I have CIU (chronic idiopathic urticaria) – how do I treat it?

If you suffer from chronic idiopathic urticaria, there’s no doubt that it’s a demoralizing condition, and the fact that allergists and dermatologists can offer no definitive treatments can mean that those with the condition have to suffer in silence. However, recent research has meant that as we start to understand more about the condition, the options for successful treatment are increasing.
What is the definition of CIU?
You’re said to have CIU when you experience daily, or almost daily wheals and itching for a period of six weeks or more, which have no obvious or known cause. In approximately 30-50% of CIU patients, the condition is due to an autoimmune process, where histamine is released in response to unknown allergens.
How is it treated?
Treatment for patients with chronic idiopathic urticaria usually consists of avoiding known triggers, taking antihistamines and being educated about the condition. Of course, if the triggers have not been identified, this can prove very difficult to treat, and as this is the case in between 50-80% of people, it means that many CIU sufferers will get little to no respite from the condition. However, 50% of sufferers do experience remission within 12 months, meaning treatment is no longer necessary. The most frequent kind of treatment for CIU involves antihistamines which are sometimes combined with other medications to control symptoms.
These are usually the first treatment prescribed, with diphenhydramine (Benadryl) and hydroxyzine (Atarax), being the most common. These are usually taken on a regular daily basis rather than just during acute episodes.
Systematic steroids
Some sufferers may be offered oral steroids which have proved very effective in controlling the symptoms of chronic urticaria. However, as these also have many possible side effects, their use is generally limited to just a couple of weeks.
Leukotriene-receptor antagonists
When histamine is released from the mast cells, other chemicals called leukotrienes are also released. Leukotriene-receptor antagonists work in conjunction with anti-histamines to block the leukotriene receptors and are usually prescribed as an additional treatment, although they can be prescribed in isolation too.
Anti- inflammatory medication
Other options for treating CIU include anti-inflammatory medications, such as dapsone and hydroxychloroquine which are believed to suppress prostaglandin and leukotriene production.

Many patients with chronic idiopathic urticaria have been found to benefit from immunotherapy, with immunosuppressants such as cyclosporine and sirolimus proving effective in inhibiting the activity of the mast cells. However this is usually the last resort for severe cases of chronic idiopathic urticaria as they have potentially serious side effects.