Itch & Neuropathic
Chronic Spontaneous Urticaria
Chronic hives; CSU
Common; affects ~1 in 100 at some point
No — you cannot catch it or spread it
Often self-limited; very controllable meanwhile
What Is It?
Chronic spontaneous urticaria is recurring hives (itchy, raised welts) that come and go for more than six weeks with no clear outside cause. Welts can appear anywhere, last less than 24 hours in one spot, then fade without a mark. Some people also get deeper swelling (angioedema) of the lips or eyes. It often settles on its own over months to a few years.
Signs & Symptoms
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Itchy, raised welts (hives) that move around the body
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Individual welts fade within 24 hours, leaving no mark
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Deeper swelling of lips, eyelids, or hands (angioedema)
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Flares that come and go for more than six weeks
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Worse with heat, pressure, stress, or certain medicines
Why Does It Happen?
The welts happen when immune cells in the skin (mast cells) release histamine, causing itch, redness, and swelling. In CSU this often reflects an overactive or misdirected immune signal rather than an allergy. Heat, stress, tight clothing, infection, and certain medicines (like NSAIDs) can worsen it, but they are triggers, not the root cause. It is NOT contagious.
Treatment Options
Treatment follows a clear ladder, starting with non-drowsy antihistamines. Most people gain good control; the goal is to suppress hives while the condition runs its course.
ANTIHISTAMINES
Daily non-drowsy (2nd-generation) antihistamines are first-line; the dose can be raised up to fourfold.
OMALIZUMAB
An injection (anti-IgE) added when antihistamines aren't enough — the main next step.
CYCLOSPORINE
An immune-calming pill for cases that resist other treatment.
TRIGGER CARE
Limiting NSAIDs, heat, and stress; short steroid bursts only for severe flares.
Tips for Managing It at Home
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Take antihistamines daily as prescribed, not just when hives appear
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Keep a simple diary of possible triggers (foods, meds, stress, infections)
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Avoid NSAIDs (like ibuprofen) if they worsen your hives
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Keep cool and wear loose clothing during flares
When to Call Your Provider
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Swelling of the tongue, throat, or trouble breathing (emergency)
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Hives with fever, joint pain, or feeling unwell
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Individual welts that last more than 24 hours or bruise
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Poor control despite regular antihistamines
Sources & further reading
The information in this handout is based on general dermatology guidance from the reputable organizations below. These links are provided for patients who wish to read more from trusted sources.
American Academy of Dermatology (AAD). Hives: Overview. https://www.aad.org/public/diseases/a-z/hives-overview
Canadian Dermatology Association (CDA). Urticaria. https://dermatology.ca/public-patients/diseases-conditions/skin-conditions/urticaria/
DermNet. Chronic Spontaneous Urticaria. https://dermnetnz.org/topics/chronic-spontaneous-urticaria
MSD/Merck Manual. Chronic Urticaria. https://www.msdmanuals.com/professional/dermatologic-disorders/approach-to-the-dermatologic-patient/urticaria
This handout is for general education and does not replace advice from your own provider. Always follow your provider’s specific instructions.
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