Kassie had dealt with allergies for most of her life, but during college, something changed. What began as hives climbing from her feet up her legs became a recurring problem that eventually spread across her body. “I would say my first big breakout was when I was 19,” she says. At first, she assumed something in her apartment was triggering it. By 21, the episodes had become much harder to dismiss.
On a recent episode of The Beauty Authority, Kassie shared what it was like to live with chronic hives, the anxiety that came with never knowing when they might return and the treatment journey that ultimately helped her get them under control.
One night, Kassie experienced a severe reaction that she says progressed to anaphylaxis and sent her to the hospital. “I remember just being so scared,” she recalls. At the time, the medications she had been relying on weren’t keeping her symptoms under control, and she began to wonder if this was simply something she would have to live with.
Trying to Find the Trigger
Like many people dealing with unexplained hives, Kassie initially focused on finding the thing that was causing them. She kept a log of what she ate, touched and encountered each day, hoping a pattern would emerge. “We kind of realized it was just five million things I was being exposed to,” she says. Eventually, her doctor raised another possibility: there might not be one specific external trigger at all.
She also overhauled her routine, cutting out scented products, including detergents and perfumes, and switching to more “natural” beauty options in an attempt to calm her skin.
Keeping notes still proved useful, though, especially once she began working more closely with her doctor. “The more detailed your journal is, the more your doctor can look inside your daily life and be able to treat you better,” she says.
When Hives Start Affecting Everything
The physical symptoms were only part of it. After her most severe episode, Kassie says she developed intense anxiety around the possibility of another reaction. “It got to a point where I was in my senior year of college, and I was kind of afraid to leave my apartment,” she says. Her now-husband became one of the few people she felt comfortable going out with because she worried about what would happen if a flare started while she was alone.
Her normal routine changed too. She had once worked out six days a week but stopped almost completely. Going to class became difficult and even being at the gym could make her anxious enough to leave. “It wasn’t just social activities,” she says. “It was the things I had to do for my daily life.”
That kind of disruption is common in chronic spontaneous urticaria, says Hershey, PA allergist-immunologist Dr. Timothy Craig. Beyond the visible redness or swelling, persistent itching can interfere with work, school and especially sleep. “Who can go to sleep when they’re itchy?” he says. “They’re tired and run down, and they’re not being productive.”
What Are Chronic Hives?
Chronic spontaneous urticaria, or CSU, is different from the occasional hives that can accompany an allergic reaction or infection. According to Dr. Craig, chronic hives are defined as hives that keep recurring for six weeks or longer and can appear and disappear unpredictably.
One of the biggest misconceptions is that they must be caused by an allergy. “We used to think that most of these are allergic, but now we think that most of them are not actually allergic,” Dr. Craig explains. Instead, he says many cases are linked to an autoimmune process involving mast cells and histamine release.
For Kassie, understanding that distinction changed the way she thought about her symptoms. Instead of endlessly trying to identify one food, product or exposure to eliminate, the focus shifted toward controlling the condition itself.
Where Treatment Usually Starts
Treatment often begins with over-the-counter antihistamines. Dr. Craig says the goal is straightforward: getting symptoms fully under control so hives are no longer interfering with everyday life. “As a doctor, I see my role as having a person have no hives and no interference with their quality of life, and be able to do whatever they wish to do on a regular basis,” he says.
If one daily antihistamine isn’t controlling symptoms, he recommends talking to a primary-care doctor or asking for a referral to an allergist. Treatment can then be stepped up according to established guidelines, with additional therapies considered when symptoms remain uncontrolled.
Kassie says her own goal was simply to get back to normal life, while also avoiding the idea of being on high doses of medication indefinitely. “We wanted to reach a point of stabilizing me and then coming back down,” she says.
When Antihistamines Aren’t Enough
For patients who continue to struggle, Dr. Craig says there are several other treatment options, including the injectable medications omalizumab, or Xolair, and dupilumab, or Dupixent, as well as the oral medication remibrutinib, or Rhapsido. “They do have a different mechanism,” he says, explaining that each targets a different part of the pathway involved in mast-cell activation and histamine release. “They all do work.”
Choosing among them isn’t simply about oral versus injectable treatment. Effectiveness, side effects, dosing and a patient’s individual circumstances all factor into the decision. “What I do is shared decision-making,” Dr. Craig says. For harder-to-control cases, cyclosporine may also be considered.
The ultimate measure, he says, is how much of a patient’s life they get back. “I actually look for complete control of the hives. And obviously I don’t want to have adverse effects from drugs,” says Dr. Craig. Once patients are doing well, he typically waits before reducing treatment. “I usually want to have people cool off for a period of time, maybe three months, and then we can start taking them off their medication.”
Feeling Like Herself Again
Today, Kassie says the anxiety that once controlled so much of her life is largely gone. She no longer fears certain foods, her hives are under control and she and her doctor are working toward gradually reducing her therapy. “It is kind of freeing to not have as much anxiety anymore,” she says.
Looking back, she wishes she had taken the condition more seriously earlier and known there were more options beyond simply taking a daily antihistamine and hoping for the best. “I wish I knew more of the options,” she says.
Dr. Craig’s advice for anyone still struggling is similarly simple: don’t assume you have to live with uncontrolled symptoms. If hives continue despite over-the-counter treatment or are significantly affecting your quality of life, talk to your doctor or ask for a referral to an allergist or dermatologist.
