Hives can be a maddening problem. At their mildest, they can simply be bothersome and at their worst can be dangerous. Trying to uncover the cause of hives is a difficult and often fruitless task.
It is helpful to break hives down into acute and chronic hives. Acute hives occur once and go away whereas chronic hives linger. Allergists see far fewer cases of acute hives, because the cause is often obvious: I went to Red Lobster and had the shrimp platter. My lip swelled immediately then it went away. Confirmatory testing is sometimes helpful, but most people simply avoid the obvious offenders.
Chronic hives often lack this sort of obvious history and, ironically, are much less likely to be allergic. Having seen thousands of cases of chronic hives over the last decade, I have learned a few things here and there. First, its not your soap/shampoo/detergent that’s causing hives. These things cause contact dermatitis, but very rarely result in hives. Second, the more foods you think may be causing hives, the less likely it is that you have a food allergy. Having more than 2 food allergies as an adult is vanishingly rare. Allergic reactions to foods most often occur within 15-30 minutes after ingestion and almost always within 2 hours, so if you’re waking up in the middle of the night, then its probably not a food allergy. Third, watch your supplements! I’ve seen numerous cases where discontinuing certain supplements/natural remedies has brought about an immediate end to hives. Finally, don’t suffer needlessly. If simple antihistamines-I like cetirizine- aren’t working, your allergist has ample experience with multiple other medications to help control symptoms. Allergists are also well versed in the myriad other rare causes for hives and can direct an appropriate work-up.