11 Skin Care Ingredients That Can Trigger Allergic Reactions
Discover common skin care ingredients that can cause allergic reactions and learn how to identify them in your products.
Next up video playing in 10 seconds
Chronic idiopathic urticaria, also known as chronic hives or chronic spontaneous urticaria, is characterized by an itchy skin rash accompanied by raised, tender, red welts or spots and may occur anywhere on the body.
The condition affects about 1.6 million people in the United States, most often in people ages 20 to 40. Women are twice as likely to experience chronic hives than men.
The term "idiopathic" means the cause of the hives isn't identifiable — for example, it's not prompted by an allergic reaction or a known infection. “Chronic” means the hives last longer than six weeks, says Brendan Camp, MD, a dermatologist at MDCS Dermatology in New York City. This is in contrast to acute hives, which occur infrequently for a shorter duration, sometimes for only minutes at a time before they begin to resolve, he says.
Just because the condition is chronic doesn't mean you'll have it for life. Effective treatment can limit and sometimes completely alleviate recurring episodes of hives, Dr. Camp says. Addressing chronic hives usually involves over-the-counter treatment initially, followed by prescription medications if those don't work well.
As with any condition, be sure to talk with your healthcare professional before starting a treatment or combining treatments to create a plan that best fits your needs.
Medication
When treating chronic idiopathic urticaria, your health team will likely take a "step-up" approach, Camp says. This means starting with a conservative, over-the-counter option and then bringing in different options if those don't prevent recurrences or offer symptom relief.
Antihistamines
The first line of therapy for most cases of chronic idiopathic urticaria are non-sedating, over-the-counter antihistamines, also called H1 antihistamines, says Camp.
"These medications block the effect of histamine, a chemical signal released in response to inflammation that leads to redness, swelling, and itching and the formation of hives," he says. Medications that don't have a sedating effect (also known as second generation H1 antihistamines) tend to be better because they can be taken at any time of the day, rather than just in the evening, he says. These include:
loratadine (Claritin)
desloratadine (Clarinex)
cetirizine (Zyrtec)
fexofenadine (Allegra)
Antihistamines known to cause drowsiness (also known as first generation H1 antihistamines) include:
Also known as H2 antihistamines, these medications work by reducing stomach acid production, which blocks histamine receptors in the stomach. Commonly prescribed for certain gastrointestinal issues, these meds can also affect histamine receptors in blood vessels, which can help alleviate redness and swelling related to hives. Options include:
famotidine (Pepcid)
cimetidine (Tagamet)
nizatidine (Axid)
"Treatment would be escalated to these medications if the over-the-counter options aren't reducing symptoms such as itch or flares," says Camp. "This treatment would also be considered if hives are having a significant, negative impact on quality of life, such as interference with work, relationships, or sleep."
It's possible to combine both H1 and H2 antihistamines, depending on the severity of your symptoms, he says. Research noted that a combination like this is statistically more effective than H1 antihistamines alone for symptoms of chronic urticaria.
Biologics
If H2 blockers are also proving ineffective, even in combination with H1 antihistamines, the next step in treatment is to consider biologic medications.
In April 2025, the U.S. Food and Drug Administration (FDA) approved dupilumab (Dupixent), an injection treatment for chronic spontaneous urticaria in people who still have symptoms despite treatment with H1 antihistamines. The medication was approved previously for atopic dermatitis, as well as other conditions like chronic obstructive pulmonary disease, asthma, and eosinophilic esophagitis. The medication works by blocking two key proteins in the immune system, leading to reduced inflammation.
Another biologic medication used for chronic hives is omalizumab (Xolair), which also alters the immune response to lessen symptoms.
Specifically, this medication — which is delivered by injection, usually once a month — blocks immunoglobulin E (IgE) antibodies, which are released by the immune system in response to allergens. That's why it's used to treat moderate to severe persistent allergic asthma in particular, but it’s also relevant for other conditions like chronic hives or chronic rhinosinusitis with nasal polyps.
Other Medication Options
In some cases, when hives haven’t gone away with other treatments, other drugs may be prescribed in combination with daily antihistamines and can be very effective for this purpose. They may include:
Medications are the primary form of treatment for chronic hives, but lifestyle habits can be helpful as well, says Camp. These can include:
Identify triggers. Although this type of hives is idiopathic, certain allergens can bring on episodes or make them worse, Camp says. Triggers may include food allergies and sensitivities, insect bites, pollen, medications, and pet dander, among others.
Avoid temperature extremes. For some people, extreme hot (especially humid) or cold temperatures can trigger symptoms. Because of that, it may be useful to maintain a consistent temperature to reduce chronic urticaria episodes.
Prevent friction. Skin irritation from friction can be another source of flares. Avoid tight clothing that creates friction, says Camp.
Moisturize often. As another way to reduce irritation, keep skin hydrated through use of a moisturizer, Camp says. Be sure to choose one that's unscented, since fragrances may be problematic when skin is sensitive.
Mental Health Treatment
While stress isn't considered a direct cause of chronic urticaria, it can be a contributing factor for symptom flares, says Geeta Yadav, MD, a dermatologist and the founder of FACET Dermatology in Toronto.
"It is extremely important for anyone with immune- and inflammatory-related skin conditions, like hives, eczema, and psoriasis, to prioritize reducing emotional and physical stress as part of urticaria management," she says. "While reducing stress is easier said than done, it can go a long way toward reducing disease activity and severity."
Research has noted that the unpredictable nature of hives can lead to emotional distress, and it's more pronounced when symptoms are severe. It’s helpful to find ways to support your mental health when you're dealing with the condition and undergoing treatment, Dr. Yadav says.
The Takeaway
There’s a range of treatment options available for chronic idiopathic urticaria, hives with no known cause that last at least six weeks.
Although chronic idiopathic urticaria can be frustrating, and sometimes cause emotional difficulties, the condition is often managed with a step-up treatment plan. This means starting with over-the-counter antihistamines that may alleviate symptoms and prevent new episodes, and if those prove ineffective, your doctor may recommend a prescription antihistamine or a biologic medication.
Lifestyle changes like identifying triggers, avoiding temperature extremes, and maintaining good skin health can also be a useful complement to medications suggested by your health provider.
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
Kou E et al. Combination of H1 and H2 Histamine Receptor Antagonists: Current Knowledge and Perspectives of a Classic Treatment Strategy. Life. January 2024.
Tawil S et al. Association of Chronic Urticaria with Psychological Distress: A Multicentre Cross-sectional Study. Acta Dermato-Venereologica. February 2023.
Asal Naderi, MD, is an assistant clinical professor of allergy and immunology at the Keck School of Medicine at the University of Southern California. Her areas of focus include allergic rhinitis, asthma, chronic sinusitis with nasal polyposis, chronic urticaria, angioedema, food allergy, drug allergy, and primary immunodeficiencies.
She received her bachelor's degree from the University of California Los Angeles and then received her medical degree from Saint Louis University. She completed her internal medicine residency at University of California Irvine, and her fellowship at the University of California Irvine. She has been a principal investigator in clinical trials for asthma as well as chronic sinusitis.
Outside of the office, she enjoys exercising, cooking and spending time with her family and friends.
Elizabeth Millard is a freelance writer based in northern Minnesota. She focuses on health, wellness, and fitness, and has written for Runner's World, Bicycling, Self, Women's Health, Men's Health, Prevention, Experience Life, and more. She is an American Council on Exercise–certified personal trainer and a Yoga Alliance-registered yoga teacher. She graduated from Harvard University with a bachelor's degree in English.
