Chronic hives, Chronic idiopathic urticaria
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Hives represent a skin response characterized by itchy welts, also known as wheals. When these welts persist for over six weeks and recur frequently over extended periods, they are referred to as chronic hives. The underlying cause of this condition often remains unclear.
Typically, the welts begin as itchy patches that transform into swollen welts of varying sizes. These welts emerge and vanish unpredictably as the reaction progresses.
Chronic hives can lead to significant discomfort, disrupting normal sleep and daily routines. For many individuals, relief is attainable through the use of anti–itch medications, such as antihistamines.
Symptoms
Hives can appear anywhere on your body. They can be as small as a pinprick or bigger than a softball. If you have chronic hives, you might experience:
- Groups of red or purple welts (wheals) that can pop up anywhere on your body.
- These welts can be big or small and can change shape. They might come and go many times.
- Itchiness (pruritus)
- Swelling might happen around your eyes, cheeks, or lips, and it could be painful.
- Certain things like heat, exercise, or stress could make the hives worse.
- These symptoms can last for more than six weeks and keep coming back for months or even years.
If you have chronic hives, it’s important to note that they generally don’t immediately lead to a severe allergic reaction called anaphylaxis. However, if you experience hives as part of a strong allergic response with symptoms like dizziness, breathing difficulties, and swelling of the tongue, lips, mouth, or throat, it’s crucial to seek emergency medical care promptly.
Causes
Many individuals grappling with chronic hives face an unclear underlying cause. In rare instances, chronic hives can be linked to allergic reactions from medications or certain foods. The appearance of raised welts in hives results from the immune system’s release of chemicals like histamine into the bloodstream. The reasons behind chronic hives’ occurrence and the transition from short–term to long–term hives often remain elusive.
The skin’s reactive response can be triggered by various factors, including:
- Changes in temperature, whether hot or cold
- Sunlight exposure
- Vibrations, like those experienced while jogging or using lawnmowers
- Pressure applied to the skin, such as from a tight waistband
- Underlying medical conditions like thyroid disorders, infections, allergies, and even cancer.
Approximately 20% of individuals experiencing chronic hives are simultaneously affected by autoimmune disorders, which encompass conditions like celiac disease, dermatomyositis, diabetes, lupus, polymyositis, rheumatoid arthritis, thyroid disease, and vitiligo.
Diagnosis
To diagnose chronic hives, your healthcare provider will probably discuss your symptoms with you and examine your skin. A key characteristic of chronic hives is the random appearance and disappearance of raised welts. You might be asked to maintain a journal to keep track of the following:
- Your daily activities
- Any medications, herbal remedies, or supplements you’re taking
- Your food and beverage consumption
- Where the hives appear, how long the welts last, and whether they leave any bruising or marks behind
- Whether the hives are accompanied by painful swelling
Additionally, blood tests might be necessary to identify the underlying cause of your symptoms. An accurate diagnosis will help determine the most appropriate treatment options. If further clarification is needed, your doctor might opt to perform a skin biopsy and examine the sample under a microscope.
Treatment
Treatment approaches for chronic hives include:
- Allergy Medications: Daily use of both over–the–counter (OTC) and prescription antihistamines can help relieve itching and manage allergic reactions associated with chronic hives.
- Allergy Shots: Regular injections of a medication like omalizumab are used to suppress the production of immunoglobulin E (IgE), particularly beneficial for severe allergies contributing to chronic hives and related conditions.
- Corticosteroids: In cases where conventional allergy medications are ineffective, corticosteroids such as prednisone can be prescribed to alleviate chronic hives symptoms.
- Hydroxychloroquine: Research suggests that hydroxychloroquine, an antimalarial drug, may provide relief for chronic hives caused by autoimmune diseases when taken consistently for three months or more.
- Cyclosporine: This immunosuppressant is known for effectively addressing severe cases of chronic hives. However, its prolonged use should be approached cautiously due to potential serious side effects.
For relief from itching and swelling, consider trying these home remedies:
- Apply an anti–itch cream that doesn’t require a prescription.
- Place cool cloths on the affected areas several times throughout the day (unless cold temperatures make the bumps worse).
- Take a refreshing, cool bath or shower.
- Use creams designed for sensitive skin to moisturize dry areas.
- Opt for loose-fitting clothing made from gentle fabrics to avoid irritating your skin.
