Chronic Spontaneous Urticaria

More than 20% of people have experienced random hives, or welts, on their skin at some point in their lives. But, there is also a longer-lasting type of hive condition called Chronic Spontaneous Urticaria (also known as Chronic Idiopathic Urticaria) that can affect up to 0.5% of people. CSU is a condition that causes random hives and welts on various locations of the body for 6 weeks or more. CSU can affect both adults and children. Usually, the condition is idiopathic, or has no known cause, but sometimes the condition can be related to a viral illness or associated with some autoimmune conditions.

It’s important to know that chronic hives that occur randomly are much different than acute, sudden-onset hives that can occur following accidental ingestion in patients with food or drug allergies, or with patients with history of allergic reactions. In those conditions, the trigger is usually very obvious, such as a food, medication, or insect sting, and leads to hives occurring usually within 30 minutes. Once treated, these hives usually resolve. One major difference is that with chronic hives, symptoms will continue and there will be no obvious trigger. Many patients suspect medications or foods as triggers, but this is not usually the case in chronic hives.

CSU is usually benign and not an indication of anything concerning or dangerous going on in the body. Sometimes, patients will have other symptoms that will require further work up with labs or other tests. However, most of the time, hives are very easy to treat using safe and effective medications to help the hives get under control and hopefully stay away for good! If you are suffering from chronic hives, be sure to address your symptoms with your allergy provider in order to get the best control and relief you need!










Sure, you know pollen causes allergies and will cover your car certain times of the year. But a lot of people don’t really know much about pollen! Keep reading if you’d like to learn more!


Pollen is very lightweight, and floats around easily. The wind can cause spread of pollen over hundreds, sometimes thousands of miles. Some pollen, like ragweed, is more allergenic than others. This means it can cause more symptoms for allergy sufferers, even if there is not very much of it in the air.   Before rainstorms, wind often kicks up the pollen. After rainstorms, the pollen is wet and heavy and stays on the ground.


When pollen floats around, it sticks to our skin, eyes, and inside our upper respiratory track (nose, throat) and lower respiratory tract (lungs). Our immune system responds to allergies by releasing inflammatory cells and causing swelling, inflammation, congestion, and mucous production.


Flowering plants tend to be less allergenic overall, because they do not release a lot of airborne pollen. Flowers have heavier pollen, and rely on insects likes bees to carry the pollen. In Arizona, many residents blame palo verde trees for all the pollen, when it is really usually other trees causing the problem! This is also why local honey is actually not effective to treat allergies. Since it is produced from flower pollen, it contains too little airborne pollen to actually help treat symptoms. Using local honey or bee pollen to treat or cure allergies is a big myth!


Some pollen can cause food reactions, a condition called oral allergy syndrome. This occurs with certain fresh fruits or vegetables causing itchy mouth or itchy throat, because the protein structure resembles pollen structure. This condition is also called food pollen syndrome.


Some plants, like birch trees, only pollinate a few weeks each year when others, like bermuda grass, pollinate almost all year long.  Research shows that pollen counts are rising and pollen is becoming more allergenic. Climate change and pollution is partially to blame for this.


The only way to know if you have pollen allergy and what specific plant types you are allergic to is to have allergy testing. Allergy testing is usually done via skin-prick testing and is best done in an allergy clinic, by board-certified allergists. There are many companies who promote allergy testing, but unless it is done properly with an allergist, the results may be very inaccurate.  Once you get tested, your provider can review the results and recommend any environmental control measures that may help. Depending on what you are allergic to, testing can give you insight on when is the best time to start taking daily allergy medications. Your team at AAAI can help come up with the best treatment plan for you, including medications, allergy drops, or allergy shots!



Vocal Cord Dysfunction (VCD), also known as Paradoxical Vocal Fold Movement (PVFM) occurs when the vocal cords do not move or open properly. Sometimes, VCD can be confused with asthma because their symptoms and triggers are very similar. Symptoms of VCD can include shortness of breath, chronic cough, throat clearing, wheezing, loud whistling sound with breathing in, difficult getting a good breath in, frequent yawning, throat tightness, or hoarse voice. VCD can be triggered during stressful or anxious events, or with exercise. Triggers also include airborne dust, pollens and irritants, or colds and viruses. VCD can affect patients of all ages and conditioning level, and is commonly seen in elite athletes or runners. Acid reflux, seen with gastroesophageal reflux disease (GERD) and post nasal drainage seen with allergies or sinus disease, can also trigger VCD.

Diagnosing VCD can be a challenge. Often times we rely on the patient’s history, symptoms, and the timing of symptom onset. Sometimes, how a patient responds to different inhaled medications can be a clue. Spirometry, a test often used for asthma diagnosis and monitoring, can sometimes show features of vocal cord irritation. The most definitive way to diagnosis VCD is with laryngoscopy with visualization of the vocal cords.

Treatment for VCD depends on the underlying cause and is different for everyone. It involves treating the underlying cause and controlling triggers, as well as speech therapy or special breathing exercises to relax the throat muscles. The providers at AAAI can help determine if you have VCD or asthma (or both) and help find the right treatment program for you.


Vasomotor Rhinitis


Vasomotor rhinitis is a condition that causes chronic sneezing, congestion, or runny nose that can be triggered by pollutants like a dusty environment, odors, foods or beverages, or weather changes. These symptoms can often seem like typical allergic rhinitis (hay fever) symptoms. About 50% of patients with allergies will have some type of vasomotor rhinitis. While vasomotor rhinitis can cause similar symptoms, what is going on in the body is much different. In allergic rhinitis, your immune system is involved and has formed antibodies to the trigger, such as pollen. In vasomotor rhinitis, the triggers merely cause an irritation which causes congestion, sneezing, runny nose.  Have you ever had a runny nose from eating a spicy food? That’s a kind of vasomotor rhinitis called gustatory rhinitis.


Many patients will have mild symptoms but if symptoms are constant and very irritating, there are treatment options to help control symptoms. Often, allergy testing will be performed to see how to best manage symptoms.    Often times, patients will mistakenly think they may be allergic to a smell or a food, when it’s actually vasomotor rhinitis! It’s important to discuss with your allergist if you are experiencing symptoms like these and have questions, so they can come up with the best recommendations for you!