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Underlying Conditions That Cause Hives

Rheumatoid Factors Connected To Cases Of Chronic Hives

HIVES, Causes, Signs and Symptoms, Diagnosis and Treatment.

Research has found that rheumatoid factors, or proteins produced by your immune system that attack healthy tissues in your body, were significantly more common in those patients with chronic hives when compared to control groups. Symptoms of rheumatoid arthritis can include painful, swollen joints and nodes or hard lumps under the skin, and various types of skin rashes.

How Do You Treat Hives

Dr. Hsu says blood and skin tests may be necessary to determine what youre allergic to and, in turn, what may be causing your hives. Generally speaking, hives alone arent dangerous, and they can usually be treated with over-the-counter antihistamines. However, if hives present as part of systemic allergic reaction, seek immediate medical attention. More severe cases of hives or those that are idiopathic require a second line of defense with prescription medications.

Autoimmune Thyroid Disease And Hives

Autoimmune thyroid disease is the most commonly reported autoimmune disease linked to chronic hives. Researchers have been studying this link for decades. Thyroid disease, also known as autoimmune thyroiditis, occurs when the body makes antibodies that attack your thyroid. Some patients with a history of chronic hives were found to have significantly higher levels of thyroid antibodies as compared to a control group of people who didnt have hives. Unfortunately, it is only recommended to do anything about these antibodies if there is accompanying thyroid hormone dysregulation. While there is an association between these thyroid antibodies and the presence of hives, it is not yet known if these antibodies are actually causing hives.

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Hives Lasting Longer Than Six Weeks Can Be Linked To Lupus Ra Or Thyroid Or Celiac Disease Heres All You Need To Know

by Health Writer

No one likes dealing with a bout of hivesthose red, itchy welts that can pop up anywhere on your body and last from a few hours to several months, and sometimes, even longer.

If your hives persist for more than six weeks, you may have a case of , a.k.a., autoimmune hives, or chronic spontaneous urticaria , meaning that your immune system is mistakenly attacking healthy tissue and overstimulating your allergy cells, which is what triggers a hives outbreak.

Whats more, hives that just wont quit are sometimes linked to an entirely different type of autoimmune condition, previously diagnosed or not, that you might have going on simultaneously, says Purvi Parikh, M.D., an immunologist with NYU Langone Health and the Allergy & Asthma Network in New York City.

The connection makes sense, when you think about it: Hives are a sign of overactivity of your immune system, and autoimmune diseases are also caused by overactivity of the immune system, Dr. Parikh explains. If you have one autoimmune disease, it increases your risks for others. Not only are chronic hives their own type of autoimmune disorder, but any autoimmune condition can trigger hives, she notes.

So, how do you know if one condition is leading to the other? And which autoimmune diseases are most often linked to chronic hives? Finally, how do you best diagnose and treat this double-whammy when it happens? Our experts are here to provide the answers.

The Connection Between Hives And Autoimmune Disease

8 types of itchy rash

Researchers believe that up to 40 percent of people with chronic idiopathic hives also have an autoimmune disease. While researchers are still trying to connect the dots, it is believed that high levels of autoantibodies may be to blame. These are the harmful antibodies produced by the immune system that attack the bodys own functions. Its also widely noted that females are more commonly affected than males.

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What Causes An Autoimmune Rash 10 Possible Conditions

What autoimmune conditions cause a rash on the skin? These are the most common autoimmune diseases that may cause rashes on your skin:

  • Lupus
  • Lichen planus
  • Behçets disease

An autoimmune disease occurs when your bodys immune system attacks healthy cells within the body. This dysfunctional immune response may lead to various symptoms, like hair loss, skin rash, or even joint pain.

More than 20 million Americans suffer from autoimmune diseases such as rheumatoid arthritis or Hashimotos thyroiditis. If you are experiencing unexplained itching, rashes, or skin sores, you should consult your healthcare provider.

Why do autoimmune conditions cause a rash? Autoimmune conditions may cause a rash because they trigger inflammation in skin cells. These diseases are often characterized by chronic inflammation in your internal organs, your skin, and everywhere in between.

