Chronic Spontaneous Urticaria (Hives)

Urticaria is the medical term for hives.

Chronic spontaneous urticaria (CSU) is a skin condition defined by widespread urticaria +/- angioedema that persist for a period of 6 weeks or more without a clear physical trigger.

It occurs in approximately 7 out of a 1,000 people and is more common in women. It is more common in those with a personal or family history of autoimmune thyroid disease.

What causes Chronic Spontaneous Urticaria (Hives)?

The majority of patients with CSU have autoantibodies against resident skin cells called mast cells, or to a class of antibody bound to their surface. There is no readily available commercial test to assess for the presence of these autoantibodies. These autoantibodies trigger the release of preformed compounds from mast cells; the most important one of which is histamine. It is the action of histamine on local blood vessels and neurons that mediates the symptoms of CSU.

CSU is NOT an allergic condition.

Frequently Asked Questions

What are the symptoms of CSU?

CSU is NOT an allergic condition.

How is CSU diagnosed?

Raised, red or pink welts (hives) on the skin.
Itching or burning sensation.
Swelling (angioedema) of the lips, eyes, hands, feet, or genitals.
Hives that come and go without an apparent trigger.

How is CSU managed?

Diagnosing CSU involves a medical history, physical examination, and sometimes additional tests to rule out other possible causes of hives. Your healthcare provider may perform the following:

Detailed medical history to assess the duration and frequency of hives.
Physical examination to evaluate the appearance and distribution of hives.
Blood tests to assess for other conditions.
Allergy tests are usually NOT required.

Will my hives ever go away?

While there is no cure for CSU, several medications can help alleviate symptoms and improve quality of life, listed as follows:

Non-sedating second generation oral anti-H1 antihistamines (e.g. fexofenadine, bilastine) are the mainstay of treatment of CSU for most patients. These may need to be dosed at up to 4 times a day to be effective.
Anti-H2 antihistamines, leukotriene receptor antagonists, doxepin – are ancillary medications that may help with more refractory urticaria.
Oral corticosteroids – are effective for urticaria but must be used under close medical supervision given the potential for side effects.
Omalizumab – Xolair (omalizumab) is a therapeutic monoclonal antibody against IgE. It has proven efficacy for CSU but has strict PBS prescription criteria and is only used in moderate to severe CSU.

Conditions Treated

Diagnostic Services

Treatments

Clinic Information