Chronic spontaneous urticaria 

If the urticaria lasts longer than 6 weeks, it is no longer called acute urticaria, but chronic spontaneous. 

Many of us suffer from this form of urticaria for decades. Some have daily wheals and angioedema. Others for days or weeks, which then disappear, only to reappear months or years later and remain for years. There are as many different courses of this type as there are different people. They all have one thing in common: itching, burning, swelling as already described on the hands, palms, fingers, feet or soles. In addition – as already mentioned elsewhere – there can be a host of other complaints. Often one gets headaches, joint and muscle pains. One feels ill, exhausted and tired. Some people feel as if they are getting a cold or flu.  

Often one gets diarrhea, because the mast cells are also in the intestine and can release histamine there. This can also be joined by internal angioedema, which causes further discomfort in the gastrointestinal tract. Abdominal pain, bloating, nausea, to name the most important. Some sufferers sense a flare-up approaching hours before it occurs. Even if no wheals are visible externally, they may be internal and cause the same discomfort. Chronic Spontaneous Urticaria also has the potential to cause angioedema, which can lead to systemic problems. One may get swelling of the airways or even shortness of breath. Affected persons are well advised to carry an emergency kit with them at this point.

In Chronic Spontaneous Urticaria, various causes are possible:

1. This can be, for example, autoreactive urticaria. There is an intolerance of the body’s own substances. To test this, the doctor injects some of the patient’s own blood into the skin of the forearm. If you get wheals afterwards, it is an autoreactive urticaria. In addition, this type of urticaria should be additionally clarified whether other autoimmune diseases (e.g. Hashimoto’s, rheumatism, ANAs or others) are present.
2. Chronic infections can also be a trigger for CSU. There are a number of recommendations – in addition to the determination of inflammatory values – as to what could be clarified:  
   1. Examination of the stomach/intestine. There may be a parasitosis or other pathogenic germs present. Also the well-known Helicobacter Pylori is still treated as a possible trigger for a CSU. 
   2. Diseases of the liver (examination whether hepatitis is present)
   3. Diseases of the bladder (inflammation, protein, blood) 
   4. Tooth-mouth-jaw (e.g. inflamed tooth roots, foci, inflammation in the jaw, etc.)  
   5. Ear, nose and throat. For example, there may be an underlying inflammation of   the tonsils. This is also often seen in connection.
   6. Sometimes it is also worth seeing a gynecologist.
3. Intolerance urticaria  
    If one has found out, for example by keeping a food diary, that one begins to wheal to certain foods and then omits them, then one can speak of an intolerance or an intolerance. In conventional medicine, a so-called elimination diet is used for this purpose. We have made further experiences with the diet. If you are interested in the field of nutrition, you can find more information here. Also visit our group Incendi’s Food Corner. There you can learn a lot about the connection between your urticaria and nutrition. 
4. Rare diseases
   1. There is no way around seeing a specialist here. An allergist will possibly test for various allergy-triggering substances, for example, by means of a prick test. Molds and candida could also be a trigger. A low-allergen diet can provide information.
   2. Further investigations of the immune and complement system.
   3. Whether so-called “life events” can actually trigger a CSU is questionable. In fact, one has to admit that any form of di-stress, no matter what disease it is, can lead to a worsening. In any case, we do not think much of asking affected persons about “life events” in lengthy psychotherapeutic sessions if no triggers have been found. Here the question rightly arises, why then not all affected persons with, for example, an anxiety disorder or depression suffer from a CSU! We will deal with this topic in detail.