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Chronic Urticaria

Recurrent itchy wheals lasting more than 6 weeks, often without identifiable trigger.

Written by: Saygı Hospital Health Guide Editorial Board
Published:

This content is for general information; please consult your physician for diagnosis and treatment.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Dermatoloji department. Book Appointment →

What is Chronic Urticaria?

Chronic urticaria is divided into chronic spontaneous urticaria (CSU) and chronic inducible urticaria (CIndU; physical triggers like cold, heat, pressure, sunlight, water, vibration, exercise). CSU accounts for roughly two-thirds of chronic cases.

The pathogenesis involves mast-cell activation through IgE autoantibodies (type I autoimmunity, e.g., against thyroid peroxidase) or IgG autoantibodies against the high-affinity IgE receptor (type IIb autoimmunity), as well as complement and basophil mechanisms.

Diagnosis is primarily clinical: a history of recurrent itchy wheals lasting <24 hours individually, persisting >6 weeks. Routine work-up is limited; extensive testing is reserved for atypical features or suspected systemic disease.

Symptoms

Pruritic, transient wheals (each lasting <24 hours) on any body area
Angioedema (deep, often non-itchy swelling of lips, eyelids, hands, genitalia) in 30–50%
Variable lesion distribution that changes daily
Sleep disturbance, fatigue, impaired quality of life
Possible burning or tingling sensation, but no scarring
Inducible types: predictable wheals after specific physical trigger

Risk Factors

Female sex (2:1 predominance)
Atopy and history of asthma, allergic rhinitis
Autoimmune thyroid disease (Hashimoto, Graves)
Other autoimmune disorders (lupus, celiac, vitiligo)
Chronic infection (Helicobacter pylori, parasitic, hepatitis), although causation is debated
Stress, NSAID exposure (worsening), recent viral illness

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Hives lasting more than 6 weeks despite over-the-counter antihistamines
  • Severe angioedema involving lips, tongue, or airway
  • Hives accompanied by fever, joint pain, or weight loss (suggests systemic disease)
  • Significant impact on sleep, work, or psychological well-being

Treatment Methods

01
Step 1: Second-generation H1-antihistamines at standard dose (cetirizine, levocetirizine, fexofenadine, bilastine, loratadine, desloratadine)
02
Step 2: Up-dose to 4× standard dose if needed (off-label, supported by guidelines)
03
Step 3: Add omalizumab (anti-IgE) 300 mg every 4 weeks for refractory disease
04
Step 4: Cyclosporine for omalizumab-refractory cases
05
Emerging: ligelizumab, dupilumab, fenebrutinib (BTK inhibitor) under clinical evaluation
06
Avoid known triggers (NSAIDs, tight clothing for delayed pressure, specific physical triggers)
07
Treat associated conditions (thyroid disease, H. pylori) when identified
08
Short courses of oral corticosteroids only for severe exacerbations (3–7 days), avoid chronic use
09
Patient education, written action plan, urticaria activity score (UAS7) self-monitoring

Which Department to Visit?

You can visit our Dermatoloji department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.