Table of ContentsView AllTable of ContentsWhat Is CIU?CausesDiagnosisTreatmentWhen to See a ProviderFrequently Asked Questions
Table of ContentsView All
View All
Table of Contents
What Is CIU?
Causes
Diagnosis
Treatment
When to See a Provider
Frequently Asked Questions
Hives, orurticaria, are raised, often itchy welts or bumps. They appear when a trigger in the body (sometimes known and other times unknown) causes mast cells in the skin to release high levels ofhistamine, serotonin, or some other chemicals.
When hives are present for more than six weeks without a known cause, the condition is calledchronic idiopathic urticaria(CIU). This article will discuss chronic idiopathic urticaria, including its causes, diagnosis, treatment, and when to see a healthcare provider.
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What Is Chronic Idiopathic Urticaria?
What Causes CIU?
The exact cause of chronic idiopathic urticaria is unknown, which can make getting a diagnosis frustrating and difficult.
Some research points to an altered gut microbiome (the balance of bacteria in your intestines) as a possible cause. This theory is based on the gut microbiome’s important role in the function and regulation of the immune system.But more research needs to be done to determine the causal relationship between the two.
Known causes of urticaria, like systemic conditions (diabetes, hyperthyroidism, cancer), viral infection (hepatitis and herpes zoster infection), and bacterial infection (Helicobacter pylori), among others, must be ruled out in order before a diagnosis of CIU can be made.
CIU Diagnosis
CIU is a diagnosis of exclusion, meaning other causes must be ruled out before making this diagnosis. Therefore, the diagnosis of CIU may involve an extensive workup in looking for the underlying conditions that serve as a potential trigger of the disease.
Chronic idiopathic urticaria is a clinical diagnosis based on your symptoms using the following five criteria:
No particular labs or tests need to be performed unless your medical history or physical examination detect specific underlying conditions as the cause of your symptoms. The healthcare providers most commonly making this diagnosis are primary care physicians or dermatologists (specialists in diseases of the skin, hair, and nails).
Chronic urticaria is usually benign and, in some cases, may resolve on its own without the need for treatment. If there are triggers that you and your healthcare provider identify as potential causes, such as contact with a foreign substance or occupational exposure, these should be avoided.
Symptom management with medication is the mainstay of treatment. Chronic hives can cause significant discomfort, greatly affecting your quality of life. Medication may be considered to lessen the severity and duration of symptoms.
Histamine receptor blockers, namely second-generation H1 antihistamines such as Zyrtec (cetirizine), Xyzal (levocetirizine), andClaritin (loratadine)are first-line drugs for the condition.
Generally, your healthcare provider will prescribe the lowest, most effective dose possible. Over time, higher doses of the same or new medications may be prescribed if your symptoms have not improved.
If second-generation H1 antihistamines are not effective, one or more drugs from the following drug classes may be prescribed instead:
When to See a Healthcare Provider
Summary
Chronic idiopathic urticaria is the appearance of persistent hives that lasts for six or more weeks for no known reason. CIU is a diagnosis of exclusion, which means other causes must be ruled out before this diagnosis is made. Therefore, the diagnosis of CIU may involve an extensive workup looking for potential triggers of the disease.
A Word From Verywell
Hives usually go away on their own. When they last for six or more weeks, however, they may indicate an underlying medical condition requiring further medical evaluation.
If your symptoms do not change with conventional first-line treatments over the course of two weeks, follow up with your healthcare provider. They can evaluate you and direct you to the proper subspecialist who can look for the potential causes behind your hives.
Frequently Asked QuestionsHives that don’t go away may indicate CIU or the presence of a number of underlying conditions, but a full workup is needed to uncover the possible causes of your hives.Learn MoreWhat Causes Hives?The following conditions may have a similar appearance to hives and may be mistaken for urticaria: contact dermatitis,eczema (atopic dermatitis), psoriasis, rosacea, and pityriasis rosea.Learn MoreItchy Rashes on Arms and LegsCIU often resolves on its own, although symptomatic treatment may be helpful. There are no medications or lifestyle modifications that cure CIU.Learn MoreTreatment for HivesHives typically last for less than two weeks. A diagnosis of CIU can only be made if your hives are present for six or more weeks.Learn MoreSymptoms of Hives
Hives that don’t go away may indicate CIU or the presence of a number of underlying conditions, but a full workup is needed to uncover the possible causes of your hives.Learn MoreWhat Causes Hives?
