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Making Sense of the Symptoms: Flare-ups

Making sense of the symptoms is part of a new series identifying and discussing some of the most common symptoms of chronic spontaneous urticaria (CSU) and other types of skin disease.


Dr. Katie Beleznay is a Clinical Instructor with the University of British Columbia Department of Dermatology. She focuses her research in the areas of acne, rosacea, psoriasis and photo protection. You can follow Dr. Beleznay on Twitter here or on LinkedIn here.

So there you are, walking down the street on a beautiful winter morning. Coffee in hand and bag in tote when all of a sudden, like a stinging snowball that comes and hits you in the face, you look down at your hand and see hives: your chronic spontaneous urticaria strikes again! 

If you suffer from chronic spontaneous urticaria (CSU) then you have experienced both the physical discomfort and emotional stress that coincide with flare-ups of this condition.1 Flare-ups may seem to come at random and can last for days or persist on-and-off for weeks.2 So why do these nasty flare-ups occur and what can you do to manage them?

Put on your lab coats…

The science behind CSU was discussed in a previous article. As a quick refresher for those who weren’t paying attention in class, when CSU flares up there is an activation of mast cells in the dermis that release histamine and cause the itchy raised wheals on the skin.3,4 We still don’t know exactly what causes this activation of the mast cells and why it happens in some people but not others. We do know that there are a number of things that have been reported, but not confirmed, to trigger CSU flare-ups:

  • Reactions to medications such as antibiotics, and through direct mast cell degranulation by some medications, including aspirin, nonsteroidal anti-inflammatory drugs, radio-contrast dye, muscle relaxants, opiates, and vancomycin.
  • Physical stimuli such as heat, cold, vibration or pressure
  • Exercise or other triggers that raise the core body temperature
  • Infections
  • Stress
  • Food or food additives that contain histamine or that may cause the release of histamine directly, such as preservatives, and coloring agents

A specific trigger is found in only 10-20% of chronic cases. It is common for people to search high and low for their trigger and it can be frustrating when no clear correlation is found. Nevertheless, it is important to keep track of flare-ups to see if you can identify a trigger. If you notice you experience a flare-up after exposure to a particular trigger, it is best to try to avoid it in the future.

Unfortunately, there is not a known cure for CSU, so if you have CSU then you should be managing flare-ups and your condition as best you can. Here are some tips on managing CSU:

Don’t give in to the itch!

No matter how bad the urge, try to avoid scratching (even though it feels so good). Scratching can release more histamine, making you itchier and lead to a frustrating itch-scratch cycle.

Sit back, and relax

Because stress can trigger or exacerbate CSU, it can be helpful to do something that will allow you to relax. Living with CSU (or any chronic skin disease) is stressful, so reducing stress is one of the key steps toward improving your quality of life.

It looks delicious, but I’ll pass

Although it is not proven, some studies have shown that changing your diet and avoiding some foods high in histamine may help. More about this on Skin To Live In, here.

Doctors orders

If your CSU flare-ups are getting tough to deal with, it’s important to schedule some time with your doctor. And, when you’re there it’s important to discuss all of your symptoms, physical, emotional, and mental. It’ll only help in your treatment plan.

Remember: Being aware of all specific triggers will help you to feel more in control. And being prepared to deal with flare-ups using some of the tips provided can also help to minimize the impact. It is not easy living with CSU. It affects all aspects of your life, from physical to mental, but don’t let your skin condition manage you, let you manage your skin condition.

  1. Vestergaard, Christian; Deleuran, Mette 2015-11-01
  2. Kenny, Tim. Chronic Urticaria (hives) http://patient.info/health/chronic-urticaria-hives
  3. Saini S. abc News. Why do I itch when I get hives? http://abcnews.go.com/Health/AllergiesOther/story?id=4521888. Accessed December 2014.
  4. Zuberbier T et al. Allergy 2014; 69(7):868-87. http://www.skintolivein.com/urticaria/urticaria-and-you/itching-for-answers/
  5. National Health Service. Urticaria http://www.nhs.uk/Conditions/Nettle-rash/Pages/Causes.aspx
  6. Website “urticarial day” – Diet. Last accessed: 13.10.15 http://urticariaday.org/urticaria/diet/
  7. Kulthanan K, Jiamton S, Thumpimukvatana N, Pinkaew S. Chronic idiopathic urticaria: prevalence and clinical course. J Dermatol. 2007;34(5):294–301.

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