Table of ContentsView AllTable of ContentsAutoimmune Diseases & Chronic HivesSymptomsDiagnosisTreatmentWhen to Seek Medical CareFrequently Asked Questions

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Table of Contents

Autoimmune Diseases & Chronic Hives

Symptoms

Diagnosis

Treatment

When to Seek Medical Care

Frequently Asked Questions

Hives(urticaria) are red, itchy bumps on the skin.You may develop hives for many reasons, includingallergicreactions, but the cause may not always be known. Sometimes hives are long-lasting (chronic) and can come and go for months or years.When hives are long-lasting without a known cause, it is called chronicidiopathicurticaria (CIU) or chronic spontaneous urticaria (CSU).About half of the people who experience CIU are believed to have hives related to anautoimmune disease(when theimmune systemattacks healthy cells).Learn about hives related to autoimmune activity, symptoms, treatment, and more.Eik Scott / Getty ImagesDo Autoimmune Diseases Cause Chronic Hives?The relationship between autoimmune disease and chronic hives is not fully understood. It is believed that there is an autoimmune connection in about half of people with chronic hives, but most of these individuals do not have any other autoimmune diagnosis.Autoimmune hives are also sometimes called chronic autoimmune urticaria, or CAU.Could a Hives Rash Be a Sign of Thyroid Disease?SymptomsAutoimmune hives appear on the skin like other types: as red, itchy bumps or welts.Other symptoms, such asfatigueor autoimmune disease symptoms, may occur. For instance, weight changes experienced with autoimmunethyroid diseasesmay co-occur with hives for people who also have thyroid disease.Unpleasant symptoms may last years for those who are not treated, which can also lead to emotional challenges.Symptoms of Autoimmune HivesSkin bumpsItchingPainRedness on the skinSwellingEmotional distressFatigueFeeling isolatedSymptoms of co-occurring autoimmune diseaseDiagnosisMany people with autoimmune hives have no other manifestation of autoimmunity. If autoimmune hives are suspected, blood is taken and tested in a laboratory to screen for thyroid disease, theautoimmune diseasemost commonly linked to autoimmune hives.No definitive tests diagnose autoimmune hives. Research studies sometimes report thebasophil histamine release assay(BHRA) and/or theautologous serum skin test(ASST).Most clinics do not perform these tests.20 Effective Ways to Treat HivesBasophil Histamine Release AssayThe basophil histamine release assay (BHRA) test measures the release ofhistamine, a chemical responsible for producing hives.Even if this test is positive, it does not necessarily mean you have autoimmune hives; it is used in research studies to better understand what causes autoimmune hives.Autologous Serum Skin TestThe autologous serum skin test (ASST) is another test used in research studies for autoimmune hives. It involves a scratch to the skin using a person’s own serum (from blood) and, like the BHRA, assesses histamine response.TreatmentHives can be treated with:Over-the-counter (OTC) medicationsPrescription medicationsComplementary and alternative medicine (CAM)Many treatment options, such asantihistaminemedications, are the same whether or not the hives are autoimmune-related.With autoimmune hives, treatments for the autoimmune condition can help treat the hives associated with it. For example, treatments for thyroid disease may be effective in helping to resolve autoimmune hives that occur with thyroid disease.Over-the-Counter (OTC) TherapiesOTC products can treat hives, including chronic and autoimmune hives. The gold standard for initial treatment of chronic hives (autoimmune or not) is nonsedating antihistamines, like Allegra (fexofenadine) andZyrtec(cetirizine).PrescriptionsPrescription medications are often used to treat hives, including autoimmune hives. Xolair (omalizumab) is often prescribed for chronic hives, while Vistaril (hydroxyzine) is a sedating antihistamine sometimes prescribed in cases of severe hives that impair sleep.Corticosteroidsmay also be prescribed.Complementary and Alternative Medicine (CAM)Prescription and OTC medications are not the only treatment options for hives; CAM options can help. For example,stresscan trigger autoimmune hives, so therapies and practices that promote relaxation and relieve stress can help prevent and relieve autoimmune hives.Some CAM methods that may help include:DailyexerciseMeditationMindfulnesspracticesStress reliefand relaxationWhen to See a Healthcare ProviderWhile hives are generally not severe, it is important to see a healthcare provider if the condition:Continues to come back after going awayDoes not improve in a couple of daysIncludes fever,swelling,difficulty breathing, or other signs ofanaphylaxis(life-threatening allergic reaction)Leads to worry or fearSpreads to other areas of the bodyAs with other chronic conditions, chronic hives can increase your risk of developing mental health issues, such asdepressionoranxiety.Speak with your healthcare provider or a mental health provider if you experience any mental health concerns.If you or a loved one are struggling with mental health, contact theSubstance Abuse and Mental Health Services Administration (SAMHSA) National Helplineat800-662-4357for information on support and treatment facilities in your area.SummaryAutoimmune hives, or chronic autoimmune urticaria, is a condition that involves red, itchy bumps or welts on the skin, lasts six weeks or longer, and is related to a response from your immune system. Other symptoms may include fatigue, mental health issues, and symptoms of the autoimmune disease co-occurring with hives (e.g., weight fluctuations from thyroid disease).Research tests used in some studies on autoimmune hives include the basophil histamine release assay (BHRA) and autologous serum skin test (ASST). Treatment options include over-the-counter (OTC) medications, such as nonsedating antihistamines, prescription medications, such as Vistaril (hydroxyzine) or Xolair (omalizumab), and complementary and alternative treatments for stress relief. Although it may take months or years, most autoimmune hives do go away.A Word From VerywellSuspecting, being diagnosed with, and living with autoimmune hives can be challenging, especially while simultaneously experiencing symptoms of an autoimmune disease. If you or someone you know has chronic hives, hives without a known cause, or autoimmune hives, help is available. Reach out to your healthcare provider for support and treatment options.Frequently Asked QuestionsYes, stress can cause hives (sometimes called stress rash). Stress can also play a role in developing hives, even if there is another underlying cause.Urticaria, or hives, can be an autoimmune response but is not always. Sometimes hives are a response to other factors, such as an allergen.Most autoimmune urticaria goes away. However, the condition can last for months or years, and hives can come and go. In some people, it continues throughout their lives, though there are usually good treatment options to control it.Viruses, such as colds, strep throat, mono, and others, can cause hives. This is more common with acute (short-term) hives than chronic (long-term) hives.

