### Understanding Chronic Spontaneous Urticaria (CSU) and New Treatments Chronic spontaneous urticaria (CSU) can be very frustrating. These red, itchy hives appear and disappear unpredictably, often without any clear reason. When CSU symptoms persist for more than 6 weeks, it can be even more stressful, especially if they don't respond to basic treatments or lifestyle changes. According to experts, up to half of people with CSU have an underlying autoimmune disorder, such as Hashimoto’s thyroiditis, rheumatoid arthritis, lupus, type 1 diabetes, or celiac disease. Blood tests can help identify these conditions. If an autoimmune disorder is found, treating it can often improve CSU symptoms. If no clear cause is found, doctors usually recommend over-the-counter (OTC) antihistamines like cetirizine (Zyrtec), fexofenadine (Allegra), or loratadine (Claritin). Higher doses than usual may be needed, but side effects like nausea or dry mouth are possible. If these aren't enough, doctors might add H2 antihistamines found in OTC heartburn medications or prescribe doxepin, an antidepressant and antihistamine. For severe cases, a short course of oral steroids like prednisone may be used. If antihistamines don't work, omalizumab (Xolair), a monoclonal antibody, can be prescribed. It's FDA-approved for CSU in people 12 and older and is given through monthly injections. Combining omalizumab with antihistamines can be very effective, but it can be expensive and may not be covered by insurance initially. In rare cases where these treatments don't work, immune-weakening drugs like cyclosporine or methotrexate may be used, but they come with serious side effects and require close monitoring. Most importantly, CSU usually goes away with time, and most patients respond to at least one of these treatments eventually.