ASCIA PCC Chronic Urticaria 202249.68 KB

Q 1: What is CSU?

Chronic spontaneous urticaria (CSU) is the medical term for hives (the common term for urticaria) that are chronic (lasting six weeks or more, three to four times per week), and spontaneous (with no known trigger).

Symptoms of CSU can be similar to other types of hives, which:

• Are red, white or skin coloured itchy blotches or lumps, that can be mistaken for mosquito bites.
• Vary in size (from a pin head to a dinner plate) and can occur on any part of the body.
• Usually last for less than 24 hours, and then show up later in another location on the body.

Some people who have CSU will also have angioedema, which are sudden swellings of different parts of the body, such as lips, eyelids, hands or feet, that can last up to several days.

Q 2: What causes hives?

Hives occur when histamine-containing mast cells, which are found under the lining of the skin, are activated and release histamine (and other chemicals) into the tissues. Histamine irritates nerve endings to cause itching, and makes blood vessels expand and leak, which causes redness and swelling.

Up to one in five people have hives at some time during their life. Common causes of hives include infections and contact allergy to plants or animals. Although hives can be part of an allergic reaction, hives that last for more than a few days are usually not caused by allergy. CSU can sometimes be caused by an underlying medical condition, but in most cases the cause of CSU is unknown (spontaneous or idiopathic).

Q 3: How is CSU diagnosed?

CSU is diagnosed when a person has spontaneous hives for more than six weeks, without any allergic cause. To confirm this diagnosis, your doctor will:

• Review your medical history (It can be helpful to keep a diary and a photo record of the hives), followed by a detailed physical examination.
• Order blood tests if an underlying condition is suspected. Allergy tests are usually not required unless there is a reason to suspect an allergic cause.

People with severe CSU symptoms that affect their daily life, and do not respond to simple treatment should be referred to a clinical immunology/allergy specialist for assessment and consideration of additional treatments.

Q 4: How is CSU treated?

Whilst most cases CSU resolve within a few weeks without any specific treatment, sometimes CSU can last for months or longer. The goal of treatment is to reduce or suppress itch and hives, whilst minimising side effects.

Non-drowsy antihistamines are often used to relieve itch, and higher than standard doses may be required. Severe CSU that is not controlled with high dose antihistamines can require specialised treatment, including:

• Immune modulators - Usually given as subcutaneous injections into the tissue between the skin and the muscle that can be given at home.
• Immunosuppressive medications - Corticosteroids can be used to treat severe symptoms for a short time.

Options for long term treatment should be discussed with your specialist.

© ASCIA 2022

Content updated February 2022

For more information go to https://allergy.org.au/patients/skin-allergy

To support allergy and immunology research go to www.allergyimmunology.org.au/donate

ASCIA is the peak professional body of clinical immunology/allergy specialists in Australia and New Zealand

ASCIA PCC Eczema FAQ 2023129.5 KB

This document has been developed by ASCIA, the peak professional body of clinical immunology/allergy specialists in Australia and New Zealand. ASCIA information is based on published literature and expert review, is not influenced by commercial organisations and is not intended to replace medical advice. For patient or carer support contact Allergy & Anaphylaxis Australia or Allergy New Zealand. For more information visit the ASCIA website and the National Allergy Council Nip allergies in the Bub website.

Q 1: What is eczema?

Eczema is a chronic health condition that affects the skin, causing redness, dryness itching and sometimes infections. When eczema worsens it is called an eczema flare and usually there is no single factor for an eczema flare. Eczema flares can be triggered by a range of irritants (see Q 8) or for no obvious reason.

Eczema is also known as atopic dermatitis:

• Atopic conditions include eczema, allergic rhinitis (hay fever), dust mite and food allergy;
• It is common for people with eczema to have other atopic conditions.
• Unlike other atopic conditions, allergens do not usually directly cause eczema symptoms.
• Dermatitis is a general term for skin inflammation (redness and swelling).

Whilst a family history of allergy increases the tendency to develop eczema, the reasons why some people develop eczema is not well understood.

What is Eczema (Atopic Dermatitis)? https://ya.250k.org.au/eczema/ is a short animated video about eczema, that has been created as part of the National Allergy Strategy 250K youth project.

Q 2: What is the scratch and itch cycle of eczema?

The scratch and itch cycle of eczema can cause discomfort, disrupt sleep and affect quality of life:

• In people with eczema the skin does not retain moisture very well, which causes it to dry out easily.
• This makes the skin more open to allergens and irritants, which can trigger the skin to release chemicals that make the skin itchy.
• Scratching itchy skin causes more chemicals to be released, making the skin feel itchier.
• If eczema is well managed this can avoid the scratch and itch cycle. It is therefore important to keep skin that is prone to eczema well moisturised, by using moisturising creams on the skin every day.

Q 3: How does eczema affect people of different ages?

