Chronic Urticaria Management, Resources & Glossary of Terms
Chronic urticaria is a skin condition that often requires a management strategy to avoid triggers and control symptoms. Work with a healthcare provider to identify triggers and medications for the treatment of chronic urticaria.
Allergy & Asthma Network has produced a series of videos and a glossary of terms that can help you gain a better understanding of chronic urticaria and other related skin conditions.
Managing chronic urticaria
Patients with chronic urticaria should seek treatment from a healthcare provider. This can be a board-certified allergist, dermatologist, primary care doctor or other health professional with knowledge of the skin disease.
Work together with the healthcare provider to come up with a treatment plan for managing chronic urticaria. If you have chronic idiopathic urticaria or chronic spontaneous urticaria, work with the healthcare provider to identify and avoid potential triggers.
Prescription and non-prescription medications are a key part of a plan for treatment of chronic urticaria. Antihistamines are generally the first-line treatment but there are other medication options for more severe symptoms, including systemic corticosteroids and biologics.
Self-management of chronic urticaria is important. The American Academy of Dermatology (AAD) has recommendations for what you can do at home to self-manage your hives.
Try not to scratch
Hives are very itchy and it can be hard to not scratch them. But when you do scratch hives, you further irritate them. Constant scratching can affect quality of life and sleep. It can also lead to mental health issues including anxiety and depression.
When you’re able to stop scratching, you stop irritating your skin. What can you do apart from anti-itch ointments and medications? Some things you can do include:
Keep yourself busy and your hands occupied so you don’t focus on the itching.
Keep fingernails cut very short to reduce harm to the skin caused by scratching.
If you must scratch, try stroking the itchy area using of the top of the hand instead of your fingernails.
If you have Black or Brown skin, excessive scratching can cause darkened areas on affected skin. These can sometimes appear after the hives clear. They often last much longer than the hives themselves.
Ease the itch
When your hives starts to itch, any of the following can bring relief:
Apply a cool compress to your itchy skin. To make a cool compress, run a clean washcloth under cold water to get it wet. Wring out the washcloth so that the water doesn’t drip. Then place the wet, cool washcloth on the itchy skin. Leave the washcloth on the itchy area for 10 to 20 minutes.
Spread an anti-itch cream (or lotion such as calamine lotion) on the itchy skin. Be sure to follow the directions. If your dermatologist has prescribed one, be sure to use it.
Add a colloidal oatmeal package to a bathtub of lukewarm water and soak for the time recommended on the label. If colloidal oatmeal is too expensive, you can put oatmeal in an old sock or nylon stocking, tie a knot in the top to keep the oatmeal from coming out, and use that for a soothing oatmeal bath.
Wear loose-fitting, 100% cotton clothes
Avoid wearing clothing that rubs against the skin or is tight, scratchy or made from wool. If urticaria appears on feet, avoid wearing tight shoes.
Use lukewarm water when taking a bath or shower
When bathing, be very gentle with your skin. Avoid rubbing the itchy skin with a washcloth, loofah, or mesh sponge. It’s best to apply your soap or cleanser by gently putting it on your skin with your hands. After your bath or shower, pat your skin dry instead of rubbing it.
Wash with a gentle, fragrance-free soap or cleanser
When washing yourself, make sure you use a fragrance-free product rather than an unscented one. An unscented product still has a fragrance. It has been covered up so that you cannot smell it. Since an unscented product contains fragrance, it can still irritate your skin.
Keep a journal
Hives develop for many reasons, so it can be hard to figure out what’s causing them. Acute hives tend to have more obvious triggers than chronic hives.
Keeping a journal may help you find the cause of acute or chronic hives. If you can avoid what triggers your hives, you can prevent new hives.
Jot down the following:
- Date and time the hives started
- What you were doing before the hives began
- Foods and drinks you recently had
- Medications you recently took, including aspirin, ibuprofen, and any prescription medications
- If you felt overheated or sweat heavily
- What you were wearing and carrying
- If you’ve been feeling stressed
How your hives began
How often you have hives
How intense is the itch when you have hives
Where (what part of your body) do you have hives
What gives you with the most relief
What treatment options work best
Write a list of questions to ask your doctor
What are your physical examination findings?
What is causing my symptoms of chronic hives?
When symptoms of urticaria come and go, how can I predict what will make them appear?
What can trigger hives?
How can I identify my triggers?
How long will hives last?
What can I do to improve my quality of life?
What kinds of tests do I need? Do these tests require any special preparation?
