CSU Treatment: What Works, What Doesn't, and How to Find Relief

When you have chronic urticaria, a condition where hives last six weeks or longer without a clear trigger. Also known as CSU, it’s not just an itch—it’s a daily battle that disrupts sleep, work, and confidence. Unlike allergic hives that come and go with exposure to peanuts or pollen, CSU happens for no obvious reason. Your immune system is overreacting, and no amount of avoiding triggers will stop it. That’s why treatment isn’t about elimination—it’s about control.

Most people start with non-sedating antihistamines, daily medications like cetirizine or loratadine that block the histamine causing the swelling and itch. If one doesn’t work, you try another. If two don’t work, your doctor will likely double the dose—that’s right, up to four times the standard amount. It’s not off-label; it’s FDA-approved for CSU. Many patients don’t know this, so they quit too soon. But if even high-dose antihistamines aren’t enough, the next step is omalizumab, a biologic injection that targets IgE antibodies, reducing flare-ups in up to 70% of patients who didn’t respond to other treatments. It’s not cheap, but for many, it’s life-changing. You’re not failing—you’re just on the next step of a proven path.

What doesn’t work? Steroids. They might calm things down for a few days, but long-term use brings weight gain, bone loss, and high blood pressure. Same with old-school sedating antihistamines like hydroxyzine—they help with sleep but leave you foggy all day. And no, cutting out gluten or dairy won’t fix CSU unless you have a confirmed food allergy. This isn’t about diet. It’s about immune regulation. The real key is consistency: taking your meds every day, even when you feel fine. Skipping doses is like turning off a fire alarm—you think you’re safe, until the next flare hits harder.

You’ll find posts here that break down exactly how to talk to your doctor about increasing your antihistamine dose, what to expect with omalizumab, and how to spot when your treatment isn’t working. You’ll also see how other patients manage side effects, track flares, and push back when insurance denies coverage. This isn’t guesswork. It’s what works for real people with real CSU—and what you need to know to take back control.