Chronic Urticaria (Hives)

Chronic urticaria is a condition where individuals get hives for most days of the week that are persistent (defined as longer than 6 weeks). Hives can either be due to a physical trigger (e.g. pressure, cold, heat) or spontaneous (chronic spontaneous urticaria). In some patients, they can be associated with swelling of the lips, hands or feet (angioedema). Although quite bothersome, the condition is not dangerous and will not progress to anaphylaxis. Chronic spontaneous urticaria affects about 1% of the population. Chronic urticaria resolves eventually on its own and about 50% of people will have resolution of their chronic urticaria in one year. However, the condition may persist for years or even decades in some.

Etiology

Chronic urticaria is believed to be due to an autoimmune process where the body attacks its own allergy cells leading to release of histamine and other compounds. It is not due to an allergy to food or other things in the environment. Chronic urticaria has been found to be associated with abnormal thyroid function and other autoimmune conditions (e.g. celiac disease, lupus, rheumatoid arthritis) in some individuals.
 

Diagnosis

There is no specific diagnostic test for chronic urticaria. Diagnosis is based on the history of symptoms and physical examination by your doctor. Blood tests are sometimes performed to rule out other (and much rarer) causes of chronic hives.

Treatment

Although not caused by foods or medications, hives can be made worse due to alcohol, certain medications such as NSAIDs (e.g. ibuprofen, naproxen) and stress. These should be avoided if possible. Medications do not alter the natural course of chronic urticaria, but can offer relief of symptoms.

The main form of treatment for chronic hives is with non-sedating antihistamines. Examples include cetirizine (Reactine®), fexofenadine (Allegra®), loratadine (Claritin®), desloratadine (Aerius®), bilastine (Blexten®) and rupatadine (Rupall®). These may be used safely at higher than standard doses as directed by your allergist. First generation antihistamines, such as diphenhydramine (Benadryl®) and chlorphenhydramine (Chlor-Tripolon®), are not recommended due to numerous side effects including drowsiness, irregular heart rhythms, poor sleep quality, dizziness and dry mouth.  For those that do not respond to treatment with non-sedating antihistamines, other therapies such as immunosuppressants or biologic agents (e.g. omalizumab (Xolair®)) can be effective.