How Long Do Chronic Hives Last?

Reviewed medically by William Truswell, MD

According to the definition, CSU refers to a condition where hives persist for six weeks or more.
Many individuals eventually experience the disappearance of their symptoms, although in some cases, hives may persist for several years.
Symptoms might persist longer if they are more intense, if an individual has a pre-existing autoimmune condition, or if locating a successful treatment approach proves difficult.

Chronic spontaneous urticaria (CSU) is a persistent skin disorder marked by itchy welts that endure for a minimum of six weeks. In contrast to acute hives, which typically subside within a few days, CSU may recur over the course of months or even years.

How long does CSU last?

To be classified as CSU, hives need to persist for a minimum of six weeks.

Approximately half of individuals with CSU experience a complete resolution of their symptoms within the initial six months. For some, the symptoms persist for several years, although it is uncommon for the condition to extend beyond a decade.

The individual hives—itchy, raised bumpswhich often appear red or brown, depending on skin tone—typically last no longer than 24 hours. However, with CSU, new hives keep appearing as previous ones go away. Individuals usually have hives on a daily basis. This ongoing cycle means that the skin rarely feels fully clear without treatment.

Why Is CSU So Prolonged?

There are two primary types of hives—chronic and acute. The main distinction between them lies in how long the symptoms last.

Acute urticaria, commonly known as hives, is widespread and typically results from a particular allergy to food, drugs, or another environmental factor. These outbreaks usually disappear within a few days and generally last no longer than six weeks.

But with chronic urticaria (CSU), symptoms last much longer since they are typically not triggered by external allergens. Research indicates that the majority of CSU cases are caused byinternal, autoimmune issues. In essence, the immune system incorrectly recognizes y cells as a danger and initiates the activation of skin-based immune cells, resulting in the development of hives.

The outcome is a continuous state of vigilance, with your body continually generating new hives. Since CSU is not triggered by something you consumed or came into contact with, there is no specific external allergen you can pinpoint and steer clear of to halt the reaction.

Elements That Influence the Duration of CSU Symptoms

Although CSU is a chronic condition, certain important factors could influence the duration of your symptoms:

Symptom intensity:If you experience regular, severe flare-ups, your recovery time might be longer compared to someone with less intense symptoms.
Angioedema:Approximately 40% of individuals with CSU also suffer from angioedema, which is characterized by swelling beneath the skin's surface, commonly occurring around the lips, eyelids, genital area, or limbs. Those experiencing angioedema often have longer-lasting hives.
Other conditions:Having a different autoimmune condition, like thyroid disease, can complicate your CSU timeline. The same could apply to CSU patients who havehigh blood pressure, although further study is required.
Medication choice:There are several treatment options available for CSU. Some individuals benefit from initial treatments, while others might still have symptoms until they discover a suitable treatment approach.
Inflammatory markers:Internal inflammatory indicators in your body, such as C-reactive protein (CRP), are associated with the seriousness of CSU. Elevated levels of CRP may indicate that your immune system is staying in a heightened state.

Will CSU Eventually Disappear?

CSU is typically not a condition that lasts a lifetime, and many individuals eventually experience remission. Remission refers to a time when hives completely cease to appear for a prolonged period.

The chance of CSU going into remission grows as time passes. Approximately half of individuals achieve remission within six months, and roughly 80% of all cases resolve within three years. About 8% of those with CSU have symptoms that last for many decades.

Remission in CSU is typically long-lasting, although there is a chance the condition may recur at a later stage in life.

Next Steps

If you're worried that you might have CSU, there are several actions you can undertake to assist in receiving a diagnosis and appropriate treatment:

Keep a symptom log:Monitor the number of days each week you have hives, and be mindful of any potential factors that could be causing your symptoms. This information may assist your physician in confirming a diagnosis of CSU.
Consult a specialist:Contact your healthcare provider to get a referral to a dermatologist, immunologist, or allergist if your hives last longer than six weeks. Collaborating with a specialist can help manage your symptoms properly.
Review medications:Discuss long-term treatment options, such asnon-drowsy antihistaminesor the injectable medication omalizumab, instead of depending on short-term solutions.
Monitor for severe symptoms:Seek urgent medical attention if your hives are paired with swelling of your lips, tongue, or throat. These may besigns of anaphylaxis, a rare but severe condition.

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