## [Chronic urticaria](/diseases/chronic-urticaria "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 ![Young friends talking about chronic urticaria at a picnic bench](/sites/novartis_com/files/styles/crop_freeform/public/2026-08/friends-discussing-chronic-urticaria-symptoms-and-management.jpg.webp?itok=5NFuep1x "Young friends talking about chronic urticaria at a picnic bench") Fictional patient image ## 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 worldwide3,5 - 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 the immune system cause CSU symptoms? Commonly, CSU develops when the body’s defense system is inappropriately activated, often through autoimmune mechanisms, rather than as a result of an allergen or external trigger: the cells that usually protect us from germs become overactive.2,7 Two main types of immune cells, mast cells and basophils, are involved in CSU, both of which contain a critical protein called Bruton’s tyrosine kinase (BTK).10-12 BTK triggers the immune cells to release histamine, causing the unpredictable flares of burning itch, hives, and/or deep tissue swelling seen in CSU.2,10-12 Learn more about the internal mechanisms that cause CSU and how these trigger symptoms. var kPlayer = KalturaPlayer_55802022 || KalturaPlayer; var config = { targetId: "kaltura_player_6a86d0fb3af34600616743", provider: { widgetId: "1_mh5rvan2", partnerId: "2076321", uiConfId: "55802022" }, playback: { autoplay: false, autopause: false, muted: false, loop: false }, sources: { options: {}, startTime: 0 }, disableUserCache: "true", plugins: {}, sources: { options: {}, startTime: 0 }, ui: { showCCButton: false, settings: { showQualityMenu: true, showSpeedMenu: false }, components: { fullscreen: { disableDoubleClick: false } }, uiComponents: [ { presets: ['Playback', 'Live'], area: 'BottomBarRightControls', replaceComponent: 'Fullscreen', get: kPlayer.ui.components.Remove } ] } }; // Check and add plugins only if they exist if (kPlayer.plugins["download"]) { config.plugins.download = { disable: true }; } if (kPlayer.plugins["transcript"]) { config.plugins["playkit-js-transcript"] = { position: "right", // Default: bottom;('left', 'right', 'top', 'bottom') to enable transcript. expandMode: "over", // Default: alongside;('alongside', 'hidden', 'over') expandOnFirstPlay: false, showTime: true, downloadDisabled: false, printDisabled: false, disable: true }; } if (kPlayer.plugins["preventSeek"]) { config.plugins.preventSeek = { preventSeekForward: false, preventSeek: false }; } config.plugins.floating = { disable: true }; if (kPlayer.plugins["navigation"]) { config.plugins.navigation = { position: "right", expandMode: "over", expandOnFirstPlay: false, visible: false }; } if (kPlayer.plugins["hotspots"]) { config.plugins['playkit-js-hotspots'] = { disable: true }; } if (kPlayer.plugins["moderation"]) { config.plugins['playkit-js-moderation'] = { disable: true }; } if (kPlayer.plugins["info"]) { config.plugins['playkit-js-info'] = { disable: true }; } if (kPlayer.plugins["share"]) { config.plugins.share = { disable: true }; } config.ui.uiComponents = []; config.abr = { "enabled": false, "restrictions": { "minBitrate": 957000 } }; if (kPlayer.plugins["googleAnalytics"]) { config.plugins.googleTagManager = {}; config.plugins.googleTagManager.customEventsTracking = {}; config.plugins.googleTagManager.containerId = 'GTM-57RJQ5'; config.plugins.googleTagManager.customEventsTracking.custom = []; config.plugins.googleTagManager.customEventsTracking = { preset: { coreEvents: true, UIEvents: false, playlistEvents: false, castEvents: false } }; } // Ensure the global player registry array always exists, regardless of embed type. window.kalturaPlayerVideos = window.kalturaPlayerVideos || []; try { var thumbEmbedPromise = __thumbnailEmbed({config, mediaInfo: {entryId: "1_z91esg9f"}}); // __thumbnailEmbed() returns a Promise that resolves with the player instance // when the user clicks the thumbnail. Use .then() to capture the player directly. thumbEmbedPromise .then(function(player) { window.kalturaPlayerVideos.push(player); // Notify kaltura_datalayer.js that a new player is ready so it can // attach custom event listeners immediately, regardless