What treatment options are available, and which do you suggest?
What medications can I use?
How do I avoid chronic urticaria triggers?
Can I use cold washcloths for relief?
Can I apply lotions or creams?
What can I use for sun protection?
Should I keep a diary of activities, medicines, supplements, foods and drink and herbal remedies?
Do the chronic urticaria treatments have any side effects?
Do I need prescription medication, or can I use nonprescription drugs or other medications to treat the condition?
How much does the medicine cost and is there a generic version?
Videos to learn more about chronic urticaria
- Learning Pathways – Info in Minutes – Chronic Urticaria 101 (Coming Soon!)
- Learning Pathways – Info in Minutes – Diagnosing Chronic Urticaria (Coming Soon!)
- Learning Pathways – Info in Minutes – Chronic Urticaria Treatment (Coming Soon!)
- Webinar “Chronic urticaria – What I wish my patients knew”
- Webinar: Dr. Marissa Shams, Understanding Urticaria: The What, Why and Itch
- Webinar: Dr. John Hagan Urticaria & Angioedema: Seeking Satisfaction in 2021
World Urticaria Day
Chronic Urticaria Awareness Day occurs October 1 every year. It is celebrated worldwide every year since 2014.
The celebration aims to raise awareness about chronic urticaria, improve quality of life of patients and foster a sense of community among people with the skin condition.
Chronic Urticaria Glossary of Terms
What’s the difference between acute and chronic urticaria? What is the first-line treatment for chronic urticaria? How are symptoms of chronic urticaria and angioedema different? Use our glossary of terms to better understand the skin condition and communicate effectively with your healthcare provider.
Acute – symptoms that last less than 6 weeks – sometimes less than 1 week.
Antihistamine therapy – treatment with antihistamines. This is the first-line treatment for chronic urticaria. Your doctor may prescribe antihistamines that are second generation antihistamines because they are less drowsy.
Angioedema – skin swelling that is underneath the skin rather than on the surface. It is more painful than itchy. Angioedema can occur on the face, throat, hands or feet and it’s potentially life-threatening. It is not associated with anaphylaxis, a severe allergic reaction. Urticaria and angioedema may occur at the same time.
Aquagenic urticaria (rare) – hives that develop after skin contact with water.
Aspirin intolerance – intolerance or hypersensitivity to aspirin. This may cause hives, itchy/watery eyes, nasal congestion, or coughing/wheezing.
Cholinergic urticaria (pinpoint hives) – hives that develop from increased body temperature, This could be caused by anything from exercise to eating spicy foods, to a warm shower, or a fever.
Chronic – symptoms that last more than 6 weeks.
Chronic Idiopathic urticaria – hives that occur without any known trigger. They last for 6 weeks or longer. Chronic idiopathic urticaria and chronic spontaneous urticaria are sometimes used interchangeably.
Chronic Spontaneous Urticaria – hives that appear suddenly and oftentimes without explanation. They last for 6 weeks or longer. Chronic spontaneous urticaria and chronic idiopathic urticaria are sometimes used interchangeably.
Cold urticaria – hives that develop after exposure to cold.
Delayed pressure urticaria – painful, swollen, and/or redness to skin to areas of the skin where direct pressure has been applied. Symptoms are delayed, typically 4-6 hours.
Dermatographia – rapid onset of skin wheals after skin pressure.
Diseases with urticaria lesions – systemic diseases that present with hives.
Duration – the time over which something occurs. This helps classify urticaria as acute or chronic.
Hives – a rash that causes round, swollen areas on the skin. It is often very itchy or painful.
Idiopathic – without a known cause.
Inducing factors – a factor that causes something to occur. (Example: cold exposure can be an inducing factor for hives in an affected patient.)
Induced Chronic Urticaria – recurrent hives for 6 weeks or more caused by specific environmental or physical factors.
Physical Urticaria (hives) – hives caused by various environmental factors such as heat, cold, or water.
Papule – a small (less than 1 mm) bump or raised area of on the skin.
Remission – when a disease goes away. There is a 90% chance of remission with acute urticaria; there is a less than 50% chance of remission with chronic urticaria.
Skin biopsy – a procedure to remove remove cells or skin samples from the body for examination in a laboratory. It can confirm a chronic urticaria diagnosis or rule out other skin conditions that cause hives.
Solar urticaria – hives that appear on the skin after exposure to the sun.
Vibratory urticaria (rare) – hives that appear on the skin after exposure to a vibration (think hands on a lawn mower).