Your activity: 4 p.v.

Factors that exacerbate chronic spontaneous urticaria (CSU)

Factors that exacerbate chronic spontaneous urticaria (CSU)
Exacerbating factor Examples Alternate explanations to consider
Nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Urticaria may worsen in patients within 24 hours after ingestion; some within 2 hours and others (particularly children) up to 4 to 24 hours later.
  • Consider alternate diagnosis of NSAID allergy or pseudoallergy if NSAIDs are the only or predominant trigger for hives or angioedema.
Environmental conditions
  • Heat.
  • Cold.
  • Sunlight.
  • Consider alternate diagnosis of cholinergic urticaria if hives are small (1 to 3 mm), surrounded by large areas of erythema, and predominantly triggered by changes in core body temperature (eg, exercise, hot showers, sweating, emotional factors).
  • Consider exercise-induced anaphylaxis if hives only occur during exercise and not with passive changes in core body temperature.
  • Consider cold urticaria or cold-associated inflammatory disorder if hives are exclusively triggered by exposure to cold.
  • Consider solar urticaria if hives appear to be exclusively triggered by exposure to sunlight.
Friction or pressure from clothing
  • Hives may form under clothing straps, in areas where tight clothing compresses the skin, or in areas of natural friction (axillae, between thighs).
  • Consider diagnosis of delayed-pressure urticaria/angioedema if pressure on skin is followed in 4 to 24 hours by erythematous angioedema of affected area. Patients with delayed-pressure urticaria often have concomitant CSU.
  • Consider vibratory urticaria if hives appear after exposure to vibration (eg, after clapping, mowing lawn, holding certain appliances).
Alcohol
  • Hives may be more numerous or severe after drinking alcoholic beverages.
  • If alcohol is the sole or predominant trigger, consider nonspecific reaction to histamine-releasing properties of some alcoholic beverages, or rarely, allergy to some component of the beverage.
Narcotic medications
  • Hives may be more numerous or severe and pruritus more pronounced after taking narcotics.
 
Stress (emotional or physical) or sleep deprivation
  • Hives can appear during stressful events, and/or control of chronic hives can be more difficult during stressful periods or periods of reduced sleep.
 
Concomitant infections
  • Hives can be more numerous or severe during viral illnesses (eg, common colds) or bacterial infections (eg, sinusitis).
 
Menstruation or perimenstrual period
  • Some women with CSU observe fluctuations with their menstrual cycle.
  • Consider alternate diagnoses of autoimmune progesterone dermatitis or other catamenial dermatoses if hives only occur in perimenstrual periods or lesions are not clearly urticarial.
Irregular use of antihistamines
  • Regular and consistent dosing of antihistamines is most effective in controlling CSU. Erratic or as-needed use may contribute to poor symptom control.
 
Graphic 98751 Version 3.0