Hives(urticaria) are red, itchy bumps on the skin.You may develop hives for many reasons, includingallergicreactions, but the cause may not always be known. Sometimes hives are long-lasting (chronic) and can come and go for months or years.

When hives are long-lasting without a known cause, it is called chronicidiopathicurticaria (CIU) or chronic spontaneous urticaria (CSU).About half of the people who experience CIU are believed to have hives related to anautoimmune disease(when theimmune systemattacks healthy cells).

Learn about hives related to autoimmune activity, symptoms, treatment, and more.

Eik Scott / Getty Images

Close up of a woman’s arm with chronic urticaria (hives).

Do Autoimmune Diseases Cause Chronic Hives?

The relationship between autoimmune disease and chronic hives is not fully understood. It is believed that there is an autoimmune connection in about half of people with chronic hives, but most of these individuals do not have any other autoimmune diagnosis.Autoimmune hives are also sometimes called chronic autoimmune urticaria, or CAU.

Could a Hives Rash Be a Sign of Thyroid Disease?

Autoimmune hives appear on the skin like other types: as red, itchy bumps or welts.Other symptoms, such asfatigueor autoimmune disease symptoms, may occur. For instance, weight changes experienced with autoimmunethyroid diseasesmay co-occur with hives for people who also have thyroid disease.Unpleasant symptoms may last years for those who are not treated, which can also lead to emotional challenges.

Symptoms of Autoimmune HivesSkin bumpsItchingPainRedness on the skinSwellingEmotional distressFatigueFeeling isolatedSymptoms of co-occurring autoimmune disease

Symptoms of Autoimmune Hives

Skin bumpsItchingPainRedness on the skinSwellingEmotional distressFatigueFeeling isolatedSymptoms of co-occurring autoimmune disease

Many people with autoimmune hives have no other manifestation of autoimmunity. If autoimmune hives are suspected, blood is taken and tested in a laboratory to screen for thyroid disease, theautoimmune diseasemost commonly linked to autoimmune hives.

