Symptoms

The symptoms of chronic spontaneous urticaria (CSU) include itchy hives (wheals) and angioedema.

 

The symptoms of CSU may appear without warning with a variable intensity (Maurer et al., 2011; Zuberbier et al., 2018) and may profoundly impact patients' day-to-day lives (Maurer et al., 2011; O'Donnell et al., 1997; Kang et al., 2009; Barbosa et al., 2011; Engin et al., 2008). In CSU, itchy hives, angioedema or both, may occur spontaneously every day, or almost daily for 6 weeks or more (Zuberbier et al., 2018).

Hives

A hive consists of three typical features (Zuberbier et al., 2018):

  1. Central swelling of variable size, usually surrounded by a reflex erythema
  2. Associated itching (pruritus), or sometimes a burning sensation
  3. Transient nature, usually resolving within 30 minutes to 24 hours
 Hives: Superficial swellings with pale centres surrounded by a red flare.

Figure 1. Hives: Superficial swellings with pale centres surrounded by a red flare.

 

Terminology
  • The terms itch and pruritus are interchangeable, as are hive and wheal
  • Reflex erythema describes the redness of the skin due to dilated capillaries that is triggered by local neural reflexes. Erythema typically blanch with pressure

Hives: Superficial swellings with pale centres surrounded by a red flare.

Figure 2. Hives: Superficial swellings with pale centres surrounded by a red flare.

Angioedema

Angioedema (deep tissue swelling) is typically characterised by (Zuberbier et al., 2018):

  1. Sudden, pronounced swelling or redness of the lower dermis and subcutis or mucous membranes (hypodermis or superficial fascia)
  2. Sometimes pain rather than itching
  3. Up to 72 hours for resolution

​The eyelids and lips are most commonly affected, while the tongue, extremities, genitalia, oral cavity mucosa and upper respiratory tract may also be affected (Kulthanan et al., 2007).

Terminology
  • The terms itch and pruritus are interchangeable, as are hive and wheal
  • Reflex erythema describes the redness of the skin due to dilated capillaries that is triggered by local neural reflexes. Erythema typically blanch with pressure

Percentage of chronic spontaneous urticaria patients with angioedema alone, hives or both.

Figure 3. Percentage of CSU patients with angioedema alone, hives or both.

Relationship between CSU symptoms and quality of life

In CSU, changes in symptom severity are closely linked to changes in health-related quality of life (HRQoL). If an improvement (or worsening) in signs and symptoms is found, it is highly likely that an improvement (or worsening) HRQoL is also experienced (Stull et al., 2016).