Digital illustration of red blood cells shielding skin from hives, representing a novel treatment for chronic urticaria.

Beating the Itch: Can Your Own Blood Help Fight Chronic Urticaria?

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Mira Elwood in Health & Wellness October 2026 • 4 min read.

"A New Study Explores Autologous Whole Blood Injection as a Potential Treatment for Antihistamine-Resistant Hives"


Chronic spontaneous urticaria (CSU), characterized by persistent and unpredictable hives, can significantly impact quality of life. Unlike hives triggered by known allergens, CSU arises spontaneously, often leaving sufferers searching for effective treatments.

Traditional approaches to CSU, such as antihistamines, sometimes fall short, leaving patients with ongoing discomfort and frustration. When standard treatments fail, individuals often seek alternative or adjunctive therapies to manage their symptoms.

Now, a recent study published in the journal Annals of Dermatology explores the potential of autologous whole blood injection (AWBI) as a treatment for antihistamine-resistant CSU. AWBI involves injecting a patient's own blood back into their system, with the goal of modulating the immune response.

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Treatment Advances

A 2018 comprehensive review identified second-generation antihistamines as first-line treatment for chronic urticaria because of their safety and efficacy profile. The review also reported that some patients need higher doses of H1 antihistamines or combinations with H2 antihistamines, leukotriene receptor antagonists, or first-generation H1 antihistamines. More recently, Medscape listed remibrutinib as a newer option for chronic spontaneous urticaria that remains inadequately controlled with antihistamines.

Autologous Whole Blood Injection: A Novel Approach to CSU Treatment

Digital illustration of red blood cells shielding skin from hives, representing a novel treatment for chronic urticaria.

The study, conducted by researchers at Pusan National University Hospital in Korea, investigated the effectiveness of AWBI in 22 patients with CSU who had not responded to antihistamine therapy. The treatment involved administering AWB injections for eight consecutive weeks, with researchers carefully monitoring the patients' urticaria activity scores (UAS) and overall clinical improvement.

Here’s a breakdown of how the treatment was administered:

  • Patient Selection: The study focused on individuals with CSU who experienced uncontrolled urticaria despite taking antihistamines for more than six weeks.
  • Exclusion Criteria: Patients with urticaria caused by specific triggers like foods or drugs, pregnant or lactating women, individuals with severe systemic diseases, and those taking immunosuppressants were excluded.
  • ASST Classification: Participants were categorized based on the autologous serum skin test (ASST) results into two groups: positive (CAU) and negative (CIU).
  • AWB Injection Protocol: After a three-day antihistamine cessation, venous blood samples were taken. A gluteal intramuscular AWB injection was administered, with 2.5 ml at week 0 and 5 ml/week for subsequent injections.
  • Monitoring and Evaluation: Pruritus intensity, wheal characteristics, and sleep/activity interference were scored weekly. UAS was calculated to assess treatment response. Antihistamine consumption was recorded at the endpoint.
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Current Evidence

Research on autologous whole-blood injections in refractory chronic spontaneous urticaria has examined D-dimer as a possible response marker; levels of at least 292 ng/mL were associated with poor responsiveness, with reported sensitivity of 75% and specificity of 83.3%. A Lancet review describes chronic urticaria as a mast cell-driven disease involving itchy wheals, angio-oedema, or both, and distinguishes spontaneous disease from inducible forms such as cold- or pressure-triggered urticaria. Current management guidance recommends step-up use of second-generation H1 antihistamines, while a 2025 review reported that fewer than 10% of patients achieve complete control with these drugs alone.

Limits of the Evidence

Chronic spontaneous urticaria can impose a substantial emotional burden and interfere with work, school, family life, social functioning, and sleep. In one study of autologous whole-blood injection for antihistamine-resistant disease, antihistamine consumption at week 8 did not differ significantly from baseline. These findings caution against assuming that the procedure reliably reduces medication needs or resolves the broader burden of chronic urticaria.

Antihistamine Comparison

A 2021 network meta-analysis examined the effects of H1 antihistamines reported in randomized clinical trials for chronic spontaneous urticaria. Comparative efficacy and safety between first-generation and second-generation H1 antihistamines have been described as unclear in the literature. However, a 2026 systematic review reported that second-generation antihistamines appeared more effective and less sedating for patients managing chronic urticaria.

The study defined a "responder" as a patient who experienced a >30% improvement in their UAS after repeated AWB injections. The results showed that 36.4% of the CSU patients responded to AWB injection. Interestingly, there was no significant difference in responder rates between the CAU and CIU groups. Notably, the study found that patients with high baseline UAS scores experienced marked improvements after AWB injections.

The Future of CSU Treatment

While the study's findings are encouraging, more research is needed to fully understand the mechanisms behind AWBI and to optimize its use in treating CSU. The authors suggest that future studies should focus on evaluating the efficacy, duration, treatment interval, and dose of AWB injections in a larger cohort of patients. Nevertheless, this study offers a promising avenue for individuals seeking relief from antihistamine-resistant chronic urticaria.

