Have you ever had itchy skin that wouldn’t go away? Sometimes, what looks like a simple rash could actually be a long-term condition called chronic urticaria (chronic hives). These raised, itchy spots affect the skin but can also have a big impact on daily life.

Doctors diagnose chronic urticaria when hives keep coming back for six weeks or longer. Some people have these hives for months or even years. If hives last less than six weeks, it’s called acute urticaria.

Knowing some key facts about chronic hives can help you manage symptoms and improve your quality of life.

1. Hives Are Caused by Histamine

Chronic urticaria causes itchy, raised bumps that can appear daily, vary in size, and show up anywhere on the body. So, why does this frustrating symptom form? In many cases of chronic hives — especially chronic spontaneous urticaria (CSU) — the immune system produces proteins called autoantibodies. Unlike normal antibodies that fight off germs, autoantibodies mistakenly target healthy tissue.

In chronic urticaria, autoantibodies attach to special places called immunoglobulin E (IgE) receptors on mast cells in the skin. This triggers mast cells to release histamine, a chemical that makes tiny blood vessels leak and irritates nerve endings in the skin. This process leads to the discolored, swollen, itchy bumps known as hives or welts.

Because the immune system is involved, chronic urticaria is sometimes called autoimmune urticaria. Some people with chronic hives may also have other autoimmune diseases, like thyroid disease (such as Hashimoto’s disease) or rheumatoid arthritis.

Many people blame chronic hives on allergies, such as a food allergy, but the true source is usually unknown. Even though their causes are often different, both acute and chronic urticaria result from histamine release.

2. Hives Can Occur With Angioedema

Sometimes, hives can happen along with angioedema — a deeper, more painful swelling. Angioedema usually affects softer parts of the body, such as:

• Lips
• Eyelids
• Tongue
• Hands
• Feet

Angioedema usually isn’t dangerous. However, if it causes your throat to swell and close, it’s a life-threatening emergency. Get medical attention immediately if this happens.

3. Hives May Not Match Your Skin Color

Hives can look different depending on your skin tone. This is called discoloration. On lighter skin, hives may appear pink or red. On darker skin, hives might look lighter or darker than the surrounding skin. If you press on a hive, it will usually blanch — meaning it turns white or pale for a moment.

4. There Are Two Main Types of Chronic Hives

Chronic urticaria is divided into two types, based on the cause. It’s possible to have both types at the same time.

Chronic Spontaneous Urticaria

The most common type is called chronic spontaneous urticaria (sometimes called chronic idiopathic urticaria). CSU happens when hives have no clear trigger such as heat or scratching. The hives seem to pop up randomly, sometimes for no obvious reason.

Chronic Inducible Urticaria

The second type is called chronic inducible urticaria (CIndU). “Inducible” means the hives are brought on by a known trigger that affects the skin. If you have CIndU, you may get hives after certain actions or exposures. Subtypes include:

• Dermographism — Hives appear after the skin is scratched or rubbed.
• Cold urticaria — Hives develop after exposure to cold, such as cold air, water, or objects.
• Cholinergic urticaria — Hives occur when the body heats up from exercise, stress, or a hot bath.
• Delayed pressure urticaria — Hives form some time after pressure is placed on the skin, like from wearing tight clothing.
• Solar urticaria — Hives appear after sun exposure.

5. Diagnosing Chronic Hives Can Be Difficult

If your hives last longer than six weeks, it’s a good idea to see your healthcare provider or a specialist, such as an allergist (a doctor with expertise in immunology) or a dermatologist (a doctor who diagnoses and treats skin diseases). Chronic urticaria is complex, so it’s important to rule out other conditions, keep track of symptoms, and get medical guidance.

To better understand the type of hives you have, your healthcare provider may use blood tests, allergy tests, or a biopsy. Blood tests can show if your body is producing too many antibodies, which can cause hives and swelling. Allergy tests check to see if your skin reacts to certain allergens. If you have signs of another autoimmune disease, your provider may order more specific tests.

6. Chronic Hives Can Be Treated With Medications

Over-the-counter antihistamines are the first line of treatment for chronic hives. These medications work by blocking the effects of histamine. Some people may need a higher dose to control their symptoms.

If high-dose antihistamines don’t help, your doctor may recommend a biologic (a drug made from living organisms). Omalizumab (Xolair), the standard biologic used for chronic hives, targets IgE antibodies to help stop mast cells from releasing histamine. This can reduce flares.

Corticosteroids (steroids) may be used for short-term relief, but they shouldn’t be used long term because of possible side effects. Steroids help reduce inflammation in the body.

Other ways to relieve itching include applying moisturizers or anti-itch creams, keeping your room cool, and taking lukewarm baths.

7. Chronic Hives May Affect Your Quality of Life

Living with chronic hives goes beyond the annoying itching and scratching. This condition can affect your day-to-day life in ways you may not expect.

Mental health issues like anxiety and depression are common among people with chronic hives. The unpredictable nature of flares may cause some people to avoid social situations because they feel embarrassed by their appearance or worry that a flare will pop up in public.

If you feel this way, it’s important to reach out to friends you trust or join a support group where you can connect with others who understand what you’re going through. Talking with a therapist or a counselor can also help you cope.

People with chronic hives often experience sleep disorders because of itching at night. Try to maintain a regular sleep routine, because losing sleep can affect how you feel the next day and make it harder to manage symptoms. If sleep problems continue, talk with your healthcare provider — they can help you find solutions to improve your rest and overall quality of life.

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

What steps have you taken to manage your chronic hives symptoms? Let others know in the comments below.