What the Trigger Doesn’t Tell You

Most patients with chronic hives never learn what sets them off. Those with chronic inducible urticaria usually can, whether it’s the rub of clothing, cold air, or the first minutes of a workout, and yet knowing rarely changes how much room the disease takes up in a day. Some will have spontaneous hives as well. Many still arrive convinced an allergy is behind it all.

Harrison Nguyen, MD, and Jason Hawkes, MD, talk through why the line between inducible and spontaneous disease still matters for prognosis, and why, when it comes to choosing therapy, it may matter less than it once did. Their discussion of treatment keeps returning to the patient’s actual life, including a shift worker they saw together whose hives were well controlled on a twice-daily oral regimen that sat awkwardly against alternating days and nights.