immune system mistakenly produces against its own cells. These misdirected antibodies activate important cells in the immune system called mast cells. These cells act as guards and become active when they sense danger to protect the body from foreign invaders. When mast cells are activated, this causes the release of histamine and other chemicals.

In chronic hives, autoantibodies cause mast cells to overreact, even when there’s no real threat. When mast cells release histamine, nearby blood vessels widen and leak fluid into the surrounding tissues. This leakage leads to angioedema (swelling) and the raised, itchy welts on the skin known as hives.

This autoimmune activation helps explain why chronic hives can occur without an allergy or infection — the immune system itself is the trigger.

Why Are Autoimmune Diseases and Chronic Hives Connected?

Researchers don’t yet know exactly why autoimmune diseases and chronic hives so often occur together, but several theories are emerging:

• Shared immune pathways — Some autoimmune diseases and chronic hives involve mast cells and antibodies. When these parts of the immune system malfunction, inflammation becomes chronic and self-perpetuating.
• Genetic predisposition — Some people may inherit immune system genes that make them more prone to developing both autoimmune conditions and chronic inflammation in the skin.
• Systemic inflammation — Ongoing inflammation in autoimmune diseases can increase mast cell activity and histamine release throughout the body, including in the skin.
• Thyroid connection — The thyroid is one of the best-studied autoimmune links in chronic hives. People with CSU are more likely to have antibodies that target thyroid proteins, even if their thyroid function is normal.

Understanding these shared mechanisms helps doctors think about chronic hives as part of a broader immune imbalance, rather than a skin problem alone.

What Autoimmune Conditions Are Associated With Chronic Hives?

Chronic hives may be caused by an autoimmune reaction, even if a person does not have another diagnosed autoimmune disease. However, many people with chronic hives also have an autoimmune disease. Chronic hives are linked to several autoimmune diseases, including:

• Thyroid disease
• Diabetes
• Lupus
• Rheumatoid arthritis
• Vitiligo
• Dermatomyositis
• Celiac disease
• Polymyositis

If you live with one of these autoimmune conditions and also have chronic hives, tell your doctor. Knowing about both can help with testing and treatment.

How Do Autoimmune Diseases Impact Diagnosis?

When you visit your doctor for chronic hives, one of the first goals is to determine whether an underlying cause — such as allergies, infections, or autoimmune activity — could be contributing to your symptoms.

In most people with chronic hives, no single trigger can be identified. Still, because autoimmune activity is common in chronic hives, your doctor may look for signs of autoimmune disease or immune system overactivity. They’ll begin by taking a detailed medical history, asking about your symptoms, medications, and how long your hives have lasted.

Your doctor may:

• Examine your skin to assess the pattern, duration, and severity of hives
• Ask you to keep a symptom diary or take photos of flare-ups to monitor changes over time
• Order blood tests to check for autoimmune markers or signs of inflammation

These tests can offer helpful clues during the diagnostic process. Together with your symptoms, they can guide treatment decisions.

How Are Chronic Hives and Autoimmune Diseases Treated?

Treatment for chronic hives — whether autoimmune or not — focuses on calming the immune system’s overreaction and preventing new hives from forming. Treatments may vary depending on the severity, frequency, and effects of symptoms. However, the first treatment step is usually antihistamines. Antihistamines block histamine’s effects, reducing hives, swelling, and itching.

Some people may need higher doses or combination antihistamines for effective control. If those aren’t enough, other treatments may include:

• Injections of medications that block IgE antibodies, which can help reduce mast cell activation and provide relief when antihistamines aren’t working
• Short-term corticosteroids that may reduce inflammation during severe flare-ups
• Immunosuppressants that may help when autoimmune activity is suspected, especially for people whose hives are resistant to other treatments

If you’re diagnosed with an autoimmune condition in addition to chronic hives, your doctor may also coordinate care with specialists such as endocrinologists or rheumatologists. Always discuss new and ongoing symptoms and medication changes with your healthcare team. This helps you manage medication side effects and find the safest plan for you.

When To Consult a Doctor

It’s important to talk to your doctor if you notice any new or worsening symptoms, especially because autoimmune diseases can cause a variety of symptoms. Inflammation is one of the main signs of autoimmune disease. This inflammation may feel like a warm area, swelling, pain in your joints, or discoloration of your skin.

If you have chronic hives and suspect you may have an autoimmune condition as well, talk to your healthcare provider. This information can be beneficial for your treatment plan. The right plan for you can make a big difference in your comfort and confidence.

Join the Conversation

On MyChronicHivesTeam, people share their experiences with chronic hives, get advice, and find support from others who understand.

Do you have chronic hives and an autoimmune disease? Let others know in the comments below.