Top Triggers of Chronic Hives, Explained

They’re back: Those itchy, raised welts that sting, burn and, frankly, look terrible. You keep getting them — again and again. But what triggers hives? Something must be causing them, right?

If you’ve been diagnosed with chronic hives (chronic idiopathic or spontaneous urticaria), there may not be a clear trigger. Allergy and immunology specialist Sonya Parashar, MD, shares some common triggers and advice for managing flares.

What can trigger recurring hives

Unlike hives caused by an allergic reaction, chronic hives usually don’t have obvious triggers.

“Acute hives almost diagnose themselves,” Dr. Parashar says. “I often talk with people who say, ‘I ate peanut butter and immediately broke out.’ That’s a classic case of acute hives.” They usually erupt within two hours of a trigger exposure. Once treated, they go away and (hopefully) never come back.

Chronic hives are different. They flare up at least twice weekly for six weeks or longer. This can go on for months or even years.

“Recurring hives have their own agenda and just pop up whenever, about 80% to 90% of the time,” she continues. “But knowing common causes can still be helpful, even if only to rule them out.”

Let’s review nine common causes of chronic hives.

Stress

If you broke out in hives randomly during a major life event, chances are, it wasn’t random at all: Both stress and mental illness are known triggers for chronic hives.

Dr. Parashar notes that she often treats chronic hives flares after major life events, like a death in the family, a divorce or a new job. Even happy changes can cause stress and chronic hives.

And yes: Having chronic hives causes stress, too. Without treatment, you could get stuck in a cycle of worry and flares. Keep in mind that doesn’t mean chronic hives are “all in your head.” It means they’re part of your body’s physical response to stress.

If your hives tend to flare in tense or challenging moments, let your doctor know. And if you have mental health concerns, Dr. Parashar urges you to ask for help.

There are lots of ways to address chronic stress. Your healthcare provider may encourage you to try stress management techniques like breathing exercises, mindful movement or meditation, or refer you to a therapist for help sharpening your coping skills. They can also prescribe medication, if that’s what’s in your best interest.

Illness or injury

Physical triggers of chronic urticaria — like injuries or infections — are some of the easiest to pinpoint. Dr. Parashar notes that infections are a common culprit.

“I’ve seen people come in weeks or months after a viral or bacterial infection, dealing with flares that last for days or even weeks,” she says. “Sometimes, they pop up during or after a big hospitalization. Other times, a common cold starts the cycle.”

Tight clothing

Pressure and irritation from tight clothes and accessories can sometimes be enough to trigger chronic hives. So, make sure your belt fits and your clothes leave plenty of room for your skin to breathe.

Extreme temperatures

Extreme hot and cold temperatures can cause hives to pop up all over. Hot weather, hot showers and hot drinks can all cause hives to recur, as can their cool counterparts.

Sunlight and sweat

A bad sunburn or a particularly sweaty session at the gym is sometimes all it takes for chronic hives to come roaring back. Protect yourself from the sun’s harmful rays with hats, sunscreen and loose, flowing clothes. And remember to shower and change after being out in hot, humid weather, especially if you’ve been exercising.

Hormones

If you ask “Why do I keep getting hives?” about once a month, it could be tied to your menstrual cycle. But you don’t have to be a woman for hormones to drive your outbreaks. Hormonal fluctuations — whether due to puberty, thyroid disorders, sleep disturbances or something else — can influence the timing of chronic spontaneous urticaria, according to Dr. Parashar.

Medications

Regularly taking nonsteroidal anti-inflammatory drugs (NSAIDs), like aspirin (Bayer^®), ibuprofen (Advil^®) and naproxen (Aleve^®), may trigger lingering hives. Prescription pain medications like opioids can have the same effect.

Acetaminophen (Tylenol^®) doesn’t trigger urticaria. Stick with it whenever possible if you have chronic hives. If it’s not enough to manage your pain, let your provider know.

Health conditions

Health conditions like asthma, lymphoma and liver disease are frequent chronic hives culprits, Dr. Parashar reports. Autoimmune conditions can also be at fault. Examples include:

• Celiac disease
• Diabetes
• Lupus
• Rheumatoid arthritis
• Thyroid disease

If you’re living with a chronic illness, make sure your provider knows. That may be the missing piece they need to solve your recurrent hives puzzle.

How to manage flare-ups

Chronic hives management — much like their cause — varies from person to person. Along with your provider, you may opt for one or a combination of the following approaches:

• Prescription drugs
• Over-the-counter medications
• Home remedies

If it turns out your hives have identifiable triggers, that list will grow. Say you get recurrent hives whenever you get a bad upper respiratory infection. You may take extra steps to boost your immune health and reduce infection risk.

But to personalize your hives management plan, Dr. Parashar says it helps to know what, if anything, is causing them.

Consider keeping a chronic hives diary as part of the fact-finding process. When you have a flare-up, note it (and what you did that day) in your diary. If you identify a trigger, let your healthcare provider know. They can help you better manage flares when you have them.

But don’t be shocked if a pattern doesn’t emerge, despite your careful reporting.

“There’s not always a clear cause,” Dr. Parashar says. “Chronic hives mostly fall into that spontaneous category, so symptom diaries can be tricky. You may never find any traceable pattern.”

And that’s OK, too. It doesn’t mean you’ll be dealing with chronic spontaneous urticaria forever. And with proper treatment, you can manage flare-ups when they happen.