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Hives. How long will they last?

If you have experienced hives (also known as urticaria), this is one question you really want the answer to.

Acute hives by definition will last less than 6 weeks. This may seem like a very long time when you are dealing with the itching, but antihistamines are generally effective, especially when taken regularly. Use caution with antihistamines such as Benadryl ®which can cause drowsiness and decreased reaction time. The “new generation” antihistamines such as Claritin®, Clarinex®, Zyrtec®, Xyzal ®, or Allegra® work just as well and have fewer side effects. It’s not clear why, but for an individual, one antihistamine may work better than another.

Chronic hives are those that last more than 6 weeks, occurring daily or several days a week. Patients with chronic hives may have ongoing symptoms for months, years or even decades. In a study from Amsterdam, almost 50% of patients with chronic idiopathic (“we don’t know”) hives had resolution within 1 year. For those with the physical hives (cold, heat, rubbing, pressure, vibration, etc.), only 16% of patients were hive-free after 1 year. For these patients, it is probably better to measure their hives duration in decades rather than years. Other studies show even lower rates of remission.

In general, the more severe the hives, the longer they will continue. For these reasons, it is important to try to avoid using steroids to treat hives. The side effects of frequent or long term use of steroid pills or injections are serious and some are irreversible. Topical creams or ointments usually lead to disappointing results. Occasionally, it will take some time to find the right dose of the right medications or combinations of medications to reduce hives. As always, the most important and first approach is to attempt to avoid the trigger of the hives, if found.

Chronic hives are frustrating for everyone, including physicians. Allow your doctor to try several approaches and try to be “patient.”

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