No definitive tests diagnose autoimmune hives. Research studies sometimes report thebasophil histamine release assay(BHRA) and/or theautologous serum skin test(ASST).Most clinics do not perform these tests.

20 Effective Ways to Treat Hives

Basophil Histamine Release Assay

The basophil histamine release assay (BHRA) test measures the release ofhistamine, a chemical responsible for producing hives.Even if this test is positive, it does not necessarily mean you have autoimmune hives; it is used in research studies to better understand what causes autoimmune hives.

Autologous Serum Skin Test

The autologous serum skin test (ASST) is another test used in research studies for autoimmune hives. It involves a scratch to the skin using a person’s own serum (from blood) and, like the BHRA, assesses histamine response.

Hives can be treated with:

Many treatment options, such asantihistaminemedications, are the same whether or not the hives are autoimmune-related.With autoimmune hives, treatments for the autoimmune condition can help treat the hives associated with it. For example, treatments for thyroid disease may be effective in helping to resolve autoimmune hives that occur with thyroid disease.

Over-the-Counter (OTC) Therapies

OTC products can treat hives, including chronic and autoimmune hives. The gold standard for initial treatment of chronic hives (autoimmune or not) is nonsedating antihistamines, like Allegra (fexofenadine) andZyrtec(cetirizine).

Prescriptions

Prescription medications are often used to treat hives, including autoimmune hives. Xolair (omalizumab) is often prescribed for chronic hives, while Vistaril (hydroxyzine) is a sedating antihistamine sometimes prescribed in cases of severe hives that impair sleep.Corticosteroidsmay also be prescribed.

Complementary and Alternative Medicine (CAM)

Prescription and OTC medications are not the only treatment options for hives; CAM options can help. For example,stresscan trigger autoimmune hives, so therapies and practices that promote relaxation and relieve stress can help prevent and relieve autoimmune hives.

Some CAM methods that may help include:

When to See a Healthcare Provider

While hives are generally not severe, it is important to see a healthcare provider if the condition:

As with other chronic conditions, chronic hives can increase your risk of developing mental health issues, such asdepressionoranxiety.Speak with your healthcare provider or a mental health provider if you experience any mental health concerns.

If you or a loved one are struggling with mental health, contact theSubstance Abuse and Mental Health Services Administration (SAMHSA) National Helplineat800-662-4357for information on support and treatment facilities in your area.

Summary

Autoimmune hives, or chronic autoimmune urticaria, is a condition that involves red, itchy bumps or welts on the skin, lasts six weeks or longer, and is related to a response from your immune system. Other symptoms may include fatigue, mental health issues, and symptoms of the autoimmune disease co-occurring with hives (e.g., weight fluctuations from thyroid disease).

Research tests used in some studies on autoimmune hives include the basophil histamine release assay (BHRA) and autologous serum skin test (ASST). Treatment options include over-the-counter (OTC) medications, such as nonsedating antihistamines, prescription medications, such as Vistaril (hydroxyzine) or Xolair (omalizumab), and complementary and alternative treatments for stress relief. Although it may take months or years, most autoimmune hives do go away.

A Word From Verywell

Suspecting, being diagnosed with, and living with autoimmune hives can be challenging, especially while simultaneously experiencing symptoms of an autoimmune disease. If you or someone you know has chronic hives, hives without a known cause, or autoimmune hives, help is available. Reach out to your healthcare provider for support and treatment options.

Frequently Asked QuestionsYes, stress can cause hives (sometimes called stress rash). Stress can also play a role in developing hives, even if there is another underlying cause.Urticaria, or hives, can be an autoimmune response but is not always. Sometimes hives are a response to other factors, such as an allergen.Most autoimmune urticaria goes away. However, the condition can last for months or years, and hives can come and go. In some people, it continues throughout their lives, though there are usually good treatment options to control it.Viruses, such as colds, strep throat, mono, and others, can cause hives. This is more common with acute (short-term) hives than chronic (long-term) hives.

Yes, stress can cause hives (sometimes called stress rash). Stress can also play a role in developing hives, even if there is another underlying cause.

Urticaria, or hives, can be an autoimmune response but is not always. Sometimes hives are a response to other factors, such as an allergen.

Most autoimmune urticaria goes away. However, the condition can last for months or years, and hives can come and go. In some people, it continues throughout their lives, though there are usually good treatment options to control it.

