Chronic spontaneous urticaria (CSU), also called chronic hives, is a condition where raised, itchy welts appear on the skin on most days, for a period of six weeks or longer. These hives can vary in size, come and go, and may be accompanied by swelling of the lips, eyelids, or hands (called angioedema). While hives are often triggered by allergies in short-term cases of hives, chronic urticaria is usually not caused by food or environmental allergies. In many people, the immune system becomes overactive (referred to as either autoallergy or autoimmunity) and releases histamine in the skin without a clear external trigger. Stress, illness, heat, pressure on the skin, or infections can sometimes worsen symptoms.
To evaluate chronic urticaria, we focus on a careful medical history. Blood testing may be done to look for signs of inflammation, autoimmunity, autoallergy, thyroid disease, or other conditions that can be associated with chronic hives. Skin or allergy testing is not always needed, since chronic urticaria is rarely due to an external allergic reaction, but it may be used in select situations. Treatment is aimed at controlling symptoms and improving quality of life. This often starts with daily non-sedating antihistamines, sometimes at higher doses than used for seasonal allergies. For patients whose hives remain uncontrolled, additional options aimed at treating the underlying mechanism of chronic hives (including targeted small molecules and biologic therapy) are available and can be highly effective.
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