Chronic Hives: When the Welts Won't Go Away
More than 6 weeks of itching: it's a disease in itself.
Dr. Nadia Kouri
Allergist-Immunologist
In simple terms
Chronic spontaneous urticaria affects 1% of the population. Rarely allergic, it requires specific treatment.
What you need to remember
- Mechanism — Cutaneous mast cells spontaneously activate and release histamine, causing vasodilation, edema, and itching.
- What is NOT Useful — Extensive allergological assessments (in chronic spontaneous urticaria, allergic tests are normal)
- Treatment — H1 Antihistamines**: first line, up to 4 times the standard dose if necessary
- Evolution — The disease progresses with flares and remissions.
Chronic spontaneous urticaria is defined by the appearance of red, raised, and itchy welts for more than 6 weeks, without an identifiable cause. Contrary to popular belief, it is rarely of allergic origin.
Mechanism
Cutaneous mast cells spontaneously activate and release histamine, causing vasodilation, edema, and itching. In 30 to 50% of cases, autoantibodies directed against the patient's own cells are involved.
What is NOT Useful
- Extensive allergological assessments (in chronic spontaneous urticaria, allergic tests are normal)
- Drastic dietary elimination diets without evidence
- Systematic infection screenings
Treatment
- H1 Antihistamines: first line, up to 4 times the standard dose if necessary
- Omalizumab: anti-IgE antibody, in case of antihistamine failure. Remarkable effectiveness.
- Cyclosporine: last line for refractory cases
Evolution
The disease progresses with flares and remissions. The median duration is 2 to 5 years, with spontaneous resolution in the majority of cases.
The words explained
Medical terms used above, in everyday language.
- Chronic
- A problem that lasts a long time, usually more than three months, and often comes back.
- Antibody
- A protein your body makes to recognise and neutralise a specific germ.
- Remission
- A period when the disease is quiet and symptoms fade or disappear.
When should you see a doctor?
- Your symptoms last more than a few weeks or keep coming back.
- They get worse quickly, or stop you doing everyday things.
- You notice sudden pain, breathing trouble, fainting or bleeding — seek urgent care.
- You already take medication and want to change anything about it.
This article explains general health information. It does not replace advice from your own doctor.
Frequently asked questions
- What is Chronic Hives: When the Welts Won't Go Away?
- Chronic spontaneous urticaria affects 1% of the population. Rarely allergic, it requires specific treatment.
- What are the main symptoms or signs of Chronic Hives: When the Welts Won't Go Away?
- Common signs vary from person to person. The article above lists the symptoms to watch for, how they progress, and when they need medical attention.
- When should you see a doctor for Chronic Hives: When the Welts Won't Go Away?
- See a doctor if symptoms last more than a few weeks, get worse quickly, stop you doing everyday things, or if you notice sudden pain, breathing trouble, fainting or bleeding.
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