Chronic Urticaria

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Published on : May 22, 2023

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Chronic Urticaria:

That Unrelenting and Nagging Itch



Author Reviewer
Christine Palmay, MD, CCFP, FCFP
Midtown Health and Wellness Clinic
Toronto, ON

Charles W. Lynde, MD, FRCPC, DABD, FCDA 

Chief Medical Director, The Lynde Institute for Dermatology & Lynderm Research Inc. 

Associate Professor, Department of Medicine, Division of Dermatology, University of Toronto

Toronto, ON

Chronic Spontaneous Urticaria/Chronic Idiopathic Urticaria, commonly known as hives, is defined when the urticaria like rash/associated symptoms last for more than 6 weeks.  While most people (up to 20%) can develop short-episodes, approximately 1% of the population suffer from long-term symptoms. Females are more affected than males. The cause is often not identifiable irritates patients as much as the rash itself! Furthermore, while often deemed trivial, we need to appreciate that CSU adversely affects a patient’s quality of life including sleep disruption and psychological distress.

When searching for those rare triggers, consider:

  1. Physical Triggers (dermatographism/dermographism, pressure, temperature changes, water exposure, exercises, solar, vibratory)
  2. Medication Triggers (ACE inhibitors being top of mind)
  3. Contact Triggers (latex, metals)
  4. Stress Triggers (COVID proving to be truly significant during the past 3 years)

Finding that golden ticket is truly a gift and a source of relief to patients, but as mentioned, CSU is generally idiopathic in nature.  As such, patient expectations need to be set.

Doc, I want an allergy test!

Patients want answers (as do we).  Most chronic urticaria cases do not warrant referral, however in cases of lack of response to medications (more to come), or red flag symptoms (constitutional symptoms, presence of angioedema or suggestion of anaphylaxis such as syncope, bronchospasm) consider reaching out to our allergy or dermatology colleagues for further assessment.




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Any views expressed above are the author's own and do not necessarily reflect the views of MDLearn.

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