Chronic hives (welts recurring past 6 weeks) are usually chronic spontaneous urticaria - no external cause is found in most cases, and it is NOT typically an allergy.
Worth checking: physical triggers (pressure, cold, heat, sweat, sun), medications (NSAIDs worsen hives), infections, and thyroid or autoimmune conditions - a couple of blood tests cover the medical leads. Daily non-drowsy antihistamines, often at clinician-guided higher doses, control most cases; stubborn ones have specialist options like omalizumab. Meanwhile avoid the aggravators: NSAIDs, alcohol, heat, tight clothing. Hives plus lip, tongue, or throat swelling or breathing difficulty is anaphylaxis - emergency care. Pymander is a free AI doctor, 24/7 by text, and can help you document your pattern.
What to do
Common questions
What causes chronic hives?
Chronic hives means itchy raised welts coming and going for more than 6 weeks. The honest headline: in most cases no external cause is ever found - it is called chronic spontaneous urticaria, the immune system releasing histamine on a hair trigger for reasons we cannot pin down, and it is NOT usually an allergy, which is why endless allergy testing often finds nothing. That said, the identifiable drivers worth checking: physical triggers (pressure, cold, heat, sweat, sunlight - some people's hives are provoked by exactly one of these), infections, medications (NSAIDs like ibuprofen can worsen hives), and - the real medical leads - thyroid disease and other autoimmune conditions, which a couple of blood tests can check. Stress does not cause it but reliably stokes it. Treatment that works: daily non-drowsy antihistamines at proper (often higher, clinician-guided) doses control the majority, and stubborn cases have effective specialist options, including an injection called omalizumab. While you wait: avoid NSAIDs, alcohol, heat, and tight clothing, which aggravate most people's welts. Seek urgent care for hives with lip, tongue, or throat swelling or breathing difficulty - that is anaphylaxis, a different emergency. Pymander is a free AI doctor, 24/7 by text, that can help you document your pattern for the appointment.