Conditions / Chronic Spontaneous Urticaria
Chronic Spontaneous Urticaria
Overview
Chronic Spontaneous Urticaria (CSU) is a skin condition characterized by the recurrent appearance of hives (urticaria) and/or swelling (angioedema) that lasts for six weeks or more without a clear external trigger. The condition is believed to be caused by an overactive immune response, leading to the release of histamine and other chemicals that result in itchy, red welts, and swelling. CSU can significantly affect a person’s quality of life, often disrupting sleep, work, and emotional well-being. While the exact cause is often unknown, many cases can be managed effectively with medication and lifestyle adjustments.
Symptoms
The symptoms of CSU can range from mild to severe and may appear daily or intermittently. Common symptoms include:
• Itchy hives (welts): Red or skin-colored bumps that can vary in size and location, often appearing in clusters.
• Angioedema: Swelling beneath the skin, especially around the eyes, lips, hands, or feet.
• Hives that change location: Welts may fade in one area and appear in another within 24 hours.
• Burning or stinging sensation: In affected areas.
• Lack of a clear trigger: Hives occur spontaneously, often without warning.
When to see a doctor
Consult a healthcare provider if you:
• Experience hives or swelling that last longer than six weeks.
• Find your symptoms are worsening or impacting daily life.
• Have frequent episodes of angioedema (swelling).
• Suspect your symptoms are linked to an autoimmune condition.
• Do not respond to over-the-counter antihistamines.
Seek immediate medical attention if you have:
• Swelling of the throat or tongue.
• Difficulty breathing or swallowing.
• Signs of anaphylaxis (a severe allergic reaction), though rare in CSU.
Causes
In CSU, the cause is typically unknown (idiopathic). However, potential underlying factors may include:
• Autoimmune response: The immune system mistakenly attacks healthy tissue.
• Infections: Viral or bacterial infections may trigger or worsen symptoms.
• Stress: Emotional stress can be a contributing factor in flare-ups.
• Hormonal changes: Such as during pregnancy or menstruation.
• Other underlying conditions: Such as thyroid disease or lupus (in rare cases).
Unlike allergic urticaria, CSU is not triggered by food, medication, or environmental allergens in most cases.
Risk Factors
You may be at higher risk for CSU if you:
• Are female (women are more commonly affected).
• Are between the ages of 20 and 40.
• Have a personal or family history of autoimmune diseases.
• Experience chronic stress or other chronic health conditions.
Complications
CSU itself is not life-threatening, but it can lead to:
• Disrupted sleep: Due to intense itching.
• Emotional distress: Anxiety, depression, and frustration from chronic symptoms.
• Work and social impairment: Flare-ups may interfere with daily life.
• Side effects from long-term medication use.
Without timely treatment, TED can cause:
• Vision impairment or loss.
• Corneal damage from eyelid exposure.
• Misalignment of eye muscles leading to double vision.
• Psychological distress due to appearance changes or visual limitations.
Mediacal Risk
CSU can often be managed with a combination of medications and lifestyle changes:
• Antihistamines: The first line of treatment, often in higher-than-standard doses.
• Leukotriene receptor antagonists: May help reduce inflammation.
• Omalizumab (Xolair): A biologic therapy for moderate-to-severe cases not controlled by antihistamines.
• Oral corticosteroids: Used short-term for flare-ups but not recommended long-term due to side effects.
• Lifestyle management: Avoiding triggers (if known), managing stress, and maintaining good sleep hygiene.
Potential medical risks include:
• Dependence on corticosteroids: Leading to long-term complications.
• Delayed diagnosis of an autoimmune disorder: If symptoms are overlooked.
• Reduced quality of life: Without proper management or support.
With the right treatment plan and regular follow-ups, many people with CSU experience significant relief and even remission over time.
Treatments