What do autoimmune rashes look like? Autoimmune rashes can look like scaly red patches, purplish bumps, or more. The appearance of autoimmune rashes will be different, depending on which autoimmune condition is triggering the skin rash.

For example, cutaneous lupus may cause a scaly red patch that does not hurt or itch. Scalp psoriasis may cause plaque buildup that results in hair loss. Lichen planus may cause purplish, itchy, flat bumps on your skin.

Can Hives Be Prevented

Simple changes to your lifestyle may be able to help you prevent hives from reoccurring in the future. If you have allergies and you know which substances are likely to cause an allergic reaction, your doctor will suggest that you avoid any possible exposure to these factors. Allergy shots are another option that may help you reduce the risk of experiencing hives again.

Avoid being in high-humidity areas or wearing tight clothing if you have recently had a hives outbreak.

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An Adverse Reaction To Exercise And Environment

Although a daily dose of thirty minutes of exercise is highly recommended, it may also be causing an individual to break out in hives. The body produces a chemical that can inhibit cell breakdown as cause rashes, known as acetylcholine, during exercise as a natural bodily response. Sweating is also known to cause a breakout of hives in those who are already prone to the condition. The sweat itself is not causing the hives, but the excess warmth of the skin can irritate the area concerned. Managing the inhabited environment, exercise, and what is consumed is paramount if hives are affecting an individual on a regular basis. There are also many environmental occurrences that can cause hives to break out such as excess heat, powerful winds, bug bites, and some plants are known to cause a breakout. If environmental concerns are worrisome, talk to a health professional about taking an antihistamine to reduce skin irritability.

The Link Between Celiac Disease And Hives

What causes urticaria?

According to one study, people with celiac disease were 1.5 times more likely to develop hives. In some cases, people may even be diagnosed with hives first, before being diagnosed with celiac disease. Researchers found that about a third of the cases of chronic hives could be attributed to the underlying celiac disease. Celiac disease is also more common among women.

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Types Of Physical Urticaria

  • Dermographism triggered by skin friction such as rubbing, scratching, or pressure. This is the most common form of CIndU.
  • Delayed-pressure urticaria triggered by sustained pressure to the skin. Symptoms appear 4-6 hours after contact.
  • Exercise-induced urticaria triggered by exercise.
  • Cold urticaria triggered by skin exposure to cold or cold water. Hives are usually limited to exposed skin.
  • Heat urticaria triggered by exposure to heat.
  • Solar urticaria triggered by sun exposure to UV rays.
  • Vibratory urticaria triggered by exposure to vibration.

Finding Relief: Treatment Options

The first step in getting treatment is to figure out if you actually have hives. In most cases, your doctor will be able to determine if you have hives from a physical exam. Your skin will show signs of the welts that are associated with hives. Your doctor may also perform blood tests or skin tests to determine what may have caused your hives especially if they were the result of an allergic reaction.

You may not need prescription treatment if youre experiencing a mild case of hives not related to allergies or other health conditions. In these circumstances, your doctor might suggest that you seek temporary relief by:

  • taking antihistamines, such as diphenhydramine or cetirizine
  • avoiding irritating the area
  • avoiding hot water, which may aggravate the hives
  • taking a cool or lukewarm bath with colloidal oatmeal or baking soda

Anaphylaxis is a medical emergency that needs to be treated immediately by a physician.

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Other Laboratory Findings In Cau

Patients with CAU had a significantly lower serum IgE than those with no autoantibody. The significance of this finding is unclear.

That basopenia is a feature of CAU has long been recognized. Histological studies of wheals suggest that one reason for these low values may be the sequestration of basophils within the affected skin. Enumeration of blood basophils, possibly by an automated method might form the basis of a screening test for CAU.

In recent times, an alternative screening test has been proposed based upon the observation that sera from ASST-positive patients with CAU when incubated with basophils from an atopic donor cause CD63 expression on the target basophils. Similarly, donor basophil CD203c expression appears to correlate with autologous serum skin test positivity. Expression of these basophil activation markers can be detected using flow cytometry. This may be developed as a screening test for CAU antibodies, but as yet still requires validation against the basophil histamine release assay.

