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Writer's pictureCatherine Keying Zhu

Behind the Hives: Unpacking the Mystery of Chronic Urticaria

We’ve all had the occasional itch or rash, but imagine waking up day after day with red, itchy hives that seem to appear out of nowhere. No matter what remedies you try, nothing seems to make them go away. If this sounds like your daily experience, you’re not alone, and it’s not just a frustrating itch—chronic urticaria is a real condition that millions around the world deal with. 


But what exactly is chronic urticaria? Through our blog series, we’ll take you on a journey into the world of chronic urticaria, exploring the causes, symptoms, and management of this stubborn condition. In this first post, let’s dive into the basics: what is chronic urticaria?


What Exactly Is Chronic Urticaria?

Chronic urticaria (CU) is characterized by the recurring appearance of wheals, angioedema, or both, lasting for more than six weeks. You might wonder what “recurring” means in this context—this refers to symptoms that come and go, with each individual hive lasting less than 24 hours. If your hives persist for less than six weeks, you may have urticaria, but it’s considered acute urticaria instead.


Chronic urticaria (CU) can be divided into two main types: chronic inducible urticaria (CIndU) and chronic spontaneous urticaria (CSU). If your hives appear after specific triggers, such as heat, exercise, sunlight, water, or cold, you likely have CIndU. On the other hand, if your hives or swelling seem to come out of nowhere with no clear cause, you probably have CSU.


Who Is Affected by Chronic Urticaria?

Now that we understand what chronic urticaria is, let’s take a closer look at who’s most affected by it. Chronic urticaria is a relatively common condition, affecting about 1% of the global population—meaning 1 in every 100 people experiences it. CU can impact both children and adults, though women are twice as likely to be affected as men.



Recognizing the Signs and Symptoms of Chronic Urticaria

Chronic urticaria is mainly defined by two symptoms: hives and angioedema. But what exactly are these?


Hives are red, itchy spots that can range from small dots to large patches. They can show up anywhere on the body, and while they can be very uncomfortable, one of the most bothersome symptoms, each hive usually disappears within 24 hours, although new ones might appear.


Angioedema is swelling that often happens around the eyes, lips, tongue, hands, or feet. While most people with chronic urticaria experience hives, 40%-50% of them also experience angioedema, and about 1 in 10 people only have angioedema without the typical hives.


What Causes Chronic Urticaria?

You might be wondering what causes chronic urticaria, but even doctors and scientists don’t have all the answers yet. However, there are a few things that can trigger the symptoms, such as infections, stress, hormonal changes, and certain physical triggers like heat or cold. Another possible cause is problems with the immune system.


When we say there’s a problem with the immune system, we mean autoimmune dysfunction. This happens when your body’s immune system, which normally protects you from illness, gets confused and attacks your own healthy tissues by mistake.


How Is Chronic Urticaria Diagnosed?

If you think you or a loved one might have chronic urticaria, it’s important to see a specialist, such as an allergist or dermatologist. These doctors are experts in diagnosing and treating this condition. While chronic urticaria isn’t dangerous, it can significantly affect your quality of life if not properly managed. A specialist can help create a plan to control symptoms and improve daily life.


Does a Chronic Urticaria Diagnosis Mean I Need Allergy Testing?

Being diagnosed with chronic urticaria doesn’t mean you need to be tested for food or environmental allergies. Unlike acute urticaria, the chronic form is very rarely triggered by allergens. In fact, in most cases, chronic urticaria is not linked to allergies at all. Because of this, allergy testing is generally not beneficial and is not typically recommended by specialists.


Living with chronic urticaria can be challenging, but understanding the condition is the first step toward managing it. In our next blog post, we’ll dive into practical tips for managing symptoms, as well as what to expect in terms of the prognosis.


Author: Catherine Keying Zhu


 

References

  1. Zuberbier T, Abdul Latiff AH, Abuzakouk M, et al. The international EAACI/GA²LEN/EuroGuiDerm/APAAACI guideline for the definition, classification, diagnosis, and management of urticaria. Allergy. 2022;77(3):734-766. doi:10.1111/all.15090

  2. Dabija D, Tadi P, Danosos GN. Chronic Urticaria. [Updated 2023 Apr 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK555910/

  3. Saini SS, Kaplan AP. Chronic Spontaneous Urticaria: The Devil’s Itch. J Allergy Clin Immunol Pract. 2018;6(4):1097-1106. doi:10.1016/j.jaip.2018.04.013

  4. Gonçalo M, Gimenéz-Arnau A, Al-Ahmad M, et al. The global burden of chronic urticaria for the patient and society. Br J Dermatol. 2021;184(2):226-236. doi:10.1111/bjd.19561

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