This site is intended for healthcare professionals
CSU Learning Zone
Declaration of sponsorship Novartis AG and J. Uriach y Compañía S.A

Disease Overview

Declaration of sponsorship Novartis AG and J. Uriach y Compañía S.A
Read time: 45 mins
Last updated:12th Mar 2020
This section of the Learning Zone introduces urticaria and covers the major topics in disease awareness. Choose one of the sections below, or scroll down the page, to learn about the epidemiology and different classifications of urticaria, the pathophysiology and symptoms to look out for, or see diagnosis and assessment tools. Current guidelines and potential treatments are also presented, allowing you to consider the options for your patient.

Added in August 2020 – further socioeconomic data has been included and current Real-World outcomes has been added to the treatment section, providing insights into efficacy and safety outside of a clinical trial setting.


Explore the prevalence and duration of urticaria, including the risk factors for increased time with the condition. The burden of disease is also explored, with consideration of the impact on quality of life, daily functioning and socioeconomic factors. 

You can also learn more on the epidemiology of chronic urticaria from Professor Marcus Maurer, filmed at EAACI 2019.


Register free for full access to


CSU is driven by the activation of mast cells, which release histamines and other immune modulators, although the precise mechanism is not fully known.

In this section we present the current understanding of the molecular and immune processes involved in urticaria.


Register free for full access to


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). 


Register free for full access to

Diagnosis and Assessment

Since there is no definitive test for chronic spontaneous urticaria, diagnosis is based on a thorough medical history and physical examination as well as diagnostic tests. 

In this section we describe the steps required to diagnose the disease, the diagnostic markers to be aware of and other conditions which can cause hives and angioedema.


Register free for full access to



Unfortunately for many patients with CSU, the itchy hives and/or angioedema associated with the condition is not all they have to contend with. A substantial number of patients also experience comorbidities associated with the development of CSU.


Register free for full access to


The Aim of Treatment
The aim of treatment for urticaria is quick and complete symptom control (Maurer et al., 2011; Maurer et al., 2015; Zuberbier et al., 2018).

The Recommended Treatment Algorithm

The 2013 EAACI/GA2LEN/EDF/WAO guidelines recommend the following step-wise approach to the treatment of urticaria (Zuberbier et al., 2018).

Register free for full access to


Best practice guidelines for CSU have been developed and published by a number of national and international groups, and those with major significance are described in this section. Broadly speaking they recommend second generation antihistamines of standard and then increased dose, followed by alternative agents such as anti-inflammatories, immunosuppressants or biologics.


CSU presents as wheals and/or angioedema which usually last for less than 24 hours and resolve without leaving a mark.  These symptoms occur for 6 weeks or more (Zuberbier et al., 2018).


Register free for full access to

Paediatric Urticaria


Having explored adult urticaria, in this section of the Learning Zone, we review the available data in paediatric urticaria and establish the impact it has on younger patients and how diagnosis and management compares to the recommendations for adult patients with CSU.


Register free for full access to