What Are Autoimmune Hives and What Causes Them?

Hives (urticaria) are red, itchy bumps on the skin. You may develop hives for many reasons, including allergic reactions, 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 chronic idiopathic urticaria (CIU) or chronic spontaneous urticaria (CSU). About half of the people who experience CIU are believed to have hives related to an autoimmune disease (when the immune system attacks healthy cells).

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

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.

Symptoms

Autoimmune hives appear on the skin like other types: as red, itchy bumps or welts. Other symptoms, such as fatigue or autoimmune disease symptoms, may occur. For instance, weight changes experienced with autoimmune thyroid diseases may 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.

Diagnosis

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, the autoimmune disease most commonly linked to autoimmune hives.

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

Basophil Histamine Release Assay

The basophil histamine release assay (BHRA) test measures the release of histamine, 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.

Treatment

Hives can be treated with:

• Over-the-counter (OTC) medications
• Prescription medications
• Complementary and alternative medicine (CAM)

Many treatment options, such as antihistamine medications, 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) and Zyrtec (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. Corticosteroids may 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, stress can 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:

• Daily exercise
• Meditation
• Mindfulness practices
• Stress relief and relaxation

When to See a Healthcare Provider

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

• Continues to come back after going away
• Does not improve in a couple of days
• Includes fever, swelling, difficulty breathing, or other signs of anaphylaxis (life-threatening allergic reaction)
• Leads to worry or fear
• Spreads to other areas of the body

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

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.