Eczema is a chronic health problem that affects people of all ages, but is most common in babies (infants):

• Infantile eczema occurs in around 20% of children under two years of age, and usually starts in the first six months of life. Infantile eczema usually improves significantly between the ages of two to five years.
• Childhood eczema may follow infantile eczema, or start from two to four years of age. Rashes and dryness are usually found in the creases of the elbows, behind the knees, across the ankles and may also involve the face, ears and neck. This form of eczema usually improves with age.
• Adult eczema is similar to that of older children with areas of very dry, itchy, reddened skin at the elbow creases, wrists, neck, ankles and behind the knees. It can cause rough, hard and thickened skin, which may also have weeping areas. Although eczema tends to improve in midlife, and is unusual in elderly people, it can occur at any age.

Q 4: Do people with eczema usually have other allergic conditions?

Many people with eczema have other allergic conditions. Studies have shown that up to 30% of babies with eczema who have a family history of allergy will develop food allergy, and up to 40% develop asthma or allergic rhinitis.

Q 5: How is eczema related to food allergy?

Whilst food allergy can trigger or worsen eczema symptoms in some people, food allergy is rarely the cause of eczema. Most food allergy causes hives (urticaria), vomiting and irritability within 30 minutes of eating the offending food. Food allergy only occasionally triggers delayed eczema flare ups.

Many babies with moderate or severe eczema will also have a food allergy. In some babies with severe eczema, short term removal of certain food/s using a medically supervised elimination diet may result in better eczema control. An elimination diet should be supervised by a clinical immunology/allergy specialist (or other medical specialist trained in allergy), in association with a dietitian with specialised knowledge of food allergies.

If there is no improvement in two weeks on the elimination diet, it means that food is unlikely to be the cause of the eczema. If the skin improves, foods are introduced one at a time as a medically supervised food challenge, to confirm which food causes the eczema to flare.

If food allergy is not the cause of eczema, removal of the food/s will not reduce symptoms.

Children with eczema and/or food allergy can have false positive allergy tests, and this can lead to unnecessary removal of foods which may affect growth and development. Removal of foods may also increase the risk of developing allergy to those foods. Therefore, allergy test results should always be interpreted by a clinical immunology/allergy specialist.

Q 6: How is eczema managed?

Eczema can be managed using the following steps, that are explained in detail in Q7-11:

• Maintain and protect skin every day.
• Avoid known triggers and irritants.
• Treat eczema flares and severe eczema.
• Control itch.
• Prevent and treat infection.

Q 7: How can skin be maintained and protected every day?

It is important to keep skin that is prone to eczema well moisturised every day:

• Moisturisers add moisture and form a barrier that protects the skin, so that it retains moisture. If the protective barrier of skin is damaged eczema frequently develops.
• Apply non-perfumed moisturiser to the face and body twice every day.
• Avoid moisturisers containing food proteins such as goat milk, wheatgerm and nut oils.
• After a bath or shower in lukewarm water, pat the skin dry and apply moisturiser.
• Use non-soap based wash or oil and avoid soap and bubbly products which dry out the skin.
• After swimming (especially in chlorinated pools), rinse and apply moisturiser.

Q 8: What triggers should be avoided?

People with eczema should avoid known triggers and irritants, which may include:

• Dry skin - this is one of the main triggers of eczema.
• Scratching - keep fingernails clipped (night gloves may be needed for young children).
• Viral or bacterial infections.
• Playing in sand, such as sandpits.
• Sitting directly on carpets or grass.
• Inhaling pollen allergens from grasses, weeds or trees in spring and summer.
• Irritants such as perfumes, soap and chemicals.
• Contact with animals, house dust mite allergen, wool and synthetic fabrics.
• Temperature changes, such as overly heated rooms.
• Stress, which can make eczema worse, although eczema is not a psychological condition.
• Constant exposure to water or chemicals, which can damage the protective barrier function of the skin.

Q 9: How should eczema flares and severe eczema be treated?

Skin damage can be prevented by applying creams or ointments prescribed by your doctor as soon as eczema is present. In contrast, not using enough of the treatments can cause skin damage due to itching, which can lead to scarring.

If prescribed, use topical corticosteroids or calcineurin inhibitors:

• These treatments actively treat inflammation (redness and itching).
• Ensure that adequate amounts are used. As a guide, one fingertip unit (FTU) is the amount of ointment from the first bend in the finger to the fingertip, which will cover an area equal to two adult hands.
• Apply moisturiser after corticosteroid cream or ointment has been applied.

If prescribed, use a recently listed treatment for severe eczema. There are now two treatments for severe eczema that are listed on the Pharmaceutical Benefits Scheme (PBS) in Australia for people aged 12 years or older with severe eczema which has not responded to other prescribed topical treatments:

• Dupixent® (dupilumab) is an immune modulating treatment given by injection that is self-administered. Dupilumab works by modifying the body’s immune response to prevent inflammation that plays a central role in eczema, but it is not an immunosuppressant.
• Rinvoq® (upadacitinib) is a Janus Kinase 1 (JAK1) inhibitor, that is taken as an oral tablet. JAK enzymes create signals in the body's immune system that result in inflammation, so JAK inhibitors work by blocking these signals. This reduces inflammation and the production of immune cells within the body.

