Living with hives that keep coming back can be frustrating. The itching and swelling may show up without warning, which can make simple routines like sleeping through the night or getting dressed feel like a challenge. Over time, the uncertainty can be just as hard as the symptoms. Maybe you’ve tried changing your diet, washing your sheets, or switching soaps, and nothing has worked. If this sounds familiar, it might be a sign that it’s time to seek a professional opinion.

In this article, we’ll talk about what’s involved in getting a diagnosis for chronic hives, also called chronic urticaria. Chronic means a condition lasts for a long time, often six weeks or more. You’ll learn about the blood tests your doctor may order, what they show, and why some people still never find a clear cause. We’ll also explain what to expect during testing and how to get ready for your appointment.

Diagnosing Chronic vs. Acute Hives

Hives are raised, itchy bumps or welts that can appear anywhere on the body. They can look different depending on the person — sometimes lighter or darker than your skin tone. Some people also develop angioedema. This deep swelling under the skin can affect areas like the face and hands.

Short-term hives that clear up within a few hours or days are called acute hives. They’re most often linked to an allergic reaction or an insect bite. Once the trigger is gone, the skin usually returns to normal.

Chronic hives last much longer. To be diagnosed as chronic, hives must appear nearly every day for at least six weeks. However, they can last for months or years. There are two main types:

• Chronic spontaneous urticaria, also called chronic idiopathic urticaria — Hives appear without a known cause.
• Chronic inducible urticaria — Something specific, such as heat, cold, or another environmental factor, triggers the hives.

The basic testing process is similar for both types. Your doctor will focus on finding possible triggers and ruling out other conditions that can look like hives.

How Does a Healthcare Provider Diagnose Chronic Hives?

Getting a chronic hives diagnosis can take time and patience. But once you know what’s going on, your healthcare provider can recommend the right treatment so you can feel better.

Physical Exam

Doctors usually start with a physical examination to look at your skin and ask questions about your medical history. They’ll want to know how long the hives have lasted, what they look like, and whether you’ve noticed any patterns or triggers.

Because chronic hives can have so many possible causes and triggers, your doctor may also ask about stress, medications, or recent illnesses. Sometimes, they’ll refer you to a specialist, such as a dermatologist (skin specialist) or an allergist, for more testing or treatment.

Biopsy

Your doctor may also want to take a closer look at your skin cells under a microscope. To do this, they’ll remove a small sample of skin (skin biopsy) for further evaluation. This can help rule out other conditions that may be causing your hives.

Blood Tests

Your doctor may also order blood tests to rule out other conditions. Chronic hives are often related to the immune system. So, these tests help look for signs of infection, inflammation, or autoimmune activity (when the immune system attacks its own healthy tissues by mistake).

Here are some common blood tests your doctor may order:

• Complete blood count (CBC) — This test checks your red and white blood cells and platelets (cell fragments that help blood clot). Abnormal results may point to infection or inflammation.
• Erythrocyte sedimentation rate (ESR) — This test measures how quickly your red blood cells settle in a tube. A faster rate can signal inflammation or other immune system problems.
• Thyroid function tests — These measure how well your thyroid gland works. Thyroid disease, especially autoimmune thyroid disease, is sometimes linked to chronic hives.
• Autoimmune markers — Tests may look for antibodies (immune proteins) that attack the body’s own cells, called autoantibodies. These can reveal autoimmune diseases, such as lupus, rheumatoid arthritis, or vasculitis (inflammation of blood vessels).
• Immunoglobulin E (IgE) — This antibody helps the body respond to allergens and defend against parasites. High levels can suggest allergic activity or certain skin or immune conditions.
• Liver function tests — These help rule out liver-related causes of chronic hives, such as viral hepatitis or autoimmune liver disease.

Sometimes, doctors may also use a test called the autologous skin serum test (ASST). A small amount of your own blood serum is injected into your skin to see if it causes a small, hivelike reaction. This helps doctors find out whether your immune system is releasing certain chemicals that could be triggering your chronic hives. The ASST can give clues about whether your hives might be linked to autoimmune activity. However, it may not be available in all clinics.

Are Allergy and Skin Tests Involved?

Allergy testing isn’t typically part of the diagnostic process for chronic hives. That’s because chronic hives are rarely caused by a specific allergen, like food, pollen, or pet dander. In most cases, the hives keep coming back, even when common allergy triggers are avoided.

However, skin or allergy tests may still be helpful if your doctor suspects an allergy could be involved. At the very least, these tests can help rule out a food allergy or acute allergic reaction, but in most cases, they usually aren’t necessary.

What Happens if Your Blood Test Results Are Normal?

Even with these tests, many people never find a clear cause. This doesn’t make the condition any less real or serious. It just means that chronic hives are complex and often not tied to one specific problem.

If this happens, your doctor may want to schedule a follow-up visit, try out different treatments, or refer you to a specialist for further testing.

Tracking Your Symptoms at Home

Keeping a simple record of your symptoms can make it easier for you and your doctor to figure out what could be causing your hives. Write down when hives appear, how long they last, and what you were doing before they showed up — such as eating, exercising, or wearing tight clothing. Tracking these details can help you spot patterns, even small ones. It also gives your doctor helpful information to guide testing, treatment, and next steps.

Effective Treatments Are Available

Even if testing doesn’t reveal a clear cause, effective treatment options are available. The main goal is to control itching and swelling so you can feel more comfortable. Healthcare providers usually recommend starting with over-the-counter antihistamines, which block the effects of histamine in the skin. If symptoms continue, doctors may add stronger medicines. Different types of medicines are available to help calm the immune system. Some people also find relief through home remedies, such as cold compresses or cool baths, or anti-itch creams.

The Emotional Impact of Chronic Hives

Living with chronic hives can take both a physical and emotional toll. The itching, swelling, and worry about when symptoms appear can lead to stress, anxiety, and even depression. In fact, studies show that about 1 in 3 people with chronic urticaria experience some form of emotional distress. Because flare-ups often happen randomly and without warning, this condition can negatively affect your self-esteem and overall quality of life.

It’s important to talk to your doctor about not only your skin but also how you’re feeling. They can connect you with a mental health professional or support group for extra help. Daily habits like gentle exercise, meditation, journaling, and spending time with friends and family can also boost your mood. Proper nutrition can also support overall health and wellness, as well as reduce the risk of infection or illness.

Join the Conversation

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

What tests were most helpful in getting your diagnosis? Let others know in the comments below.