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Toward Personalization

Expert commentary describes optimal management of chronic spontaneous urticaria as challenging because of knowledge gaps about triggers, variable treatment responses, and limited data for special populations. Second-generation H1 antihistamines remain the first-line treatment and are reported to be effective in approximately 50% of patients. Another expert review argues that urticaria care is moving toward personalized medicine, including biomarkers that may help predict treatment response and avoid unnecessary testing.

Where AWB sits among controlled urticaria evidence

A later systematic review identified eight clinical trials involving 529 patients with CSU. It found that autologous serum therapy was not more effective than placebo for reducing symptoms at the end of treatment.[1]

The same review found that AWB did not have a higher response rate than placebo at the end of follow-up.[1]

  • The available controlled studies differ in design, sample size, controls, dose, treatment frequency, duration, and indication. That variation makes results from separate AWB studies difficult to compare directly.[2]
  • The need for new approaches may be particularly relevant to autoimmune CSU, in which mast cell-activating IgG autoantibodies have been associated with nonresponse or delayed response to omalizumab.[3]

Questions about the treatment context

Does a response to AWB mean CSU is cured?

No. The evidence does not establish a disease-modifying treatment that induces long-term CSU remission after medication withdrawal. A change in symptoms is not the same as demonstrating lasting remission.[3]

Angioedema
A feature that can occur with CSU alongside wheals.[3]
Omalizumab
A second-line treatment for antihistamine-refractory CSU.[3]

Sources

  1. Efficacy of autologous whole blood or serum therapy for chronic spontaneous urticaria: a systematic review and meta-analysis (scholars.lib.ntu.edu.tw, 2019)
  2. Intramuscular autologous blood therapy - a systematic review of controlled trials (pmc.ncbi.nlm.nih.gov, 2006)
  3. Update on the Treatment of Chronic Spontaneous Urticaria - PMC (pmc.ncbi.nlm.nih.gov)

About this Article -

Written with AI assistance from published research, and reviewed by the Mystum team. See our About page for more information.

Everything You Need To Know

1

What exactly is chronic spontaneous urticaria?

Chronic spontaneous urticaria (CSU) is a skin condition characterized by the presence of hives that persist for an extended period without any identifiable external cause like allergies. The hives appear spontaneously, making it difficult to predict or prevent outbreaks. CSU can significantly affect a person's quality of life due to persistent itching and discomfort. Traditional treatments, such as antihistamines, may not always provide sufficient relief, especially in antihistamine-resistant cases, prompting the search for alternative therapeutic approaches.

2

What is autologous whole blood injection, and how is it used to treat hives?

Autologous whole blood injection (AWBI) is a medical procedure where a patient's own blood is drawn and then injected back into their body. In the context of treating chronic spontaneous urticaria (CSU), AWBI aims to modulate the patient's immune response to reduce the severity and frequency of hives. It is considered a novel approach for individuals with antihistamine-resistant CSU, offering a potential alternative when conventional treatments have failed.

3

What is the autologous serum skin test (ASST) and what does it tell doctors about chronic urticaria?

The autologous serum skin test (ASST) is a diagnostic test used to classify patients with chronic spontaneous urticaria (CSU) into different subgroups. Patients are classified as either CAU (positive ASST) or CIU (negative ASST). The test involves injecting the patient's own serum into their skin to observe any reaction. This classification helps researchers and clinicians understand potential differences in treatment response and underlying mechanisms of CSU. In the context of autologous whole blood injection (AWBI) the ASST results may help predict how effective the treatment will be.

4

What is the urticaria activity score (UAS) and how does it relate to treatments?

Urticaria activity score (UAS) is a tool to measure the severity and impact of chronic spontaneous urticaria (CSU) symptoms. It evaluates factors such as the intensity of itching (pruritus), the number and size of hives (wheals), and the interference with sleep and daily activities. The UAS is used to assess the effectiveness of treatments like autologous whole blood injection (AWBI). A reduction in the UAS indicates improvement in the patient's condition, and a responder is defined as someone who achieves a significant reduction in their UAS after treatment.

5

What are the exclusion criteria for patients in the autologous whole blood injection study, and why are they important?

In the study, several criteria were used to ensure the selection of appropriate participants and the safety of the intervention. Exclusion criteria included pregnant or lactating women, individuals with urticaria caused by specific triggers like foods or drugs, those with severe systemic diseases, and those taking immunosuppressants. These exclusions are important to consider because these conditions or medications could influence the results of the study or pose risks to the participants during the autologous whole blood injection (AWBI) treatment. Careful patient selection helps ensure that the study focuses on the specific population of interest and minimizes potential confounding factors.

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