Chronic spontaneous urticaria (CSU) is the medical term for hives that:
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Have no known cause
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Last a long time
Chronic = Lasts for 6 weeks or longer
Spontaneous = No obvious cause or trigger
Urticaria = Red and itchy raised welts or patches on the skin (hives)
What causes CSU?
When your immune system detects a threat, it releases histamine and other inflammatory chemicals.
Histamine can widen blood vessels, which can lead to skin swelling, itchiness and redness.
What triggers hives?
Common triggers of hives usually include:
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Bacterial infections, including UTIs and strep
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Viral infections, including colds and mono
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Certain medicines, including antibiotics and ibuprofen
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Extreme hot or cold temperatures
Unlike other types of hives, CSU usually has no identifiable trigger and the cause is unknown. But it is often linked to type 2 inflammation .
Type 2 inflammation = an overactive immune response that can contribute to inflammatory conditions.
Treatments for CSU
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Antihistamines used first
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Biologics (monoclonal antibodies that target the immune system) if symptoms still aren’t controlled
Help for CSU
If you have hives that last 6 weeks or longer or keep coming back, talk to your primary care provider, dermatologist or allergist.
This educational resource was created with support from Regeneron and Sanofi.
- The Type 2 Inflammation Connection ›
- Like an Itch That Couldn’t Be Scratched, My Hives Kept Coming Back ›
- More than Just Skin Deep: The Impacts of Living with Chronic Spontaneous Urticaria ›
- Chronic Spontaneous Urticaria 101 ›






