Do my persistent hives indicate chronic urticaria?

Question

Hello doctor,

I am 34 years old and have been experiencing hives on and off for the past three months. Red, itchy swellings appear suddenly, especially at night, and usually disappear by morning. I am taking an antihistamine like Levocet (Levocetirizine), which provides relief, but the rash returns when I stop the medication.

My IgE levels were elevated, and my eosinophils were 7%. I have not introduced any new foods or changed soaps recently. The itching is severely affecting my sleep.

Could this be chronic urticaria?
Can stress alone trigger daily outbreaks?
Is it safe to take antihistamines long-term, or could my body become resistant to them?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and understood your concern.

Based on your history of daily or near-daily hives for more than six weeks, with spontaneous onset and resolution, this pattern is consistent with chronic spontaneous urticaria.

In most cases, no clear external trigger is found. Stress can definitely worsen and trigger episodes, especially nighttime flares, but it is usually not the only factor. Mild elevation of IgE (immunoglobulin E) and eosinophils is common and does not necessarily point to allergy in chronic spontaneous urticaria.

Antihistamines are the main treatment. It is safe to take them long-term under medical guidance. They do not cause dependence, and the body does not get used to them in a harmful way. Sometimes, dose adjustment or regular daily use is needed rather than on-and-off use.

The return after stopping is because the condition is still active. Antihistamines control symptoms but do not cure the disease.

I would suggest the following instructions:

Take an antihistamine regularly for a few weeks instead of stopping abruptly.
Avoid aggravating factors: heat, tight clothing, alcohol, stress, NSAIDs (nonsteroidal anti-inflammatory drugs).
Maintain good sleep and stress control, which is very important in your case.

Since your sleep is getting affected, you may need step-up therapy or a dose adjustment, which should be guided by a dermatologist. If there are ever lip or eyelid swelling or breathing symptoms, or details about the exact dose being taken, further guidance can be provided.

I hope you are satisfied with my answer. For further queries, you can consult me at iCliniq.

Thank you.