Chronic Urticaria: Hives That Won't Stop
Antihistamines at higher than label doses are usually safe and effective.
Dr. Sophie Renard
Dermatologist
Itchy wheals appearing and disappearing within 24 hours, sometimes with angioedema. Usually not triggered by a specific allergen.
Triage
Most cases are autoimmune or idiopathic. Extensive allergy testing is rarely useful.
Treatment
- Second-generation H1 antihistamines first-line, up to 4x standard dose
- Add omalizumab for refractory disease
- Avoid known triggers: pressure, heat, NSAIDs in some patients
Course
Most cases resolve within 1-5 years. Symptom control rather than cure is the realistic short-term goal.
Daytime sedation from antihistamines is uncommon with modern agents at standard doses.
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