Lifestyle Tips for Managing Your Chronic Hives

If you’ve been diagnosed with chronic idiopathic or spontaneous urticaria, the formal term for chronic hives, you know all too well how unpredictable (and uncomfortable!) they can be.

But did you know that there are changes you can make — many of them simple — that can bring much-needed relief?

Allergy and immunology specialist Sonya Parashar, MD, walks us through the basics of chronic spontaneous urticaria self-care.

What to do for urticaria self-care

Chronic hives often calm down with long-term treatment and lifestyle adjustments. They may even disappear for good. But it can sometimes take a year or more to clear them up completely.

Besides patience, here are some changes you can make at home to help your hives.

Avoid known triggers

Up to 90% of the time, chronic hives do not have any obvious triggers. But if your flare-ups have a common theme, you can use that information to help prevent them.

Examples of common triggers you may be able to manage include:

• High or low temperatures: Your hives may be triggered by sudden changes in temperature or humidity, which you can’t always help. But even eating or drinking very hot or cold items can sometimes be enough to provoke a reaction.
• Water: The temperature issues apply here, too. That means a relaxing hot shower or refreshing dip in a cold pool may send you into a scratching frenzy.
• Stress: Stress is one of the biggest known triggers for chronic hives. Life happens, and there’s not much you can do about that. But learning coping mechanisms, like meditation, mindful movement and breathing exercises, can help you limit the effects of those stressful situations.
• Alcohol: Many people with chronic hives find that drinking makes their symptoms worse. For some, it’s enough to cause a full-fledged flare.

Use OTC medications

Managing chronic hives sometimes requires prescription medications, but over-the-counter (OTC) options can also help when your symptoms are in overdrive. Consider stocking up on nonprescription drugs, like:

• Allergy medicine: It’s unlikely that your chronic spontaneous urticaria is the result of an allergy. But Dr. Parashar says non-drowsy, 24-hour antihistamines, like Claritin^®, Zyrtec^® and Allegra^®, can still make a dent in the itching, redness and irritation from a bad case of hives.
• Mild sedative antihistamines: Sleep deprivation throws off your immune system and revs up your stress reactions. Wondering how to sleep with hives flaring up on you? Ask your provider if you might benefit from using diphenhydramine (Benadryl^®, Unisom^® or ZzzQuil^®) at night.
• Topical anti-itch creams: Hydrocortisone cream is a low-dose steroid that may help manage itching in a pinch. Other topicals to ask your provider about include calamine lotion and topical Benadryl^®.

One other thing: Nonsteroidal anti-inflammatory drugs (NSAIDs) may seem like a good call when your back hurts or chronic hives are causing discomfort. But Dr. Parashar says they can trigger or worsen flare-ups for some people. If you’re one of them, acetaminophen (Tylenol^®) is a better choice. That, or ask your provider for other pain-management recommendations.

Practice hive-friendly skin-care

While skin care may be a hobby for some, it’s a prevention and treatment step for people living with chronic spontaneous urticaria.

But that doesn’t mean you need lots of lotions and potions or a complicated routine to keep hives away. It’s all about taking simple, supportive actions each day so you can better handle flare-ups when they happen. Help your skin help you by:

• Using tepid water in your bath and shower: “Lukewarm water is often a good choice to help limit urticaria flares,” Dr. Parashar says.
• Avoiding harsh cleansers: Stick with soaps and body washes designed for sensitive skin. They’re less likely to contain fragrances and additives that strip skin and irritate chronic hives.
• Keeping your skin supple: Repair your skin barrier by applying fragrance-free, hypoallergenic moisturizer immediately after your bath or shower. This step locks in needed hydration.
• Ditching tight, scratchy clothing: The pressure and rubbing from too-tight waistbands, sleeves or straps can irritate your skin. So can wool and manufactured fabrics, like nylon or polyester. Dr. Parashar recommends wearing loose cotton clothing. It may help keep flare-ups at bay.
• Using cold compresses: They can soothe angry red spots and reduce inflammation.
• Considering desensitizing therapy: Ask your provider if you’re a good candidate to try desensitizing at home. With this approach, you gradually expose yourself to increasingly hot or cold temperatures over time at home. Think taking slightly warmer showers each day.

Protect your skin

Between the heat, the sweat and the possibility of skin damage, it’s no wonder that too much time in the sun can leave you covered in angry red welts.

Dr. Parashar reminds us that it’s important to block UV (ultraviolet) rays by:

• Limiting sun and heat exposure: Whenever possible, limit the amount of time you spend in hot, humid conditions. And don’t underestimate the power of the sun in winter!
• Applying sunscreen: Many dermatologists recommend mineral sunscreens for people with sensitive skin, due to some concerns about chemical sunscreens causing irritation. Talk to your provider to find out what’s best for you. Then, use it every day — hot or cold, rain or shine.
• Wearing sun-protective clothing: The way these pieces are made makes them great for ultraviolet protection (UPF). They have more threads than regular clothing, which gives UV rays fewer gaps to penetrate. Most sun-protective clothing has a UPF rating of 50 or higher. Just be sure to wear a looser fit, since these clothes are rarely made with cotton.

When to seek medical care

For most people, hives are a sign that it’s time to see a doctor. But if you’ve been diagnosed with chronic spontaneous urticaria, it can be hard to know when you need medical attention for a flare.

Dr. Parashar says you should still follow the “better safe than sorry” approach.

Trust your gut and call your provider if something about your hives seems different or worse, but you aren’t in distress. The same goes for signs of a secondary infection, such as fever, blistering, discharge or hard, crusty skin.

Treat hives as an emergency if they come with signs of a life-threatening allergic reaction called anaphylaxis. Those symptoms include:

• Swelling of your face, lips or tongue
• Difficulty breathing
• Chest tightness
• Swallowing problems
• A weak pulse and high heart rate
• Dizziness or fainting
• Nausea, vomiting, cramps or diarrhea

An ongoing conversation

You and your healthcare provider may need to experiment a little to find the right combination of medical treatments and self-care approaches to keep your skin clear. No two people experience chronic hives in the same way. Triggers and flare frequency vary from person to person.

One of the best things you can do to make progress is to have open, honest and ongoing conversations with your provider.

“Successful self-care depends, in part, on how open you are to talking about what seems to trigger your hives,” Dr. Parashar says. “It takes patience to build a hive treatment plan, but by working together, we can help you be better prepared for flares when they happen and, hopefully, reduce their frequency.”