How to Ease the Itch From Chronic Spontaneous Urticaria

One of the most frustrating symptoms of chronic spontaneous urticaria (CSU) is undoubtedly the itchy hives that seemingly come out of nowhere.

“It’s called spontaneous because there’s nothing you’re doing to cause the hives to appear,” says Allen Kaplan, MD, a clinical professor of medicine at the Medical University of South Carolina in Charleston. “You could go to bed feeling fine, with no rash whatsoever, and wake up covered with hives.”

Hives from CSU usually last 12 to 24 hours at a time. In the meantime, there are ways to ease the itch. Keep reading to learn how.

What to Do When You Can’t Stop Scratching

With proper treatment from an allergist, dermatologist, or immunologist, plus the tips below, the itchy hives often dissipate.

1. Talk to Your Doctor About Medication

The first-choice treatment for CSU is a daily dose of an over-the-counter or prescription second-generation antihistamine. First-generation antihistamines are not recommended, because they can cause drowsiness and easily interact with other medications, says Dr. Kaplan.

If antihistamines don’t take away the itch, says Kaplan, other options include omalizumab, an anti-inflammatory medication that’s delivered by injection every four weeks, and dupilumab, a biologic that helps halt inflammation.

Sometimes, an immunosuppressant medication called cyclosporine is prescribed off label for CSU, but it’s only used when other treatments have failed, says Kaplan. (This medication is used to help people with organ transplants avoid organ rejection.) It’s not a top choice, because it can raise blood pressure levels and interfere with kidney function.

2. Apply a Cool Compress to Your Skin

3. Don’t Scratch Your Skin

4. Rethink Using Pain Relievers

“Generally, it’s best to avoid NSAIDS, but if you know taking it does not affect the urticaria, it’s okay to use,” says Kaplan. If you have CSU along with another condition that causes chronic or occasional pain, ask your doctor about the best pain-relief options for you. For example, acetaminophen should not worsen hives, says Kaplan.

5. Consider Dietary Triggers

6. Try to Reduce Stress

The Takeaway

• Chronic spontaneous urticaria can trigger an intense itch that interferes with your quality of life.
• Taking both over-the-counter and prescription medications can help keep hives at bay.
• Other strategies, such as avoiding NSAIDs and lowering stress levels, can also help ease the itch.