Hives that don’t go away may indicate CIU or the presence of a number of underlying conditions, but a full workup is needed to uncover the possible causes of your hives.
Learn MoreWhat Causes Hives?
The following conditions may have a similar appearance to hives and may be mistaken for urticaria: contact dermatitis,eczema (atopic dermatitis), psoriasis, rosacea, and pityriasis rosea.Learn MoreItchy Rashes on Arms and Legs
The following conditions may have a similar appearance to hives and may be mistaken for urticaria: contact dermatitis,eczema (atopic dermatitis), psoriasis, rosacea, and pityriasis rosea.
Learn MoreItchy Rashes on Arms and Legs
CIU often resolves on its own, although symptomatic treatment may be helpful. There are no medications or lifestyle modifications that cure CIU.Learn MoreTreatment for Hives
CIU often resolves on its own, although symptomatic treatment may be helpful. There are no medications or lifestyle modifications that cure CIU.
Learn MoreTreatment for Hives
Hives typically last for less than two weeks. A diagnosis of CIU can only be made if your hives are present for six or more weeks.Learn MoreSymptoms of Hives
Hives typically last for less than two weeks. A diagnosis of CIU can only be made if your hives are present for six or more weeks.
Learn MoreSymptoms of Hives
3 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Kocatürk, E., Grattan, C.Is chronic urticaria more than skin deep?Clin Transl Allergy. 2019;9:48. doi:10.1186/s13601-019-0287-2Zhang X, Zhang J, Chu Z, Shi L, Geng S, Guo K.Gut microbiome alterations and functional prediction in chronic spontaneous urticaria patients.J Microbiol Biotechnol. 2021;31(5):747-755. doi:10.4014/jmb.2012.12022Schaefer, P.Acute and chronic urticaria: evaluation and treatment.Am Fam Physician. 2017;95(11):717-724.
3 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Kocatürk, E., Grattan, C.Is chronic urticaria more than skin deep?Clin Transl Allergy. 2019;9:48. doi:10.1186/s13601-019-0287-2Zhang X, Zhang J, Chu Z, Shi L, Geng S, Guo K.Gut microbiome alterations and functional prediction in chronic spontaneous urticaria patients.J Microbiol Biotechnol. 2021;31(5):747-755. doi:10.4014/jmb.2012.12022Schaefer, P.Acute and chronic urticaria: evaluation and treatment.Am Fam Physician. 2017;95(11):717-724.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Kocatürk, E., Grattan, C.Is chronic urticaria more than skin deep?Clin Transl Allergy. 2019;9:48. doi:10.1186/s13601-019-0287-2Zhang X, Zhang J, Chu Z, Shi L, Geng S, Guo K.Gut microbiome alterations and functional prediction in chronic spontaneous urticaria patients.J Microbiol Biotechnol. 2021;31(5):747-755. doi:10.4014/jmb.2012.12022Schaefer, P.Acute and chronic urticaria: evaluation and treatment.Am Fam Physician. 2017;95(11):717-724.
Kocatürk, E., Grattan, C.Is chronic urticaria more than skin deep?Clin Transl Allergy. 2019;9:48. doi:10.1186/s13601-019-0287-2
Zhang X, Zhang J, Chu Z, Shi L, Geng S, Guo K.Gut microbiome alterations and functional prediction in chronic spontaneous urticaria patients.J Microbiol Biotechnol. 2021;31(5):747-755. doi:10.4014/jmb.2012.12022
Schaefer, P.Acute and chronic urticaria: evaluation and treatment.Am Fam Physician. 2017;95(11):717-724.
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