Chronic Urticaria

Chronic urticaria (CU) is defined by the recurrence of wheals and/or angioedema for more than 6 weeks. It is divided into chronic inducible urticarias (CIndU) and chronic spontaneous urticaria (CSU), previously termed chronic idiopathic urticaria. In CIndU, signs and symptoms are provoked by a specific and definite trigger such as exercise, friction or cold. Patients with CSU display symptoms independently of definite triggers. Most patients with CSU experience recurrent wheals angioedema, some only have wheals and a few patients have only angioedema. In most cases, CU is a self-limiting disorder. CSU, on average, persists for several years, whereas CIndU tends to be of longer duration. Type I and IIb autoimmunity, i.e., IgE and IgG/IgM autoantibodies to autoallergens and IgE receptor, respectively, have been implicated in the pathogenesis of CSU in most patients. Treatment of patients with CU is aimed at complete control. Guideline-recommended treatment options are limited to second-generation H1-antihistamines, at standard or up to fourfold times the standard doses, omalizumab and cyclosporine. CU activity, impact and control should be assessed in all patients with CU as this helps to guide effective treatment.