Doctor Nguyen Phuc Tan, from the Clinical Immunology Department at Tam Anh General Hospital, TP HCM, states that hives lasting or recurring for more than 6 weeks are called chronic hives. Women are more commonly affected than men. The condition occurs when immune cells in the skin, especially mast cells, are activated and release histamine and other mediators. These substances cause vasodilation, increase vascular permeability, creating edematous plaques, red papules, and itching. In chronic spontaneous urticaria, this process can occur without a specific external trigger being identified. Patients may experience recurrent hives despite eliminating many risk factors.

For instance, Ms. Sau, 45, from Tay Ninh, developed hives after giving birth to her second child. For about three years, the condition has recurred frequently, especially with weather changes. Dense red patches on many body areas cause intense itching at night, leading to insomnia. She avoids many foods suspected of causing hives, yet the condition still recurs weekly.

Doctor Tan advises Ms. Sau on treatment methods. Photo: Tam Anh General Hospital

Similarly, Mr. Thuc, 32, from TP HCM, has suffered from hives for many years, using various medications, including immunosuppressants, but still falls into the category of refractory hives, and itching worsens with stress. He has no other medical conditions, and no one in his family has allergies.

Doctor Tan explains that the challenge in treating chronic hives is not finding the cause, while many factors can exacerbate symptoms. Chronic spontaneous urticaria can be linked to various pathogenetic mechanisms, including immune cell dysfunction and autoantibodies, rather than solely a specific allergen.

According to Doctor Tan, it is necessary to distinguish between the underlying cause and factors that trigger or worsen symptoms. Weather changes, physical activity, friction, psychological stress, or certain foods can cause hives to appear or worsen in some individuals, but these are not always the root cause of the condition.

Doctors advise patients not to restrict their diet excessively without clear evidence of a specific food or agent. Patients should monitor the frequency of hive outbreaks, severity of itching, impact on sleep, and accompanying factors to provide information to their doctor.

With chronic hives, the goal is not only to find the cause but, more importantly, to control symptoms and bring the condition to a stable state. This is also a challenge for patients who do not respond to conventional treatment regimens. Some individuals still experience hives even after their antihistamine dose has been increased up to 4 times, as in Mr. Thuc’s case. In such situations, doctors need to re-evaluate the disease progression, response level, aggravating factors, and potential co-existing conditions to adjust the treatment approach.

Mr. Thuc receives biological treatment once a month. This method targets immune mechanisms related to the condition, helping control hives and itching in those who respond insufficiently to conventional regimens. After two injections, his hive outbreaks and itching significantly reduced. The doctor continues to monitor to assess the level of control and adjust the regimen as needed.

For Ms. Sau, the doctor assessed the disease progression, related factors, and response to previous treatments to develop a suitable new regimen. After two weeks of treatment, her itching and hive outbreaks significantly decreased, and she slept better.

Doctor Tan notes that chronic hives can be long-lasting, and the level of control may vary over time. If the condition recurs frequently, causes insomnia, or does not respond to antihistamines, patients should seek medical attention instead of self-increasing doses, changing medications, or over-restricting their diet. Do not self-administer immunosuppressants or stop medication without medical advice.

Minh Huong

*Names of individuals have been changed