Viruses, such as colds, strep throat, mono, and others, can cause hives. This is more common with acute (short-term) hives than chronic (long-term) hives.

12 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.National Health Services.Hives.American Osteopathic College of Dermatology.Urticaria.Fraser K, Robertson L.Chronic urticaria and autoimmunity.Skin Therapy Lett. 2013;18(7):5-9.Vikramkumar AG, Kuruvila S, Ganguly S.Autologous serum skin test as an indicator of chronic autoimmune urticaria in a tertiary care hospital in south India.Indian Dermatol Online J. 2014;5(Suppl 2):S87-S91. doi:10.4103/2229-5178.146166Najafipour M, Zareizadeh M, Najafipour F.Relationship between chronic urticaria and autoimmune thyroid disease.J Adv Pharm Technol Res. 2018;9(4):158-161. doi:10.4103/japtr.JAPTR_342_18Curto-Barredo L, Yelamos J, Gimeno R, Mojal S, Pujol RM, Giménez-Arnau A.Basophil activation test identifies the patients with chronic spontaneous urticaria suffering the most active disease.Immun Inflamm Dis. 2016;4(4):441-445. doi:10.1002/iid3.125Iqbal K, Bhargava K, Skov PS, Falkencrone S, Grattan CEH.A positive serum basophil histamine release assay is a marker for ciclosporin-responsiveness in patients with chronic spontaneous urticaria.Clin Transl Allergy. 2012;2:19. doi:10.1186/2045-7022-2-19Goh CL, Tan KT.Chronic autoimmune urticaria: where we stand?Indian J Dermatol. 2009;54(3):269-274. doi:10.4103/2F0019-5154.55640American Academy of Dermatology Association.Hives: diagnosis and treatment.American Academy of Dermatology Association.10 ways to get relief from chronic hives.Bansal CJ, Bansal AS.Stress, pseudoallergens, autoimmunity, infection and inflammation in chronic spontaneous urticaria.Allergy, Asthma & Clinical Immunology. 2019;15(1):56. doi:10.1186/s13223-019-0372-zTat TS.Higher levels of depression and anxiety in patients with chronic urticaria.Med Sci Monit. 2019;25:115-120. doi:10.12659/2FMSM.912362

12 Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.National Health Services.Hives.American Osteopathic College of Dermatology.Urticaria.Fraser K, Robertson L.Chronic urticaria and autoimmunity.Skin Therapy Lett. 2013;18(7):5-9.Vikramkumar AG, Kuruvila S, Ganguly S.Autologous serum skin test as an indicator of chronic autoimmune urticaria in a tertiary care hospital in south India.Indian Dermatol Online J. 2014;5(Suppl 2):S87-S91. doi:10.4103/2229-5178.146166Najafipour M, Zareizadeh M, Najafipour F.Relationship between chronic urticaria and autoimmune thyroid disease.J Adv Pharm Technol Res. 2018;9(4):158-161. doi:10.4103/japtr.JAPTR_342_18Curto-Barredo L, Yelamos J, Gimeno R, Mojal S, Pujol RM, Giménez-Arnau A.Basophil activation test identifies the patients with chronic spontaneous urticaria suffering the most active disease.Immun Inflamm Dis. 2016;4(4):441-445. doi:10.1002/iid3.125Iqbal K, Bhargava K, Skov PS, Falkencrone S, Grattan CEH.A positive serum basophil histamine release assay is a marker for ciclosporin-responsiveness in patients with chronic spontaneous urticaria.Clin Transl Allergy. 2012;2:19. doi:10.1186/2045-7022-2-19Goh CL, Tan KT.Chronic autoimmune urticaria: where we stand?Indian J Dermatol. 2009;54(3):269-274. doi:10.4103/2F0019-5154.55640American Academy of Dermatology Association.Hives: diagnosis and treatment.American Academy of Dermatology Association.10 ways to get relief from chronic hives.Bansal CJ, Bansal AS.Stress, pseudoallergens, autoimmunity, infection and inflammation in chronic spontaneous urticaria.Allergy, Asthma & Clinical Immunology. 2019;15(1):56. doi:10.1186/s13223-019-0372-zTat TS.Higher levels of depression and anxiety in patients with chronic urticaria.Med Sci Monit. 2019;25:115-120. doi:10.12659/2FMSM.912362

