Chronic urticaria

What is chronic urticaria?

Chronic urticaria, is a long-lasting, serious condition marked by recurring episodes of itchy hives and/or deep tissue swelling that can unpredictably flare and subside over time for more than six weeks and may continue for months or even years.¹

 

There are two main types of chronic urticaria:

• Chronic spontaneous urticaria (CSU): Hives that occur with no known external trigger.¹
• Chronic inducible urticaria (CIndU): Hives caused by a specific trigger, such as heat, cold or exercise.¹

What is chronic spontaneous urticaria (CSU)?

CSU is the most common form of chronic urticaria, characterized by its unpredictability and debilitating impact, and is usually driven by internal causes rather than external triggers.^2-4

• It affects over 40 million people worldwide^3,5
• Women are 2 times as likely to be impacted than men³
• It occurs most frequently between the ages of 20-40 years³

Living with CSU can be very distressing and it can have a severe impact on quality of life, including sleep and daily activities.^2,3,6

The patient voice is the key trigger in changing how CSU is treated. Start a conversation with your doctor about how itching affects daily life and overall wellbeing.

What are the symptoms of CSU?

CSU is characterized by the sudden appearance of itchy hives (rash/wheals) and/or deep tissue swelling (angioedema).^2,7 The burning skin rash and painful swelling can appear anywhere, but often affect visible areas like the face, which can make everyday interactions unbearable.^2,6

These debilitating flare-ups can happen at any time and without warning, lasting anywhere from 6 weeks, to months, to years.^2,3 The condition can resolve over time - however there is no way to predict when this may happen.⁸

Recent survey findings show that 70% of people with CSU say treating the debilitating itch is their most important treatment goal.⁹

How does CSU affect daily life?

CSU symptoms (especially itch) and their unpredictability can impact all aspects of life, from everyday routines including work, finances and sleep, while also taking a severe toll on quality of life, including emotional wellbeing and relationships.^3,13

How is CSU managed?

Antihistamines are currently the recommended first-line treatment option for CSU, however in recent surveys, doctors and patients reported CSU symptoms and antihistamine effectiveness differently:^3,7

• Over 25% of patients report symptoms as more severe than their doctor¹⁸
• 76% of people with CSU, the majority being treated with antihistamines, said they continue to experience symptoms despite treatment, while doctors believe only 23% are still affected⁹

Increasing antihistamine doses up to 4 times the usual amount may only provide limited relief, with 45-55% of people still experiencing symptoms.^19,20 People with CSU find that antihistamines become less effective over time and/or may cause side effects such as drowsiness.²¹

Beyond antihistamines, injectable biologic therapies have been shown to be an alternative, but fewer than 20% of CSU patients worldwide are treated with them.²²

It’s important for patients and doctors to have conversations about itch, its impact on daily life and sleep, and how CSU is managed. Intermittent symptoms and unpredictable flare-ups can make the full impact difficult to communicate, so if treatment isn’t providing enough relief, speak up, share symptoms and discuss a care plan with a doctor.^18,23,24

What Is Chronic Inducible Urticaria (CIndU)?

CIndU is a type of chronic urticaria caused by an identifiable external trigger like pressure, sunlight, friction, heat, cold or water.¹ In CIndU, hives can last for a few minutes or for a few hours, and typically appear in the exact spot where the skin was triggered.¹

• CIndU affects approximately 29 million people worldwide^27,28
• CIndU differs from CSU, which has no specific triggers¹

Identifying triggers is a key part of managing the condition. There are several types of CIndU, but the three most common subtypes are:

• Symptomatic Dermographism (SD): SD occurs following light scratching, rubbing, or friction on the skin. Itchy hives appear within 5 minutes of contact and usually last 30 minutes.^4,29 For some people, even clothing seams, towels, or gentle pressure on the skin can trigger symptoms^4,29
• Cold Urticaria (ColdU): ColdU occurs after skin exposure to cold, leading to wheals or angioedema that develop within minutes after exposure and are usually limited to areas exposed to the cold^4,29
• Cholinergic Urticaria (CholU): CholU is triggered by a rise in body temperature, such as during exercise, hot showers, stress or strong emotions. It often appears as clusters of small, itchy hives that develop shortly after the body begins to heat up^4,29

Other less common forms of CIndU can be triggered by things like sustained, heavy pressure on the body for a prolonged period, such as from manual labor or tight clothing (delayed pressure urticaria), exposure to direct heat (heat urticaria), or by coming into contact with certain substances like foods, latex, or chemicals (contact urticaria).³⁰

Less common triggers of CIndU also include sunlight (solar urticaria), contact with water (aquagenic urticaria), or continuous vibration exposure, like using a push-style lawnmower (vibratory angioedema).³⁰

What questions can you ask your doctor?

Use the questions below to help guide a conversation with your doctor and explain how chronic urticaria is affecting your daily life. Remember to be open and share all daily impacts, no matter how small.

1. How should I track my symptoms between appointments? 
2. How can I manage my symptoms (painful hives, itch and swelling) at home?
3. How do I explain to my employer or family about chronic urticaria?

Hear from the chronic urticaria community:

“My skin was burning like a volcano all day and night and I found concentrating very difficult. When I was sick, my concentration was over and it was impossible to think, because I was thinking about the pain and the itching all the time. I didn’t feel comfortable and well, I lost my job,” — says Marta, CSU patient from Spain. “Years of trying so many things were so frustrating – it’s been a long and difficult journey for me.”

Support and resources

“For many patients, chronic urticaria goes far beyond itchy skin. It affects concentration at work, impacts personal relationships and makes it difficult to sleep. Too often, this burden is not fully recognized in the clinic and patients do not feel they have access to the support and information that they need to help manage their condition,” — shares Tonya Winders, President and CEO, Global Allergy and Airways Patient Platform (GAAPP).

For more information about tracking and managing symptoms, check out the following resources:

• Global Allergy & Airways Patient Platform (GAAPP) for patient support at an international level
  • Visit their members page to find local patient support groups, which may provide emotional support, practical advice, and opportunities to connect with others who are living with chronic urticaria
• UCARE CRUSE app for tracking symptoms, which can be a useful tool for patients to use in medical appointments to explain the frequency, duration, and daily life impact of flare-ups

Glossary

• Allergy: A condition in which the immune system reacts abnormally to a usually harmless substance, such as food, pollen, or medication.
• Angioedema: Sudden swelling that occurs beneath the skin, often affecting the face, lips, tongue, throat, or limbs and sometimes associated with allergic reactions.
• Antihistamine: A medication that blocks the effects of histamine to reduce allergy symptoms such as itching, hives and swelling.
• Autoimmune: A term describing conditions in which the immune system mistakenly attacks the body’s own tissues.
• Basophils: A type of white blood cell involved in immune and allergic responses, including the release of histamine.
• Bruton's tyrosine kinase (BTK): An enzyme that plays an important role in immune cell signaling and activation, particularly in certain white blood cells.
• Chronic hives: Hives that last for six weeks or longer and may occur almost daily.
• Dermatology: The branch of medicine that focuses on conditions of the skin, hair and nails.
• Histamine: A chemical released by certain immune cells during allergic reactions that causes symptoms such as itching, redness, swelling and hives.
• Immune system: The body’s defense system that protects against infections and harmful substances.
• Itching: An uncomfortable skin sensation that creates an urge to scratch, often associated with allergic or inflammatory conditions.
• Mast cells: Immune cells found in the skin and other tissues that release histamine and other chemicals during allergic reactions.
• Wheals: The raised, swollen areas of skin that appear during hives, often surrounded by redness.