of when // the user clicked the thumbnail relative to page load. document.dispatchEvent(new CustomEvent('kalturaPlayerReady', { detail: { player: player } })); }) .catch(function(error) { console.error(error); }); } catch (e) { console.error(e.message) } ### 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 Sleep In a recent survey, almost 80% of people living with CSU reported disruptions to their sleep as a result of the unpredictability of the condition. Uncontrolled itch means those living with CSU can take longer to get to sleep and sleep for shorter periods of time.14,15 Work Research also shows that over 55% of CSU patients report a significant impact on work, including up to ~40% productivity loss.16 In some cases, patients report challenges keeping employment.16 Socializing Many people with CSU avoid social situations because they are embarrassed by their visible symptoms, leading to social withdrawal and isolation.17 Emotional and mental health Patients living with CSU are not only impacted physically but also emotionally.18 Findings show that CSU patients are 2 times as likely to face mental health problems, such as anxiety or depression, compared to those not living with the condition.18 ### 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 ### Finding hope for a life less disrupted by CSU CSU symptoms, like uncontrolled itch, substantially impact quality of life.25,26 Learn how talking to a doctor about how itch affects daily life and overall wellbeing can help you find hope for a life less disrupted by CSU. var kPlayer = KalturaPlayer_55802022 || KalturaPlayer; var config = { targetId: "kaltura_player_6a86d0fb49757209255689", provider: { widgetId: "1_f42x9whu", partnerId: "2076321", uiConfId: "55802022" }, playback: { autoplay: false, autopause: false, muted: false, loop: false }, sources: { options: {}, startTime: 0 }, disableUserCache: "true", plugins: {}, sources: { options: {}, startTime: 0 }, ui: { showCCButton: false, settings: { showQualityMenu: true, showSpeedMenu: false }, components: { fullscreen: { disableDoubleClick: false } }, uiComponents: [ { presets: ['Playback', 'Live'], area: 'BottomBarRightControls', replaceComponent: 'Fullscreen', get: kPlayer.ui.components.Remove } ] } }; // Check and add plugins only if they exist if (kPlayer.plugins["download"]) { config.plugins.download = { disable: true }; } if (kPlayer.plugins["transcript"]) { config.plugins["playkit-js-transcript"] = { position: "right", // Default: bottom;('left', 'right', 'top', 'bottom') to enable transcript. expandMode: "over", // Default: alongside;('alongside', 'hidden', 'over') expandOnFirstPlay: false, showTime: true, downloadDisabled: false, printDisabled: false, disable: true }; } if (kPlayer.plugins["preventSeek"]) { config.plugins.preventSeek = { preventSeekForward: false, preventSeek: false }; } config.plugins.floating = { disable: true }; if (kPlayer.plugins["navigation"]) { config.plugins.navigation = { position: "right", expandMode: "over", expandOnFirstPlay: false, visible: false }; } if (kPlayer.plugins["hotspots"]) { config.plugins['playkit-js-hotspots'] = { disable: true }; } if (kPlayer.plugins["moderation"]) { config.plugins['playkit-js-moderation'] = { disable: true }; } if (kPlayer.plugins["info"]) { config.plugins['playkit-js-info'] = { disable: true }; } if (kPlayer.plugins["share"]) { config.plugins.share = { disable: true }; } config.ui.uiComponents = []; if (kPlayer.plugins["googleAnalytics"]) { config.plugins.googleTagManager = {}; config.plugins.googleTagManager.customEventsTracking = {}; config.plugins.googleTagManager.containerId = 'GTM-57RJQ5'; config.plugins.googleTagManager.customEventsTracking.custom = []; config.plugins.googleTagManager.customEventsTracking = { preset: { coreEvents: true, UIEvents: false, playlistEvents: false, castEvents: false } }; } // Ensure the global player registry array always exists, regardless of embed type. window.kalturaPlayerVideos = window.kalturaPlayerVideos || []; try { var thumbEmbedPromise = __thumbnailEmbed({config, mediaInfo: {entryId: "1_y4e3r2j6"}}); // __thumbnailEmbed() returns a Promise that resolves with the player instance // when the user clicks the thumbnail. Use .then() to capture the player directly. thumbEmbedPromise .then(function(player) { window.kalturaPlayerVideos.push(player); // Notify kaltura_datalayer.js that a new player is ready so it can // attach custom event listeners immediately, regardless of when // the user clicked the thumbnail relative to page load. document.dispatchEvent(new CustomEvent('kalturaPlayerReady', { detail: { player: player } })); }) .catch(function(error) { console.error(error); }); } catch (e) { console.error(e.message) } ## 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 worldwide27,28 - 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 symptoms4,29 - **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 cold4,29 - **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 up4,29 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: ![Melitta, CSU patient from Germany](/sites/novartis_com/files/styles/cta_image/public/2026-08/melitta-csu-patient-from-germany.jpg.webp?itok=k6CttJwm "Melitta, CSU patient from Germany") *"At the beginning of the illness every symptom kept getting worse over time, and at some point I reached a stage where I didn’t even want to sleep anymore, because I knew that if I went to bed and actually tried to sleep, then the worst phase of the day would start again, and that was very, very difficult."* — says **Melitta**, CSU patient from Germany. *“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.”* ![Prof. Dr med. Martin Metz, Deputy Director, Institute of Allergology, Charité Universitätsmedizin Berlin, Germany](/sites/novartis_com/files/styles/cta_image/public/2026-08/prof-dr-med-martin-metz.png.webp?itok=cWpot53A "Prof. Dr med. Martin Metz, Deputy Director, Institute of Allergology, Charité Universitätsmedizin Berlin, Germany") *"CSU, with its itchy wheals that appear daily, affects every aspect of a person’s life - from sleep and work to their social life. For patients with CIndU, thinking about how they can avoid triggers is also something that substantially affects their quality of life. However, patients don’t usually bring these issues up – we normally have to ask how symptoms affect their daily life."* *"Patients are stuck with uncontrolled disease because they don’t receive the treatment they need. With new care options available, treatment guidelines need to be followed, and care should be sufficiently stepped-up."* — says **Prof. Dr med. Martin Metz**, Deputy Director, Institute of Allergology, Charité Universitätsmedizin Berlin, Germany. ### 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)](https://gaapp.org/about/member-organizations) 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](https://ucare-network.com/cruse-chronic-urticaria-self-evaluation-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. **References** 1. 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Acta dermato-venereologica 2018; 98: 641-647. 24. Zuberbier T, Abdul Hameed Ansari Z, Abdul Latiff AH, et al. The International Guideline for the Definition, Classification, Diagnosis and Management of Urticaria. Allergy; 2026. 25. Maurer M AM, Bérard F. The burden of chronic spontaneous urticaria is substantial: Real-world evidence from ASSURE-CSU. Allergy 2017; 72: 2005-2016. 26. Balp M-M, Vietri J, Tian H, et al. The Impact of Chronic Urticaria from the Patient’s Perspective: a Survey in Five European Countries. Patient 2015; 8: 551-558. 27. World Population Prospects, Department of Economic and Social Affairs Population Division, United Nations. Available from: [https://population.un.org/wpp/downloads?folder=Standard%20Projections&group=Population](https://population.un.org/wpp/downloads?folder=Standard%20Projections&group=Population) \[Last accessed: July 2026\]. 28. Maurer M, et al. How to approach Chronic Inducible Urticaria, The Journal of Allergy and Clinical Immunology, 2018, Volume 6, Issue 4, Pages 1119-1130. 29. Pozderac I, Lugović-Mihić L, Artuković M, et al. Chronic inducible urticaria: classification and prominent features of physical and non-physical types. 2020. 30. Maurer M, Bonnekoh H, Grekowitz E, et al. An algorithm for the diagnosis and treatment of chronic inducible urticaria, 2024 update. In: Wiley Online Library; 2024.