chronic spontaneous urticaria

Urticaria: A Brief Review


Yvonne Deng,1 Amir Gohari,2 Joseph M. Lam, MD, FRCPC,3

1Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
2Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.
3Department of Pediatrics, Department of Dermatology and Skin Sciences, University of British Columbia, Vancouver, British Columbia, Canada.


Abstract: Urticaria is a common, mast cell-driven disorder that presents with transient wheals, angioedema, or both. Clinically, it is classified into acute or chronic, depending on the duration of symptoms, and further classified by the presence or absence of inducible stimuli. Although urticaria is rarely life-threatening, it can reduce quality of life and carry significant socioeconomic burden on patients. While there is no cure to the disease, the treatment algorithm for urticaria focusses on the control of symptoms with antihistamines as the mainstay of therapy and immunosuppressive/immunomodulating therapies for severe cases.
Key Words: urticaria; pediatric urticaria; angioedema; acute urticaria; chronic spontaneous urticaria.

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Urticaria is a common pruritic condition that is divided into acute or chronic forms. It can be idiopathic or inducible by triggers that including foods, medications, infections, environmental factors, physical stimuli, and medications.
Acute and chronic urticaria are clinical diagnoses guided by a detailed history and physical examination, and diagnostic testing is not routinely indicated, unless clinical suspicion warrants exclusion of underlying causes.
Pathogenesis of urticaria involves mast cells and subsequent release of histamines and proinflammatory mediators that result in sensory nerve activation, vasodilatation, and plasma extravasation with leukocyte recruitment to lesions.
Second-generation, non-sedating H1-antihistamines are the mainstay of treatment for all types of urticaria and dosed up to fourfold to achieve adequate control.
Individual wheals typically resolve within 24 hours without leaving residual changes on the skin. If the duration of wheals is unclear, patients or clinicians can draw a line around the lesion to observe for changes or resolution
In addition to the physical stimuli in chronic inducible urticaria, other triggers of chronic urticaria include psychosocial stress, work exposures, surgical implants, and menses.
Investigations are not needed to make a diagnosis. However, a limited work-up can be considered for potential comorbidities (e.g. thyroid hormones and autoantibodies for active thyroid disease) or to exclude other diagnoses in the appropriate clinical context (e.g. skin biopsy for urticarial vasculitis).
With the exception of avoiding alcohol consumption, pseudoallergen-free or other food elimination diets should not be routinely recommended to patients for symptom control. In fact, IgE-mediated food allergy is rarely an underlying cause of urticaria.
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