How Are Chronic Hives Diagnosed

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Your healthcare provider can diagnose chronic hives by examining your skin and learning more about your symptoms.

Diagnostic tests for chronic hives can pinpoint or rule out causes. You may get one or more of these tests:

  • Allergy test to see if an allergen is causing a reaction.
  • Blood test to check for high levels of antibodies, proteins that help your body fight off bacteria, allergens and other substances.
  • Urine test to look for bacterial infections.
  • Skin biopsy procedure to confirm the diagnosis and evaluate for other causes.

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Treatment Of Cau: Special Considerations

Patients with proven CAU are initially treated in exactly the same way as patients with CIU. H1 antihistamines remain the initial treatment of choice. The newer second-generation compounds appear to be safe and effective even in off-label dosages.

The treatment of CIU has recently been reviewed. After making the diagnosis of CIU, patients with CAU should initially be treated in the same way as those without autoantibodies.

Infection Or Medical Treatment Can Trigger Hives

Some people get hives when they develop an infection like strep throat, a urinary tract infection, or COVID-19.

Others get hives when they have a medical treatment like radiation therapy or a blood transfusion.

Hives was the first sign of COVID-19 for this girl

A few days after getting hives, this 5-year-old girl began to develop the more common symptoms of COVID-19 like fever and a cough.

Hives due to radiation therapy

This medical treatment can be lifesaving but hard on your skin. If your body releases histamine to protect itself, hives can develop.

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Chronic Idiopathic Hives May Stem From One’s Own Immune System

When the body reacts to allergens, it releases histamine and other chemicals that cause inflammation and fluid to accumulate under the skin. According to the American Osteopathic College of Dermatology, about half of the cases of chronic idiopathic hives stem from a persons own immune system, which has become overactive and begins attacking normal tissues, causing hives. In these cases, patients make an autoantibody that activates their mast cells on the surface of their skin.

Hives Are Rarely Due To A Serious Underlying Disease

Treatment for Chronic Hives at Ohio State

Whilst a clear cause of hives in not obvious in many cases, causes may include:

  • Infection from a virus is the most common cause of hives in children, especially if they last for more than 24 hours.
  • Contact allergy to plants or animals may cause localized hives.
  • Allergic reactions to food, medicines or insect stings can appear as hives. They usually occur within one to two hours of exposure and disappear in most cases within six to eight hours.

An allergic cause for hives should be suspected if episodes are rare, short-lived and occur under specific circumstances, for example:

  • Only when exercising.
  • Always within two hours of a meal.
  • When symptoms involving other organs occur around the same time, such as stomach pain, vomiting, difficulty breathing or dizziness.
  • If hives occur with swelling of the tongue or throat, difficulty breathing or low blood pressure, anaphylaxis should be suspected. Urgent administration of adrenaline and medical assessment is required. Information about anaphylaxis is available on the ASCIA website.

Ongoing hives lasting days at a time are almost never allergic in origin, with the exception of some cases of allergy to medicines. Stress is a very rarely the cause of hives but may make the symptoms worse.

In some people hives are caused by physical triggers, including cold , heat, sunlight , vibration, rubbing or scratching of the skin , and delayed pressure , stress, alcohol, spicy food or coffee may cause symptoms.

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What Causes Hives Anyway

Most hives result from an acute allergic response to some environmental irritant, food, or medication. Ingesting or coming into direct contact with one of these allergens can cause your body to produce histamines, which in turn may lead to a sudden breakout of hives. Stress, exercise, excessive sweating, and tight clothing can also trigger hives. In some cases, hives are a symptom of an underlying illness or infection. Finally, chronic hives refer to hives that linger for a while and/or recur at various intervals — the underlying reason for chronic hives can be difficult to discover.

Can Stress Or Anxiety Cause Chronic Hives

Stress and anxiety can worsen skin diseases. Anti-anxiety medicines may help. You may also benefit from stress-relieving therapies like mindfulness or meditation.

A note from Cleveland Clinic

Chronic hives can be itchy and uncomfortable. You may become self-conscious about your appearance. Most of the time, providers cant pinpoint the cause of chronic hives. However, treatments like antihistamines, steroids and even immunosuppressants can help. You can also take steps at home to ease itching and swelling. For many people, chronic hives eventually go away, although it may take a year or longer.

