Chronic hives usually have no known cause or trigger that explains symptoms. This is called "idiopathic" or "spontaneous" hives. However, there still may be factors that worsen symptoms of chronic hives. Avoiding these triggers is an important part of treatment.
It is often hard to know which factors worsen your hives. Keeping a diary of symptoms and exposures is a good way to track possible triggers. If you suspect something is worsening symptoms, try to avoid it and see if symptoms improve.
Physical triggers
Many people with chronic hives have worse symptoms after exposure to certain physical factors. If a physical trigger is the main cause of symptoms, you may have "physical" or "inducible" hives. But even people with idiopathic hives can have physical triggers. Some common physical triggers include:1
- Extreme heat or cold
- Pressure and friction
- Sunlight
- Exercise
Some ways to avoid exposure to these physical factors include:2
- Taking lukewarm baths and showers
- Keeping your home relatively cool
- Wearing loose and soft clothing
- Dressing in layers to keep body temperature normal in any weather
- Avoiding exercise in hot weather
- Wearing clothes that protect skin from sunlight
- Staying hydrated, especially during the summer
- Wearing sunscreen and reapplying often if you are sweating or swimming
Medicines
Non-steroidal anti-inflammatory drugs (NSAIDs) reduce inflammation and pain. However, they can worsen symptoms for many people with chronic hives. Symptoms can happen within hours or days of taking NSAIDs.3
Commonly used NSAIDs include:4
- Aspirin (Bayer®)
- Naproxen sodium (Aleve®)
- Ibuprofen (Advil®, Motrin®)
Talk to your doctor about other pain-relief treatment options to avoid NSAIDs. They may suggest trying acetaminophen (Tylenol®). It can reduce pain and fever but is not an NSAID.4
Herbs and supplements might also help relieve pain. However, some of these can worsen symptoms and may not be right for you. Do not take any herbs or supplements without telling your doctor.4
Medicines for other conditions can also worsen your hives. For example, antibiotics and ACE inhibitors have been reported to trigger symptoms. Talk to your doctor about changing medicines if you notice that certain drugs worsen your hives.5
Foods and alcohol
Some people with chronic hives report that certain foods worsen symptoms. Food allergy is not a cause of chronic hives. This is why most experts do not recommend dietary changes to treat chronic hives. However, if you think food sensitivity is triggering hives, there are some diets you may want to try. These include:6
- Pseudoallergen-free diet
- Low histamine diet
- Fish avoidance diet
In general, these diets try to avoid foods that cause non-allergic sensitivity reactions. These include:2,3,6
- Spices and herbs
- Egg products
- Smoked meats and seafood
- Certain vegetables, such as tomatoes and artichokes
- Fresh fruits
- Certain breads
- Foods with additives or preservatives
- Alcohol
Avoiding these foods is difficult and can prevent you from getting enough nutrients. Plus, there is not much evidence that these diets will work.6
Talk to your doctor about diet options you are considering. You may first want to try eliminating 1 or a few foods at a time. Then you can decide whether to continue avoiding them based on how your symptoms change.6
Stress
Physical and emotional stress worsens symptoms for many people with chronic hives. Unfortunately, chronic hives often cause stress because of unpredictable symptoms.1
Avoiding stress can also help you manage the emotional burden of chronic hives. Ways to reduce stress include:2
- Meditation and mindfulness
- Yoga
- Relaxation techniques
- Regular exercise
- Eating a healthy diet
- Making time for hobbies and activities
Treating other condition
Chronic hives are linked to many other conditions. People with chronic hives seem to have a higher risk of:8
- Allergic diseases, such as asthma, eczema, and hay fever
- Autoimmune conditions, such as thyroid diseases, systemic lupus erythematosus, and rheumatoid arthritis
- Osteoporosis
- Diabetes
- Mental health conditions, such as sleep-wake disorders, anxiety disorders, and mood disorders
These conditions usually do not trigger hives or affect the severity of chronic hives. However, they can affect your quality of life and health. This can affect your ability to treat and manage chronic hives. This is why it is important to have your doctor diagnose and treat any other conditions you have.