Chronic spontaneous urticaria
CSU, chronic hives
Autoimmune conditionHives that appear on their own, without a clear trigger, most days for 6 weeks or longer. In many people, autoantibodies drive the reaction.
What happens
Mast cells in the skin release histamine, causing itchy welts that come and go within a day, sometimes with deeper swelling of the lips, eyelids, hands, or feet. In many people, autoantibodies activate those mast cells. It isn't usually an allergy to a food or product.
Who gets it
About twice as common in women, often starting between 20 and 40. Autoimmune thyroid disease is more common in people with chronic hives.
Common signs
- Itchy, raised welts that move around and fade within 24 hours
- Swelling of the lips, eyelids, hands, or feet
- Flares with heat, pressure, stress, alcohol, or NSAID painkillers
- Itching that's often worse at night
Labs to ask about
- Complete blood count with differential
- CRP or ESR
- TSH and TPO antibodies
- Total IgE
How it's usually treated
- Daily non-drowsy antihistamines, sometimes at higher doses under supervision
- Biologic medicine (such as omalizumab) for hives that don't respond
- Short courses of steroids only for severe flares
Supportive steps to discuss with your provider
- Track flare triggers such as heat, tight clothing, alcohol, and NSAIDs.
- Most chronic hives aren't food allergies. Ask before starting a strict elimination diet.
- Get your thyroid checked.
- Build in stress management. Stress is a common trigger.
See a doctor promptly if you have
- Swelling of the tongue or throat, or trouble breathing or swallowing: call 911
- Hives with fever or joint pain
- Welts that last longer than 24 hours or leave bruise-like marks
Related conditions
Hashimoto's thyroiditis
The most common cause of an underactive thyroid in the US. The immune system slowly damages the thyroid, so it makes less hormone over time.
Learn more →Graves' disease
The most common cause of an overactive thyroid. Antibodies switch the thyroid 'on' so it makes too much hormone.
Learn more →Lupus
A whole-body autoimmune disease that can inflame the skin, joints, kidneys, blood, heart, lungs, and brain.
Learn more →
Wondering if your symptoms fit a pattern?
Dr. Lesher is a naturopathic doctor who specializes in women's autoimmune and chronic conditions. Since 2020, she has helped more than 900 patients overcome and heal from their conditions.