Last reviewed by a Cleveland Clinic medical professional on 05/02/2022.


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Some People Have Greater Risk Of Developing Any Type Of Hives

While anyone can develop hives, you have a greater risk if you:

  • Are a woman of African American heritage

  • Have atopic dermatitis

  • Smoke cigarettes

If you have long-lasting or widespread hives, seeing a dermatologist can help you feel more comfortable. Seeing a dermatologist is also a good idea to make sure that what you have really is hives.

Find out how dermatologists diagnose and treat hives at: Hives: Diagnosis and treatment.

Related AAD resources

ImagesImage 1: Used with permission of the American Academy of Dermatology National Library of Dermatologic Teaching Slides.

Image 2: Images used with permission of JAAD Case Reports.

  • JAAD Case Reports 2021 11:137-8.

Image 3. Image used with permission of the Journal of the American Academy of Dermatology.

  • J Am Acad Dermatol 2006 5428-46.

ReferencesAntia C, Baquerizo K, et al. Urticaria: A comprehensive review: Epidemiology, diagnosis, and work-up. J Am Acad Dermatol. 2018 79:599-614.

Grattan CEH, Saini SS. Urticaria and angioedema. In: Bolognia JL, et al. Dermatology. . Mosby Elsevier, China, 2018:304-19.

Hide M, Takahagi S, et al. Urticaria and angioedema. In: Kang S, et al. Fitzpatricks Dermatology. McGraw Hill Education, United States of America, 2019:684-785.

Hymes SR, Strom EA, et al. Radiation dermatitis: Clinical presentation, pathophysiology, and treatment. 2006. J Am Acad Dermatol. 2006 54:28-46.

What Are The Symptoms Of Dermatomyositis

Itchy Skin Rash

The symptoms are caused by swelling and inflammation in the blood vessels that supply your skin and muscles, and can include:

  • Red or purple rash on sun-exposed areas that may be painful or itchy

  • Red or purple swelling of the upper eyelids

  • Red or purple spots on the knuckles, elbows, knees, and toes

  • Joints that feel stuff and turn pale and painful in cold conditions and feel better when warmed

  • Scaly, rough, dry skin, which can lead to hair thinning

  • Swollen, red areas around the fingernails

  • Hard lumps under the skin caused by calcium deposits

  • Muscle weakness in the neck, hip, back, and shoulders

  • Trouble swallowing and voice changes

  • Tiredness, fever, and weight loss

  • Muscle aches

  • Trouble rising from a chair or getting out of bed due to muscle weakness

Sometimes the muscle weakness also spreads to the heart, GI tract, and lungs. This can cause breathing trouble and coughing. Adults may have a low-grade fever, along with lung inflammation and sensitivity to light.

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Whats The Difference Between Hives And Chronic Hives

Chronic hives are different than acute hives:

  • Acute hives start to fade within 24 hours . They are gone within six weeks. A recent viral infection often causes acute hives.
  • Chronic hives are visible at least twice per week for more than six weeks. Some chronic hives last for months or years. The cause is often unknown.

Symptoms Of Hives And Rashes

Like causes, hives and rashes also share several symptoms. One of the most common symptoms is how they present themselves on the skin as red or raised bumps, but other features indicate whether your skin is reacting.


Hives typically present themselves as raised skin, such as welts, that may or may not be red due to the inflammation. They itch, and individuals with more allergies than others are likelier to get hives. Depending on the underlying cause of hives, their sizing can vary. For some individuals, the raised skin can combine to create more extensive areas of irritation.

Other symptoms of hives as the result of a severe reaction include:


Cramping in the stomach


In the same vein as hives, rashes are typically red from inflammation and present as a cluster of irritated patches. The difference between hives and rashes is usually raisedmost rashes do not cause significantly raised patches of skin, unlike hives, but they can cause small bumps. Rashes are generally swollen tissues underneath the skin and may or may not itch.

Rashes may be painful, itchy, red, blotchy, raw, and scaly. When suffering from a rash, you may notice plaques or even blisters. If you see a painful or spreading rash, you should seek medical attention.

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