Chronic hives, also known as chronic urticaria, is an uncomfortable skin condition marked by itchy red welts that can appear anywhere on your body. “About 85 percent of the time, we don't know what causes it,” says Miriam Anand, MD, an allergist with Allergy Associates and Asthma in Tempe, Arizona. When the cause of hives can’t be determined, the condition is known as chronic idiopathic urticaria. This poses a challenge when it comes to treating chronic hives, which by definition last longer than six weeks, and can sometimes come and go for years.

Besides causing discomfort, chronic hives can interfere with daily activities, but there are many ways to manage the condition — even if you don’t know its cause. Start with these steps to soothe or prevent the symptoms associated with chronic hives:

1. Avoid known triggers

One of the best ways to control hives is to avoid known triggers, according to a report published in the June 2015 issue of the Journal of the European Academy of Dermatology and Venereology. To determine which triggers may be affecting you, the first step is to see your allergist. “We do allergy testing to see if your body is reacting to one of the many allergens that can cause hives,” says Dr. Anand. Some of these allergens are:

Some foods, especially peanuts, eggs, nuts, shellfish, and some food additives
Certain pain medications, such as aspirin and ibuprofen
Physical stimuli such as pressure, temperature, exercise, and sun exposure
Bacterial infections, including urinary tract infections
Viral infections, such as the common cold and hepatitis
Pet dander
Pollen

If one or more of these allergens is found to be the cause of your hives, says Anand, your doctor will work with you to figure out ways to avoid exposure. “If a trigger isn’t found after testing, your doctor will look for other causes of chronic hives,” she adds. One of those could be an autoimmune condition — almost half of all cases of chronic hives are due to an overactive immune system, according to the American Osteopathic College of Dermatology. Treating an underlying medical condition, says Anand, can help rid you of the symptoms of chronic hives.

2. Take your medications

Antihistamines are usually the first line of treatment for chronic hives. “I usually prescribe a long-acting antihistamine once a day first,” says Anand, “and if that doesn’t work, I’ll add a second one.” If antihistamines don’t help, your doctor may prescribe another medication. According to a study published in March 2013 in the New England Journal of Medicine, omalizumab, an injectable medication commonly used to treat asthma, was found to be effective in treating most people who did not respond to antihistamines. Other treatments your doctor might prescribe include corticosteroids (for short-term use only) or epinephrine injections (if you experience swelling in your lips or throat). To help boost the effectiveness of your treatment, always follow your doctor’s instructions when it comes to taking your medications, and don’t skip any doses. Talk to your doctor if you have any questions or concerns about your medication.

3. Soothe your skin

The drier your skin is, the itchier it feels, tempting you to scratch. But scratching is one of the worst things you can do, says Anand, because it can aggravate your hives. To calm the itching, keep your skin moisturized, she says. Taking frequent baths can also help reduce itching and scratching, according to the American College of Allergy, Asthma & Immunology (ACAAI).

In addition, cooling the affected area can feel soothing to your skin (as long as cold temperature isn’t one of your hive triggers). There are many ways to cool your skin, including:

Applying an anti-inflammatory medication or cream, as prescribed by your doctor
Positioning yourself in front of a fan
Applying a cold compress

4. Wear loose, light clothing

Constant friction and pressure on your skin can worsen your hives, according to the ACAAI. Avoid wearing constricting clothing, tight belts, and even ill-fitting shoes — hives can also appear on the soles of your feet. Choose loosely fitting clothing in soft fabrics instead.

5. Talk to your doctor about a vitamin D supplement

Adding a vitamin D supplement to your treatment plan may help reduce the symptoms of chronic hives, according to a small study published in January 2014 in the Annals of Allergy, Asthma & Immunology. In the two-year study, people with chronic hives who took a daily supplement of vitamin D3 along with their regular allergy medications experienced a decrease of 33 percent in their symptoms within the first week. More research is needed to confirm the benefits of vitamin D supplementation for chronic hives. Talk to your doctor about possibly adding a supplement to your treatment.

6. Consider alternative therapies

Stress has been found to worsen hives, and techniques that promote relaxation, such as deep breathing, meditation, and yoga, can be good ways to reduce stress, says Anand. Some studies point to a potential link between acupuncture and a decrease in the symptoms of chronic hives, but more research is needed to confirm these findings.

7. Manage your emotions

When you have chronic hives, most of your efforts may naturally be directed toward managing visible symptoms. But don’t forget to address the condition’s invisible symptoms: Anxiety and depression often accompany chronic hives. “This stands to reason,” says Anand, “since living with a chronic condition can be challenging and uncomfortable.” Chronic hives has specifically been found to increase emotional distress, feelings of isolation, and fatigue. If these symptoms sound familiar, talking to a therapist may help you relieve some emotional pressure.

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