Chronic Spontaneous Urticaria | Allergy UK | National Charity
Helpline01322 619898Chronic Spontaneous Urticaria (CSU) is a common and distressing skin condition that causes itchy, red and sometimes painful hives or wheals (raised patches or rash) on the skin without an obvious cause or trigger.
The rash can appear as small bumps or larger raised patches of different shapes and sizes and can affect any part of the body. Some people also experience
swelling beneath the skin called angioedema, which commonly affects the face, lips, hands, feet or eyelids.
To be diagnosed with CSU, symptoms must occur regularly for at least six weeks. It is called “spontaneous” because there is no identifiable trigger causing the
symptoms.
CSU can look different from person to person and may appear differently on different skin tones.
CSU varies from person to person, and it is not possible to predict how long symptoms will continue. While some people experience symptoms for a relatively short period of time, others may have CSU for several years.
Although CSU can be a long-term condition, effective treatments are available that can help control symptoms and improve quality of life. If your symptoms are not well controlled, speak to your healthcare professional about the treatment options available to you.
CSU occurs when immune cells called mast cells release chemicals, including histamine, into the skin. This causes the itching, redness, swelling and raised rash associated with urticaria.
Mast cells are a normal part of the immune system and help protect the body from infection and support healing. In CSU, these cells become activated when they should not, leading to symptoms.
Some factors may make symptoms worse in certain people, including stress, infections and some medications, but these do not usually cause CSU itself.
CSU is often unpredictable and can have a significant impact on quality of life. It may affect:
No. CSU is not caused by allergens (substances which cause an allergic response) or an allergic reaction.
Because of this, allergy testing, elimination diets, and avoidance of the usual triggers are not always useful in trying work out the cause or
manage symptoms.
Some people notice that certain things make their symptoms worse, but these do not cause CSU. Unlike other types of urticaria, there is often no identifiable trigger for CSU.
Soothe the skin:
Avoid scratching:
Scratching causes the release of more histamine, which can make itching worse and can lead to skin damage and colour changes.
Some people find that relaxation techniques, mindfulness or other distractions can help them cope with itching.
Wear comfortable clothing:
Loose, lightweight clothing can improve comfort.
Identify factors that worsen symptoms:
Some people find symptoms are aggravated by:
Always speak with your healthcare professional before stopping any prescribed medication.
If you think you may have CSU, make an appointment with your GP or healthcare professional. They may:
Because CSU can come and go, it may take more than one appointment before a diagnosis is confirmed.
Before your appointment:
Useful questions to ask:
There is currently no cure for CSU. Treatment focuses on controlling symptoms and improving quality of life.
Step 1: Non-sedating antihistamines
A daily non-sedating antihistamine is usually the first treatment offered. If symptoms continue, healthcare professionals may increase the dose up to four times the usual licensed dose in line with clinical guidelines, this must only be done under the supervision and advice of a healthcare professional.
Step 2: Additional medication
If antihistamines do not adequately control symptoms, a leukotriene receptor antagonist may be considered. A short course of corticosteroid tablets may occasionally be prescribed for severe flare-ups. Repeated courses can have adverse health effects in the long term; therefore they are not given frequently.
Step 3: Biologic therapies (started in specialist centres)
For people whose symptoms remain difficult to control, biologic therapies may be prescribed by specialist hospital teams. These treatments target specific parts of the immune system involved in CSU.
Step 3 continued: Immunosuppressant treatment (started in specialist centres)
Specialist treatments such as ciclosporin may be recommended. These treatments reduce immune system activity and require regular blood-test monitoring.
It is important to note that for many medical conditions, there are ongoing research trials and new medications being explored and considered for new treatments. This is the case for CSU, this is why seeing your GP and when appropriate getting a referral to a specialist team is very important in exploring the best treatment options for you.
Speak to your healthcare professional if:
Seek urgent medical attention if:
Living with CSU can be challenging, but it is important to remember that you are not alone. Although the condition can affect sleep, work, relationships and emotional wellbeing, effective treatments and specialist support are available.
If your symptoms continue despite treatment, speak to your healthcare professional about the options available to you and whether a referral to a specialist is appropriate.
With the right support and treatment plan, many people can achieve good symptom control and regain confidence in managing their condition.
Acknowledgements:
The content of this booklet was developed by Anne Biggs, Deputy Clinical Director, Allergy UK, and externally reviewed by Sarah Denman, MRCPharm
(Consultant).
Novartis Pharmaceuticals UK Ltd has provided sponsorship funding towards this project. Novartis has had no input or involvement into any of the content.