Living with CSU When Triggers Are Everywhere

Chronic Spontaneous Urticaria (CSU) is a condition characterized by the spontaneous appearance of hives, angioedema, or both for six weeks or longer without an identifiable external trigger. Living with CSU can be challenging, especially when triggers seem ubiquitous. This article explores how CSU affects individuals differently, highlights new treatment options, identifies common triggers, and emphasizes the importance of support systems.​

Some classifications of CSU:

• Acute spontaneous urticaria: Spontaneous occurrence of wheals and/or angioedema for a total duration of fewer than six weeks.
• Chronic spontaneous urticaria (CSU): Spontaneous occurrence of wheals and/or angioedema for a total duration of six weeks or more. This is synonymous with “chronic urticaria” and “chronic idiopathic urticaria.”
• Chronic inducible urticaria (CIndU): Occurrence of wheals for a total duration of six weeks or more, which is inducible by physical factors (e.g., touch, pressure extremes). This is synonymous with “physical urticaria.”

RELATED: Diet, Stress, & CSU: How You Can Control Chronic Hives

How CSU Impacts Black Skin Differently

CSU can manifest differently on darker skin tones, making diagnosis and treatment more complex. Hives on Black skin may not present the typical redness seen on lighter skin; instead, they might appear as skin-colored or slightly darker or lighter welts. This variation can lead to underdiagnosis or misdiagnosis. Healthcare providers must be trained to recognize these differences to ensure accurate diagnosis and effective treatment. 

Additionally, studies suggest that individuals with darker skin may experience greater chronic subclinical inflammation, potentially exacerbating CSU symptoms. ​

According to Alexa Boer Kimball, M.D., of the Department of Dermatology at Harvard Medical School, physicians should be made aware of this increased risk in their darker-skinned patients and possibly try to modify their topical treatments in order to stem the subclinical inflammation present in their skin. Some patient populations tend to use products that are more ointment-based or more emolliating, possibly because these patients feel this subclinical inflammation, to some extent.

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Dr. Kimball suggests that a simple change in the maintenance regimen in dark-complexioned patients may be of benefit, as well as possibly starting them on topical anti-inflammatory or antioxidant approaches. Topical corticosteroids could also be employed; however, these should be reserved for clinically evident inflammatory processes, she says.

RELATED: Living with Chronic Spontaneous Urticaria: 4 Tips For Coping

New Medications Worth Talking to Your Doctor About

Recent advancements have introduced new treatments for CSU:​

• Dupilumab (Dupixent): Approved by the FDA in April 2025 for patients aged 12 and older with CSU unresponsive to antihistamines. Clinical trials demonstrated significant reductions in itch and hives compared to placebo. ​
  • Approval based on Phase 3 trials demonstrating Dupixent significantly reduced itch and hives compared to placebo
  • In the U.S., there are more than 300,000 adults and adolescents aged 12 years and older living with CSU who remain symptomatic despite antihistamine treatment
  • CSU is the seventh disease with underlying type 2 inflammation for which Dupixent is approved
• Remibrutinib: An oral Bruton’s tyrosine kinase (BTK) inhibitor showing promise in clinical trials. Patients experienced significant relief from itching and hives as early as one week into treatment. ​
• Barzolvolimab: A novel therapy targeting the KIT receptor, demonstrating complete response rates between 38 to 51 percent in phase 2 trials. Common side effects included changes in hair color and neutropenia. ​

Discuss these options with your healthcare provider to determine the best course of action for your condition.​

Food, Fabric, and Frustration: Avoiding Springtime Triggers

The intense itching. The sleepless nights. The unpredictability. All the things you’ve tried to get rid of your hives — or at least to calm the itch a bit. Though they’re not the underlying cause of CSU, some things have the potential to aggravate your condition, says Jacquelyn Sink, MD, a dermatologist at Northwestern Medicine Regional Medical Group in Chicago. 

This is actually good news because with some careful tracking, you just may be able to figure out exactly what your triggers are. And if you can ID your triggers, you can take steps to avoid them, as Spring can introduce various CSU triggers:​

• Environmental Factors: Pollen, increased sunlight, and temperature fluctuations can exacerbate symptoms. ​
• Clothing: Tight or restrictive clothing can trigger or worsen hives due to friction and pressure. ​
• Dietary Triggers: Certain foods may increase inflammation or cause histamine reactions. Common culprits include dairy, fried and processed foods, excess sugar, and alcohol. ​

Identifying and avoiding personal triggers is crucial. Keeping a symptom diary can help pinpoint specific factors contributing to flare-ups.​

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What are the symptoms of chronic urticaria?

• Red, raised bumps or circular welts on people with white skin.
• Raised bumps or circular welts on people with skin of color that either…
  • match the skin color of the surrounding skin;
  • appear as slightly darker than the skin color;
  • appear as slightly lighter than the skin color.
• Skin often feels itchy, tender or sometimes painful to the touch.

How long do symptoms of chronic urticaria last?

Chronic Spontaneous Urticaria can last from six weeks to years. They can last for weeks at a time, go away for a while, and then come back later. This can go on for years.

As a comparison, acute urticaria symptoms last anywhere from a day to several weeks. If symptoms are present most days of the week and last longer than six weeks, then it is considered chronic.

Finding Support: You Are Not Alone

Living with CSU can be isolating, but support is available:​

Discussing a chronic illness is different for everyone. Maybe you value your privacy, and sharing is not something you like to do. Or maybe you are an open book, and talking comes naturally to you. Wherever you are on the spectrum, you will likely need to tell someone what you are dealing with and how it is affecting you.

When you do share, it is important to not only discuss the actual symptoms, but also how those symptoms affect you daily. This will allow family and friends to get a better understanding of what you are dealing with and find ways to support you.

• Online Communities: Virtual support groups provide platforms to share experiences and coping strategies. 
• Educational Resources: Websites like the Allergy & Asthma Network provide information on managing CSU and connecting with others facing similar challenges.​

Engaging with these resources can offer emotional support and practical advice for managing CSU.