Have you struggled with hives that come and go for six weeks or more? You’ve got what experts call chronic hives, and they can be exhausting — especially because they can cause changes in your sleep, performance at work or school, and social life. “The impact chronic hives can have on somebody’s quality of life is well studied,” Friedman says.

While many of the triggers are the same as acute hives (ones that completely clear up in six weeks or fewer), chronic hives have several different causes, including autoimmune issues and long-standing infections. In some cases, you might have to undergo extra testing to determine the cause — and unfortunately in many cases, a definitive cause will not be identified. (4)

The good news is that while treatment generally starts in the same manner as for acute hives, doctors do have additional medications and, in some cases, tests they can use to help diagnose and treat chronic hives. You’ll just have to make sure you put patience on your side, as it can often take several years for improvements to happen.

Other potential (but rare) complications of either acute or chronic hives can include:

• Angioedema
• Anaphylaxis (which technically is a complication that can happen in tandem with rather than because of hives, but can be life-threatening)
• Anxiety
• Depression

About 1 in 5 people will experience hives at some point in their lives. (1) And more than 10 percent of children will experience hives at least once. (6)

About 1 in 20 people will experience chronic hives, which are episodes that last for more than six weeks. (10) About half of people with chronic hives still have them after antihistamine treatment. (7) And for about half of cases, the trigger of chronic hives is unknown. (4) Twenty percent of chronic hives patients suffer for more than five years. (11) Chronic hives are more common among women than men. (12)

Much of the research surrounding hives in the past couple of years has focused on the effectiveness of omalizumab (sold under the brand name Xolair). It’s an anti-immunoglobulin E antibody that was somewhat recently approved as a treatment option and is available by prescription. It’s now recommended to treat chronic hives. (13)

Other studies from the past two years include:

• A 2019 study found that tests intended to diagnose or assess chronic hives rarely shed light on what’s causing the issue, though they significantly increase financial costs. (14)
• A 2018 study explored the diets of people with chronic spontaneous urticaria and how food can exacerbate certain symptoms. The researchers found that food typically is not the trigger for chronic hives, even though many patients think it is. (15)
• Another 2019 study found that autoimmunity and autoallergy antibodies can lead to the development of chronic spontaneous urticaria and predispose people to developing other autoimmune diseases. The researchers also found that patients with the autoallergy antibody seem to respond more quickly to omalizumab than those with autoimmunity issues. (16)
• New treatment options, including infusions, topical treatments, and oral ones, are being explored to treat chronic hives patients who have not responded to current treatments. (11)

Much of the research that’s currently being done regarding hives involves testing whether certain medications are effective treatment options, such as fenebrutinib, AK002, UB-221, ligelizumab, and dupilumab. (17)

Finally, researchers are also exploring how vitamin D levels among hives patients compare with those of others and how vitamin D supplementation affects the severity of hives. (17)