Chronic Urticaria: What It Is, Why It Happens, and How to Manage It.

Most people have experienced hives at some point - red, itchy welts that come and go. But what happens when they don’t go away?

If you’ve been dealing with hives that keep coming back for weeks or months, you might be facing something called chronic urticaria.

Let’s walk through what it is, why it happens, and what you can do about it.

What is chronic urticaria?

Chronic urticaria (CU) is a condition where hives last or come back regularly for more than six weeks. The welts may appear anywhere on the body. They’re usually itchy and sometimes painful or burning. In some cases, they’re accompanied by swelling (angioedema), often around the eyes, lips, hands, or feet.

Unlike typical allergic hives that fade once the trigger is removed, CU is often not tied to a specific allergen.

What causes it?

Here’s the tricky part: in many cases, we don’t know the exact cause.

Chronic urticaria usually falls into one of two categories:

Chronic spontaneous urticaria (CSU) These hives seem to appear for no clear reason. They're not caused by food, medications, or other known allergens.

Chronic inducible urticaria These hives are triggered by specific physical stimuli, such as heat, cold, pressure, vibration, or even water.

Underlying issues like autoimmune conditions, thyroid disease, or infections can sometimes play a role, but most of the time, the condition behaves independently.

How is chronic urticaria diagnosed?

There’s no single test to confirm CU. Diagnosis usually involves:

• A detailed medical history
• Physical exam
• Bloodwork to rule out autoimmune or thyroid conditions
• Sometimes allergy testing to rule out other causes

But in many cases, the diagnosis is clinical, based on how long the hives have lasted and how they behave.

How do you treat it?

The goal is to control symptoms and improve quality of life.

First-line treatment: Non-sedating antihistamines like cetirizine, loratadine, or rupatadine. These are often used daily, and the dose can be increased under medical supervision.

Second-line options:

• Prescription medications like Montelukast (Singulair) or H2 blockers
• Omalizumab (Xolair), an injectable biologic shown to be highly effective in resistant cases
• In rare, severe cases, oral steroids may be used short-term

Important: Even if hives are not caused by a true allergy, antihistamines still work by calming the immune response that triggers the skin reaction.

Can you cure chronic urticaria?

For many, chronic urticaria eventually goes into remission. About half of people see it resolve within 6 months to a year. For others, it may last longer, but symptoms can usually be controlled with the right treatment plan.

When to see a specialist

If you’ve been struggling with hives for more than six weeks, especially if they’re:

• Waking you up at night
• Interfering with work or daily life
• Not responding to over-the-counter meds
• Accompanied by swelling, tight throat, or difficulty breathing

…it’s time to book with an allergist.

We can help identify possible triggers, recommend the most effective medications, and guide long-term care.

Tired of dealing with endless hives?

Let’s get to the bottom of it. Chronic urticaria can be frustrating, but you don’t have to manage it alone.

Please note:

We require a referral from your family doctor to schedule a consultation. They can fax the referral to 416-850-9993 or use our referral form under our FAQ page.