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

National Health Services.Hives.American Osteopathic College of Dermatology.Urticaria.Fraser K, Robertson L.Chronic urticaria and autoimmunity.Skin Therapy Lett. 2013;18(7):5-9.Vikramkumar AG, Kuruvila S, Ganguly S.Autologous serum skin test as an indicator of chronic autoimmune urticaria in a tertiary care hospital in south India.Indian Dermatol Online J. 2014;5(Suppl 2):S87-S91. doi:10.4103/2229-5178.146166Najafipour M, Zareizadeh M, Najafipour F.Relationship between chronic urticaria and autoimmune thyroid disease.J Adv Pharm Technol Res. 2018;9(4):158-161. doi:10.4103/japtr.JAPTR_342_18Curto-Barredo L, Yelamos J, Gimeno R, Mojal S, Pujol RM, Giménez-Arnau A.Basophil activation test identifies the patients with chronic spontaneous urticaria suffering the most active disease.Immun Inflamm Dis. 2016;4(4):441-445. doi:10.1002/iid3.125Iqbal K, Bhargava K, Skov PS, Falkencrone S, Grattan CEH.A positive serum basophil histamine release assay is a marker for ciclosporin-responsiveness in patients with chronic spontaneous urticaria.Clin Transl Allergy. 2012;2:19. doi:10.1186/2045-7022-2-19Goh CL, Tan KT.Chronic autoimmune urticaria: where we stand?Indian J Dermatol. 2009;54(3):269-274. doi:10.4103/2F0019-5154.55640American Academy of Dermatology Association.Hives: diagnosis and treatment.American Academy of Dermatology Association.10 ways to get relief from chronic hives.Bansal CJ, Bansal AS.Stress, pseudoallergens, autoimmunity, infection and inflammation in chronic spontaneous urticaria.Allergy, Asthma & Clinical Immunology. 2019;15(1):56. doi:10.1186/s13223-019-0372-zTat TS.Higher levels of depression and anxiety in patients with chronic urticaria.Med Sci Monit. 2019;25:115-120. doi:10.12659/2FMSM.912362

National Health Services.Hives.

American Osteopathic College of Dermatology.Urticaria.

Fraser K, Robertson L.Chronic urticaria and autoimmunity.Skin Therapy Lett. 2013;18(7):5-9.

Vikramkumar AG, Kuruvila S, Ganguly S.Autologous serum skin test as an indicator of chronic autoimmune urticaria in a tertiary care hospital in south India.Indian Dermatol Online J. 2014;5(Suppl 2):S87-S91. doi:10.4103/2229-5178.146166

Najafipour M, Zareizadeh M, Najafipour F.Relationship between chronic urticaria and autoimmune thyroid disease.J Adv Pharm Technol Res. 2018;9(4):158-161. doi:10.4103/japtr.JAPTR_342_18

Curto-Barredo L, Yelamos J, Gimeno R, Mojal S, Pujol RM, Giménez-Arnau A.Basophil activation test identifies the patients with chronic spontaneous urticaria suffering the most active disease.Immun Inflamm Dis. 2016;4(4):441-445. doi:10.1002/iid3.125

Iqbal K, Bhargava K, Skov PS, Falkencrone S, Grattan CEH.A positive serum basophil histamine release assay is a marker for ciclosporin-responsiveness in patients with chronic spontaneous urticaria.Clin Transl Allergy. 2012;2:19. doi:10.1186/2045-7022-2-19

Goh CL, Tan KT.Chronic autoimmune urticaria: where we stand?Indian J Dermatol. 2009;54(3):269-274. doi:10.4103/2F0019-5154.55640

American Academy of Dermatology Association.Hives: diagnosis and treatment.

American Academy of Dermatology Association.10 ways to get relief from chronic hives.

Bansal CJ, Bansal AS.Stress, pseudoallergens, autoimmunity, infection and inflammation in chronic spontaneous urticaria.Allergy, Asthma & Clinical Immunology. 2019;15(1):56. doi:10.1186/s13223-019-0372-z

Tat TS.Higher levels of depression and anxiety in patients with chronic urticaria.Med Sci Monit. 2019;25:115-120. doi:10.12659/2FMSM.912362

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