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.
For education only — this guide can't diagnose you. If these signs sound familiar, talk with a healthcare provider. Book a consult
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.
Signs worth getting checked
- 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
Treatments your doctor may discuss
- 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
Ready to find the root cause?
Dr. Lesher is a Naturopathic Doctor who focuses on autoimmune and chronic conditions in women. Since 2020, she's helped hundreds of patients stop managing symptoms and start healing.