It starts with an itch. Then come the raised, red patches that seem to appear out of nowhere. You may assume it is something you ate, a new product you used or simply a temporary allergic reaction. But what if the hives keep coming back, week after week?
When itching and hives continue to recur for more than six weeks, it could be chronic spontaneous urticaria (CSU). CSU is a type of chronic urticaria where recurring itchy hives, deeper swelling called angioedema, or both occur without an identifiable external trigger. Unlike a one-time allergic reaction, there may not be one specific food, medicine or environmental factor that explains why the symptoms keep returning.
In a conversation with HT Lifestyle, Dr Poonam Jalan Agrawal – consultant at Swastik ENT and Skin Clinic, Kolkata – explains, “People often associate hives with an allergy and expect them to disappear quickly. However, when hives or itching keep coming back for more than six weeks, it is important to consider chronic spontaneous urticaria. The condition can also affect sleep, energy levels and daily activities. Recognising these symptoms and consulting a dermatologist or allergist can help patients understand what they are experiencing and seek appropriate care.”
Here are five signs that may indicate your recurring hives and itching could be CSU:
1. Your hives keep coming back
Hives are raised, itchy patches or welts that can appear on different parts of the body. Individual hives often disappear within hours, while new ones may appear elsewhere. If this pattern continues for more than six weeks, Dr Agrawal recommends speaking to a healthcare professional.
2. The itching affects your sleep and energy
Persistent itching can make it difficult to sleep comfortably and leave you tired during the day. In a 2025 survey of people living with CSU, 62 percent reported sleep problems during flare-ups and 49 percent experienced fatigue. This can also affect concentration and daily routines.
3. You notice swelling along with your hives
Dr Agrawal explains, “CSU can cause angioedema, a deeper swelling beneath the skin. It commonly affects the lips, eyelids, hands or feet and can occur with or without hives. Recurring, unexplained swelling should be discussed with a healthcare professional.”
4. You cannot identify a clear trigger
When hives keep appearing, it is natural to look for a reason, such as a particular food, medicine or skincare product. However, according to the dermatologist, CSU is characterised by recurring symptoms without an identifiable specific external trigger. Certain factors may worsen symptoms, but there may not be one clear cause behind each episode.
5. It starts affecting your everyday life
CSU can affect more than physical comfort. Visible hives or swelling may make some people uncomfortable in social situations, while repeated flare-ups can make everyday plans harder to manage. Over time, this can also affect emotional wellbeing.
“For someone experiencing recurring hives, the six-week mark can be an important point to pause and look beyond the assumption of a temporary allergy. When symptoms keep returning, recognising the pattern can help put a name to what may be happening and highlight the impact CSU can have beyond the skin,” concludes Dr Agrawal.
Note to readers: This article is for informational purposes only and not a substitute for professional medical advice. Always seek the advice of your doctor with any questions about a medical condition.
Dr Poonam Jalan Agrawal is a Kolkata-based dermatologist, paediatric dermatologist and cosmetologist with 20 years of experience. She holds an MBBS, an MD in Dermatology, Venereology and Leprosy from Christian Medical College, Vellore, and a DNB in Dermatology and Venereology.
