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Ask the Allergist

Ask the Allergist

What's causing these mysterious hives?

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I don't know what I am allergic to, but I keep getting hives. They go away but come back when I am sleeping.

If your hives have been occurring for over 6 weeks, the hives are not likely caused by an allergy. When hives occur for more than 6 weeks, we typically call it “chronic urticaria”.

When we can't find the cause of the hives, it's called “chronic spontaneous urticaria” or "CsU". This is the most common cause of hives when they occur over   6 weeks. People with CsU do not have allergies. Research suggests that the hives are caused by the spontaneous release of histamine from skin allergy cells. This is not caused by an allergic trigger. It may be due to the accidental development of an antibody. This antibody binds to allergy cells and breaks them open. This causes the spontaneous release of histamine which causes hives and itching. This often resolves over time but can last months to years.

Treatment includes the use of non-drowsy antihistamines which you can buy over the counter. Current guidelines for the treatment of CsU support using more than the recommended dose.

I would suggest a consultation with a board-certified allergist. Board-certified allergists are very familiar with how to treat CsU and could help you better manage your symptoms.

Hives (Urticaria)
Answered by

Douglas T. Johnston, DO, FAAAAI, FACAAI, is an allergist/clinical immunologist at Carolina Asthma & Allergy Center in Charlotte, North Carolina, and Assistant Professor at Edward Via School of Osteopathic Medicine in Spartanburg, South Carolina. He is a fellow of the American College of Allergy, Asthma, and Immunology (ACAAI) and the American Academy of Allergy, Asthma, and Immunology (AAAAI). He has lectured at national and international medical conferences and has publications in several medical journals, including “Clinical Immunology,” “World Allergy Organization Journal,” “Journal of Allergy, Asthma, and Immunology,” “The Journal of the American Medical Association,” and the “New England Journal of Medicine.”

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