Chronic hives, or chronic urticaria, are characterised by itchy, red skin welts lasting more than six weeks. These welts can appear and fade repeatedly. The exact cause of chronic hives is often difficult to identify. Potential triggers may include certain foods, medications, infections, or stress. Unlike acute hives, which are usually due to an allergic reaction and resolve quickly, chronic hives persist and can significantly affect a person's quality of life. Treatment focuses on managing symptoms and identifying triggers to prevent outbreaks.

Symptoms of Chronic hives

Red or skin-coloured welts—These welts are the primary symptom of chronic hives. They can appear anywhere on the body and vary in size, from small spots to large blotches. Welts are typically raised and can be distinctly round or irregular. They may also join together to form larger areas of raised skin. Because these welts can appear and disappear quickly, their transient nature can be a notable condition characteristic.
Itching- It is one of the most common and distressing symptoms associated with chronic hives. It can range from mild to severe and often worsens at night or in response to specific triggers, such as heat or stress. The constant itch can lead to scratching, which may aggravate the skin further and even lead to infections if the skin is broken.
Swelling (Angioedema)- Angioedema is a deeper form of swelling, often accompanying hives, though it can also occur independently. This swelling can affect the eyelids, lips, hands, feet, and genital areas, as well as the throat, which can be particularly dangerous if it leads to breathing difficulties. Unlike the surface welts of hives, angioedema tends to last longer (up to 72 hours), can be painful, and feels more like a swelling within the skin rather than on the surface.
Pain or burning—Not as common as itching, burning pain or sensations in the affected areas are sometimes experienced by those with chronic hives. Certain stimuli, like pressure or temperature changes, can exacerbate this discomfort, making the condition more difficult to manage day-to-day.

Causes of Chronic hives

Autoimmune Responses- Chronic hives are often considered an autoimmune disorder. The immune system mistakenly attacks healthy tissue, believing it to be harmful. Hive symptoms might result from this immunological reaction, causing skin cells to release histamine and other substances.
Genetic Factors- Chronic hives may have a genetic component, as the condition sometimes runs in families.
Infections- Chronic infections, such as viral, bacterial, or fungal infections, can trigger or exacerbate chronic hives. Examples include hepatitis, H. pylori infection (a common cause of stomach ulcers), and sinus infections.
Hormonal Imbalances- Changes in hormone levels, such as those during pregnancy, menopause, or due to thyroid disorders, can also be linked to outbreaks of hives.
Physical Stimuli- In some individuals, physical factors such as pressure, temperature changes (cold or heat), sunlight exposure, and excessive sweating can induce hives.
Medications- Certain medications can provoke hives as a side effect. These include aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), blood pressure medications (like ACE inhibitors), and antibiotics.
Stress- Emotional stress and anxiety are frequently reported triggers for the appearance of hives. Stress has the potential to exacerbate symptoms. However, the precise mechanisms are not quite clear.
Underlying Health Conditions- Sometimes, additional underlying medical conditions, including thyroid illness, autoimmune diseases (such as lupus or rheumatoid arthritis), and even some types of cancer, are linked to chronic hives.

Conclusion

Chronic hives, or chronic urticaria, present as red, itchy welts on the skin that can persist for weeks or even months. The symptoms—itching, red welts, swelling, and sometimes pain or burning—significantly impact daily life. While the exact cause often remains elusive, factors such as autoimmune reactions, genetic predispositions, infections, hormonal imbalances, physical stimuli, certain medications, stress, and underlying health conditions can contribute. Managing chronic hives involves identifying and avoiding potential triggers alongside medical treatment to control symptoms, offering relief and improving the quality of life for those affected by this challenging condition.

Frequently Asked Questions about Hives

Q. What causes acute hives?
A. Acute hives, or acute urticaria, are primarily caused by an allergic reaction to specific triggers. These triggers can include allergens like certain foods, medications, insect stings, or latex. Infections, particularly viral ones, are also common causes. Physical stimuli such as extreme temperatures, pressure on the skin, or excessive sun exposure can also provoke hives.

Q. What causes chronic hives?
A. Various factors, including autoimmune responses, genetic factors, infections, hormonal imbalances, physical stimuli, certain medications, emotional stress, and other underlying health conditions, can cause chronic hives.

Q. Can allergies cause chronic hives?
A. Yes, allergies can trigger chronic hives in some individuals. Allergens can cause the body to release histamine and other chemicals, leading to the development of hives.

Q. Can chronic hives cause an allergic reaction?
A. Chronic hives are not an allergic reaction but a symptom that can result from various triggers, including allergies. However, chronic hives can coexist with allergic reactions, especially in individuals prone to allergies.

Reference

https://www.mayoclinic.org/diseases-conditions/chronic-hives/symptoms-causes/syc-20352719
https://my.clevelandclinic.org/health/diseases/22900-chronic-hives-chronic-idiopathic-urticaria