What is Chronic Urticaria?

Chronic urticaria is a long-term, inflammatory skin condition characterized by the presence of welts. Generally, chronic urticaria possesses an unknown etiology, meaning it has no known cause. Over-the-counter (OTC) and prescription medications are generally used to alleviate the discomfort associated with urticaria. If treatment is inappropriate or absent, widespread allergic reaction can threaten organ and system function placing one at risk for shock.

Histamine is at the root of all urticaria outbreaks. Released by mast cells in the skin, histamine is the chemical responsible for vascular swelling and skin inflammation in the presence of an irritant or allergen. The itching that accompanies this adverse reaction directly results from the release of histamine in the area of irritation causing welts to form on the skin's surface. Individuals whose systems produce excess histamine often experience more pronounced symptoms and may be at an increased risk for complications.

Those with chronic urticaria will usually experience bouts of hives that last more than 30 days. Instead of prolonged outbreaks, others may experience recurrent episodes of urticaria that may last from a few hours to several days before subsiding. It is not unheard of for an underlying condition to trigger chronic urticaria symptoms, such as an allergic reaction to medication, autoimmune disease or an undiagnosed infection.

Sometimes, individuals with chronic urticaria may also develop angioedema. Like urticaria, angioedema is characterized by the presence of welts on the skin; however, angioedema occurs just below the skin's surface. In addition to the irritation caused by angioedema, individuals may also experience facial swelling, intense itching and pain.

A complete medical history is essential to establishing a diagnosis of chronic urticaria. Symptomatic individuals should be forthcoming about all medications and supplements they take. Additionally, information regarding when symptoms first appeared, their intensity and duration are pivotal to making a diagnosis. A battery of blood and allergy tests is generally administered to detect possible triggers and rule out other conditions. It is at the physician's discretion whether additional testing may be performed.

Hives, also known as wheals, possess a characteristic appearance that make them easy to identify. Individuals with chronic urticaria will develop round, raised welts that persistently itch. Often inflamed, hives can erupt singly or in clusters. Depending on the severity of one’s condition, hives can last from a few hours to several days before subsiding. It is not uncommon for new wheals to appear in place of ones that are fading.

Individuals able to identify possible triggers may take proactive measures to avoid the responsible substance and subsequent outbreaks. Treatment for those whose trigger is nonexistent or elusive generally involves the regular use of either an over-the-counter (OTC) or prescription antihistamine to manage symptoms. Other possible treatment options for chronic urticaria include the administration of corticosteroids and antidepressants to alleviate inflammation and irritation. Severe symptoms often require epinephrine to alleviate swelling and stabilize one’s condition.