Hello, You should understand urticaria vs anaphylactic reaction. Chronic spontaneous urticaria (CSU) is defined by the presence of recurrent urticaria. CSU is rarely a sign of another underlying disease and rarely permanent. It is not an allergic reaction, and it rarely puts the patient at any acute risk. This can be confusing to patients because acute urticaria and angioedema are manifestations of allergic reactions, which can be life-threatening. However, CSU is limited to the skin and mucosal tissues and does not involve other organ system as an allergic reaction can. CSU symptoms can be adequately controlled in the majority of patients. Using one or more medications that do not cause significant side effects for that individual. The majority of available therapies have not been shown to cure CSU. In most patients, CSU spontaneously resolves in two to five years, although it may recur or persist in a significant minority. You should avoid of exacerbating factors. Even though, CSU , by definition, has no external cause or triggering stimulus that explains all episodes. Such as Physical factors that some of patients with CSU have some flares that are triggered by physical stimuli. As an example, heat ( hot showers, extreme humidity), and tight clothing or straps can also aggravate symptoms. Nonsteroidal anti-inflammation drugs(NSAIDS) worsen symptom in many patients, and patient with CSU should be advised to avoid them. Foods, some patients may notice that some foods seem to aggravate their symptoms, although food allergy is not cause of CSU. Stepwise approach to treatment: We have step 1 to step 4 in using medication to control your symptoms. Discuss with your doctor about the medication. Your doctor should follow up you back after try all the step of treatment. If still not control your symptoms they also add systemic glucocorticoids for short term control if you experience severe exacerbations of urticaria that significantly impair quality of life. Many patients with CSU require multiple medications to control symptoms fully. You should be refer to specialist if you have an underlying disorder is suspected( refer to an allergist/immunologist or other appropriate specialist), you have signs or symptoms suggest urticarial vasculitis, such as urticarial lesions that have a purpuric quality, leave residual ecchymotic markings, or are accompanied by fever or joint pain, and symptoms are not controlled with steps 1,2,3, or you are requiring repeated or prolonged treatment with glucocorticoids. Hope I have answered your query. Let me know I can assist you further. Kind regards, Dr Heang Chan Raksmey, General and Family Physician