Sunday, June 7, 2020

Why do I get hives all the time with seemingly no cause?

If you suffer from hives for months without many other symptoms, you may be suffering from a condition called 'Chronic Urticaria'. Chronic (urticaria) hives are hives that last 6 weeks or more. This 6 week cut-off is important as hives that last for longer than 6 weeks are rarely caused by an external cause (trigger). The culprit for most hives cannot be identified in majority of cases.

Six-week cut-off is important

Acute hives, i.e. hives that last for a few days or few weeks (but less than six weeks) may be on occasion be tracked back to an external ‘trigger’. These triggers can be an allergy (a new medication, new food, new thing that you may come in contact with or environmental allergen breathed in etc). More commonly, acute hives can be part of a recent or ongoing infection (common viral or bacterial infections) can manifest with hives as ‘by-product’ of the immune activation necessary to treat the infection.

Acute hives can have triggers

Chronic hives, they are another story..When hives last as long as what people with chronic hives suffer from (often several months, years or even decades), this is not an a ‘reaction’ to an external trigger (as in case of acute hives) but a reflection of an ‘internal issue manifesting on surface’. This manifestation is in form of chronic hives, and thus they are a symptom of an internal disorder. Now, this internal disorder can be as a result of subtle or significant disturbances. And this can be found by doing common laboratory testing, such as complete blood count, liver, kidney, thyroid function or a urine analysis and occasionally markers of inflammation (either ESR – erythrocyte sedimentation rate, also called ‘sed rate’) or CRP (C-reactive protein).

If the common tests are normal, and a person has chronic hives, it is presumed that this internal issue is subtle and the disease is called Chronic Idiopathic Urticaria (CIU). If there is obvious abnormality in any of the common tests, then the test can possibly point towards a potential cause of hives and is called Chronic Secondary Urticaria ("secondary", since it is as a result of, or secondary to this other condition, that is driving the hives). Thus there are 2 main categories of chronic hives, chronic idiopathic (spontaneous) urticaria OR Chronic secondary urticaria.
Classification of hives based on how long you've had them

Chronic idiopathic urticaria is more like a nuisance - a ‘tendency’ to hive. There is no ‘smoking gun’ pointing to the cause and a person just hives as part of who they are. Sometimes, people suffering from chronic hives drive themselves crazy thinking they are allergic to this or that. They may question whether they are now allergic to banana, since they broke out in to a hive-rash after having a banana an hour ago, but they’ve had bananas all their life! Or it was something around the house, a new perfume, a new soap and the list goes on and on...many patients of chronic hives may mistakenly attribute all of their hive flares to an ‘allergy’ and have an exceptionally long list of things they are allergic to. In reality, the hives are just how they are, ‘it just is’, a nuisance, a manifestation of a subtle internal issue, no more.

Chronic secondary urticaria is a symptom on another problem, one that is lurking just underneath the surface and chooses to declare itself in form of bothersome hives. Often conditions that can present with chronic secondary urticaria are inflammatory, autoimmune conditions, blood disorders, cancers, chronic infections etc. Fortunately, these very conditions can be detected by routine tests and which is why it is important to obtain routine testing in chronic urticaria.

To jump to other sections in this topic
  1. What if my hives bruise, blister, scar or heal with marks on skin?
  2. What is happening in skin that leads to chronic hives? 
  3. How to effectively manage hives and why do antihistamines work in most cases?
  4. What are lifestyle recommendations in management of chronic hives?

Popular Posts