You scored concert tickets. You and your besties have multiple beach days planned. Your crush wants you to hike his favorite trail with him. And yet…you’re not exactly psyched about these summer plans. Why? Because you’re living with urticaria—aka hives, those itchy red welts that have a tortured relationship with summer temps—which means all that warm-weather fun can quickly turn miserable.
Christina Kantzavelos, 36, who lives in San Diego and was diagnosed with chronic spontaneous urticaria (CSU) over 10 years ago, can relate. “The hardest part is the unpredictability,” she says. “Some days I look and feel fine. Other days I’m exhausted, uncomfortable, or visibly covered in hives. That makes it hard to plan ahead, even when others can’t see what’s happening beneath the surface.”
For most people, a case of hives is temporary, lasting anywhere from a few days to a few weeks. But with long-lasting hives—what doctors call chronic urticaria—flare-ups occur most days of the week, if not daily, for six or more weeks, as the result of a particular trigger like a specific food or medication.
With CSU, in contrast, the cause is unknown. “Compared with other forms of chronic hives, CSU doesn’t have an identifiable trigger,” says Brittany Craiglow, MD, an associate adjunct professor of dermatology at Yale School of Medicine. “Some patients with CSU also experience systemic symptoms such as headaches, fatigue, joint pain or swelling, and gastrointestinal symptoms.”
Women develop CSU at twice the rate of men, usually between the ages of 20 and 40. Experts aren’t sure why, but one possible reason is that “women are more likely to have autoimmune diseases,” in which the body’s immune system mistakenly attacks its own healthy cells and tissues, causing inflammation and damage, says Steve Daveluy, MD, professor and program director in the department of dermatology at Wayne State University. “Estrogen and the hormonal changes that happen during the menstrual cycle impact the immune system, making it more reactive.” And that, in turn, makes it more likely to cause chronic hives.
Treating CSU often requires working with a dermatologist to develop a multi-pronged approach that includes some combination of medication, light therapy, and lifestyle modifications around diet, exercise, and stress. “Identifying personal triggers and trying to avoid them as much as possible is an important part of management,” Dr. Craiglow says.
For Kantzavelos, that means being mindful of everything from her pantry to her wardrobe. “I avoid high-histamine foods and drinks like alcohol and processed snacks,” she says. “I use unscented skincare and laundry products, and wear soft, loose clothing that won’t irritate my skin.”
Your summer survival guide for managing CSU
Summer is particularly challenging for those living with chronic hives. “Heat, sunlight, sweat, and even the pressure from shoes or swimsuits can all trigger flares,” Kantzavelos says. “It takes a lot of planning to move through social settings when you’re managing a condition that reacts to almost everything.”
This doesn’t mean you have to sit the season out, though. Here are tips for how to manage CSU through all the situations you’re likely to find yourself in this summer, so you can interact with others stress-free—and be as psyched as ever about your jam-packed social calendar.
At the beach
A trip to the seashore may seem like a no-go for someone with CSU, but it’s doable if you time it right. “Sunlight and heat can both trigger hives, so morning, late afternoon, or evening may be better times to visit,” says Dr. Craiglow. “When you’re there, cover up—think broad-brimmed hat and rash guard—or even better, hang out under an umbrella.”
Cold temperatures can also worsen hives, says Dr. Craiglow. But of course, this isn’t normally an issue in the summer, unless the ocean water is chilly, in which case she advises staying on the shore.
At a barbecue
The stress of knowing your CSU can flare at any moment is enough to make you opt out of anything remotely social, even a casual cookout with friends. When you consider the two-way relationship between stress and chronic hives—one causes the other—it’s easy to see why.
“The pattern I see most often is the ‘spotlight effect’—believing everyone is watching and judging you when flare-ups happen,” says Erinn Everhart, a therapist in El Dorado Hills, California, who has worked with teens and adults navigating social anxiety caused by unpredictable physical symptoms like hives. “One technique that’s been game-changing for my clients is creating what I call ‘connection anchors’ before social events. This means identifying two to three people at the gathering whom you genuinely want to catch up with, then focusing conversations on them rather than your condition. When you’re interested in someone else’s story, your own self-consciousness naturally fades into the background.”
Also, reframe social situations as practice rounds rather than performances, Everhart suggests. In other words, view each interaction as a way to build your resilience tool kit, rather than a test you could pass or fail.
On a hike
Preventing a flare-up is easier when you have a standard case of chronic urticaria; you can simply avoid your known triggers. With CSU, the triggers are unknown (hence the “spontaneous” part of the name).
So how can you enjoy a hike when nature itself is unpredictable? Play it safe, says Kantzavelos. For her, that means hiking during cooler times of the day, wearing soft, protective layers, and carrying a stash of electrolytes, water, and her emergency meds. It’s also important to not overexert yourself, as increased body temperature can trigger hives. “I check in with my body often and take breaks before I actually need them,” she says. “Nature can be healing, but only when I move at a pace that feels safe for my system.”
On a date
Something to keep in mind when choosing your date-night outfit, notes Dr. Craiglow: Friction and pressure from clothing can exacerbate hives. Even the pressure of a purse strap on your shoulder can trigger a flare-up. “A flowy maxi dress or jumpsuit is going to be a better option than a tight, strappy dress or top,” she says.
When possible, suggest a date spot that’s low-key and climate-controlled, as Kantzavelos does. She also shares early in a relationship that she lives with a chronic condition that sometimes causes visible symptoms. “It helps remove pressure and allows me to show up more fully,” she says.
At a pool party
Although not a true allergen, chlorine can irritate the skin and potentially trigger or exacerbate hives for people with CSU—especially those with sensitive skin. But that doesn’t mean the pool is off-limits.
Kantzavelos has her pool routine down pat: “I always rinse before and after swimming and moisturize with a product my skin can tolerate,” she says. “I avoid hot tubs completely. And I bring a cooling towel and stay near shaded areas, so I have an easy exit point if my body starts to feel off.”
