OBJECTIVES: To assess the economic burden of patients with chronic idiopathic urticaria (CIU) in terms of labor force participation, work and activity impairment, and healthcare utilization, using patients currently treated for chronic hives (CH) as a proxy. METHODS: Data were obtained from the US National Health and Wellness Survey (NHWS) in 2010-2012, representative of US adult population in terms of age, sex, and ethnicity.  Measures included labor force participation, the Work Productivity and Activity Impairment questionnaire, and self-reported healthcare use in the prior 6 months.  Respondents indicating current use of a prescription for CH (cases) were matched 1:4 to those who never experienced CH (controls), using survey year, sex, race, age (±2 years), and Charlson comorbidity index (CCI) category (0, 1-2, 3-4, or 5+), and compared using t-test and chi-square.   RESULTS: Cases (n=253) and controls (n= 1,012) did not significantly differ in terms of age, body mass index, marital status, educational attainment, or mean CCI (all p>0.05). Currently-treated CH patients participated in the labor force at a similar rate (58.1% vs. 62.2%, p=0.24), but reported higher mean levels of absenteeism (12.64% vs. 5.00%, p=0.0014), presenteeism (32.71% vs. 15.49%, p<0.0001), overall work impairment (37.32% vs. 18.26%, p<0.0001) and activity impairment (45.93 vs. 26.90, p<0.0001) relative to controls. Mean healthcare utilization in the prior 6 months was greater among cases than controls for visits to traditional healthcare providers (8.39 vs. 5.03, p<0.0001), general practitioners (1.72 vs. 1.25, p=0.0043), allergists (0.49 vs. 0.07, p<0.0001), dermatologists (0.40 vs. 0.16, p=0.0004), emergency rooms (0.50 vs. 0.33, p=0.0608), and hospitalizations (0.36 vs. 0.23, p=0.0985). CONCLUSIONS: Using CH as a proxy for CIU, a considerable economic burden on patients was evident in work productivity and use of healthcare compared to patients without CH with similar sociodemographic characteristics.