Chronic Urticaria: Recent Advances

Abstract

Chronic urticaria is an umbrella term, which encompasses physical urticarias, chronic "idiopathic" urticaria and urticarial vasculitis. It is important to recognize patients with physical urticarias as the investigation and treatment differs in important ways from patients with idiopathic chronic urticaria or urticarial vasculitis. Although relatively uncommon, urticarial vasculitis is an important diagnosis to make and requires histological confirmation by biopsy. Underlying systemic disease and systemic involvement, especially of the kidneys, should be sought. It is now recognized that chronic "idiopathic" urticaria includes a subset with an autoimmune basis caused by circulating autoantibodies against the high affinity IgE receptor (FceR1) and less commonly against IgE. Although the autologous serum skin test has been proven useful in prompting search for and characterization of circulating wheal-producing factors in chronic urticaria, its specificity as a screening test for presence of functional anti-FceR1 is low, and confirmation by demonstration of histamine-releasing activity in the patient's serum must be the benchmark test in establishing this diagnosis. Improved screening tests are being sought; for example, ability of the chronic urticaria patient's serum to evoke expression of CD 203c on donor human basophils is showing some promise. The strong association between autoimmune thyroid disease and autoimmune urticaria is also an area of ongoing research. Drug treatment continues to be centered on the H1 antihistamines, and the newer second-generation compounds appear to be safe and effective even in off-label dosage. Use of systemic steroids should be confined to special circumstances such as tapering regimens for acute flare-ups. Use of leukotriene antagonists is becoming popular, but the evidence for efficacy is conflicting. Cyclosporin is also effective and can be used in selected cases of autoimmune urticaria, and it is also effective in non-autoimmune cases, although less so.

Role of Leukotriene receptor antagonist Montelukast in the treatment of chronic urticaria: A hospital based study

“…An overall average lifelong prevalence of chronic urticaria is estimated to be about 1-2%. Urticaria can be highly distressing and can cause personal, social and occupational disability [1][2][3][4].…”

“…Pathophysiologically it is characterized by local vasodilatation and increased permeability of capillaries and small venules followed by transudation of plasma constituents into the papillary and upper reticular dermis. A large number of substances including kinins, prostaglandins, leukotrienes, proteolytic enzymes and the best-known histamine have been found to elicit the typical weal and flare reactions [1][2][3][4].…”

Fibromyalgia syndrome in chronic urticaria patients

“…Ürtiker plakları tipik olarak 24 saatten kısa sürer ve kaybolur, bir süre sonra tekrarlar 1,[12][13][14] . Bu ataklar latent periyotlar ile birlikte 6 haftadan kısa süreli ise akut, daha uzun süreli ve haftada en az 2 gün tekrarlayacak şekilde ortaya çıkıyorsa kronik ürtiker olarak adlandırılır [14][15][16] 2 . Mast hücreleri üzerinden degranülasyonu sağlayan bir nöral kontrolün olduğunu gösteren pek çok çalışma vardır.…”

Chronic idiopathic urticaria and autoimmunity: frequency and association in patients with positive versus negative autologous serum skin test

“…It affects 0.1-1.0% of the general population. 1 Chronic idiopathic urticaria (CIU) is a subset of urticaria where no known trigger is identifiable and it constitutes the largest subgroup of total CU patients. Further around 50% patients of CIU have a functional complement activating autoantibody directed against high affinity receptors of IgE or IgE itself.…”