It is important to ask your clinical immunology/allergy specialist or dermatologist to see if you are eligible for one of these treatments for severe eczema, which target different parts of the immune system.

Q 10: How can itch be controlled?

The following actions may reduce itch, to help control the scratch and itch cycle of eczema:

• Keep skin well moisturised every day.
• Use cold compresses and wet dressings/wraps, as directed.
• Consider using non-sedating antihistamines, especially if there are hives (urticaria). Sedating antihistamines are generally not recommended and should not be used in young children without specialist supervision.

Q 11: How can infections due to eczema be prevented and treated?

People with eczema that is not well managed can be more likely to have skin infections with bacteria such as Staph (Staphylococcus aureus), and viruses such as the cold sore (herpes simplex) virus.

People with eczema who have infections need to treat these as they occur. They may also need long term prevention strategies, such as diluted bleach baths, which can help prevent future skin infections.

Long term oral antibiotics can be helpful for people who suffer from recurrent infected eczema.

© ASCIA 2023

ASCIA is the peak professional body of clinical immunology/allergy specialists in Australia and New Zealand. For more information go to www.allergy.org.au 

To support allergy/immunology research go to www.allergyimmunology.org.au

Content updated March 2023

Eczema (atopic dermatitis) affects the skin, causing redness, itching and sometimes infections. Eczema can usually be well managed by maintaining skin every day by applying moisturiser at least twice a day to the face and body, and avoiding known triggers or irritants.

When eczema worsens this is called an eczema flare. It is important to treat eczema flares or severe eczema, prevent and/or treat infections and use immune modulating or other treatments, if prescribed for severe eczema.

Hives (urticaria) are pink or red itchy rashes that can appear as blotches or raised red lumps (wheals) on the skin. In most cases hives are not due to allergy, but can be treated with antihistamines. Chronic (ongoing) urticaria may require additional medication. 

Angioedema is a condition that causes swellings due to small blood vessels leaking fluid into the tissues, and  is very rarely caused by allergy. It can be possible to prevent swellings with medications, once the cause is confirmed.  

Fast Facts

Action and Management Plans for Eczema

Click on the links below for more information (A-Z)

Angioedema 

Chronic Spontaneous Urticaria

Contact Dermatitis

Eczema (Atopic Dermatitis)

Hives (Urticaria)

Orofacial Granulomatosis 

Videos and other resources

What is Eczema? - a National Allergy Council initiative with information about managing eczema in young adults 

Nip allergies in the Bub - a National Allergy Council initiative with information about managing eczema in babies 

Scan the QR code to view this webpage on a mobile phone

Useful Links

Webpage updated April 2025

ASCIA PCC Orofacial granulomatosis 201968.17 KB

Orofacial granulomatosis (OFG) is also known as Melkersson-Rosenthal syndrome, Cheilitis Granulomatosis, and Schuermann's Glossitis Granulomatosa. It is an uncommon inflammatory condition that affects the face and lips in people, but it is most common in early adult years.

OFG is an inflammatory disease

 OFG results in swelling and inflammation of tissues, with clumps of many different types of white cells. The cause of OFG is unknown. While inflammation in OFG has been blamed on infections, there is no definite proof that OFG is due to any one infectious organism. 

Lip swelling is common

Lip swelling due to OFG may initially only last a few hours at a time, and can be difficult to distinguish from another type of lip swelling known as angioedema. As the condition progresses, swelling tends to last for days at a time, and eventually becomes permanent. Sometimes cracking and dryness of the lips occurs.

Other common symptoms

Swelling of the face and eyes can also occur in OFG. Some people have a fissured tongue, and may sometimes develop facial paralysis. Mouth ulcers and inflammation of the gums, known as gingivitis may be seen. Other symptoms include tongue swelling or a sensation of a burning tongue. Occasionally facial numbness, and cheek or gum swelling can develop.

Confirming the diagnosis

As there are many possible causes of lip swelling, tests are often required to prove the diagnosis, and to exclude diseases that can mimic OFG. These tests may include blood tests, taking a sample of the involved tissue (biopsy), x-rays or other specialized tests.

Treatment options

Swellings may resolve spontaneously without treatment, but most persist for many years. While no one treatment is always effective, a number of options are available. These include:

• Elimination diets.
• Medications that reduce inflammation.
• Radiotherapy.
• Plastic Surgery.

© ASCIA 2019

ASCIA is the peak professional body of clinical immunology/allergy specialists in Australia and New Zealand.

ASCIA resources are based on published literature and expert review, however, they are not intended to replace medical advice. The content of ASCIA resources is not influenced by any commercial organisations.

For more information go to www.allergy.org.au

To donate to immunology/allergy research go to www.allergyimmunology.org.au

Updated May 2019