Understand that chronic hives can be caused by many things. The itchy, swollen areas of skin are often referred to as wheals. Acute cases of hives that last for less than six weeks are usually caused by an allergen such as a food or certain medications. Long-lasting hives however are not normally an allergic reaction, and look no different to acute urticaria but can be quite painful and difficult to manage. Chronic hives, which last for six weeks or longer, accounts for up to a third of all hives cases.
The hives are caused by an inflammatory reaction in the skin, whereby capillaries in the upper dermis level of the skin leak, causing a reddish swelling. Hives are a reaction of the body to something in the environment or within the body itself. Stress and poor emotional well being has long been linked to cases of skin hives. If you are suffering from a prolonged case of chronic hives, your doctor will generally run tests to first rule out an allergic reaction, then check that the urticaria is not an auto-immune response. Recent research suggests that chronic hives may in fact be a reaction of the immune system against the skin, with uncertain cause.
Approaches to finding a hives treatment and controlling future outbreaks relate to stemming the factors that tend to exacerbate the condition. For example, scratching is a key way in which hives is encouraged to worsen, so the application of ointments can prevent the itchiness and promote healing. Other triggers of chronic hives cases include heat and friction on the skin such as that caused by constricting clothing like bras and belts. There are environmental causes of hives such as cold or sun-exposure, vibration (though less common) and inhalation of pollens and substances like pollens and dust, so avoiding these environmental triggers is important in such cases.
A hives rash can also be triggered by infections in the body, such as bladder or vaginal infections, sinus infections – even Athlete’s foot may cause an outbreak. When an infection is to blame, treating it usually results in relief from the chronic hives condition too.
Some people find relief through creams and ointments while others prefer to take medications. Other medications that may be effective are antihistamines, with the drowsiness-causing antihistamines recommended for use only at night. Antihistamines suitable for daytime use include Claritin and Zyrtec, while evening medications include Benadryl and Atarax. Some antihistamines like Claritin are readily available over the counter while others are prescription only.
H2 blockers such as Zantac work on a different set of antihistamine receptors in the body. All types of antihistamine medications work by reducing the release of histamine in the skin cells, which causes the red hives. Other medical treatments include oral steroids such as Prednisone that may be used to treat chronic cases of hives that do not respond to antihistamines – however the prolonged use of steroids is not advised. Generally the dosage of oral steroids will be reduced as the hives come under control.
Very occasionally, foods are the cause of cases of chronic hives, and so allergy testing is recommended. If hives last for longer than two to three months it is a good idea to see a specialist, however unfortunately it is likely that the cause may never be found.