Urticaria and Angioedema: an Update on Classification and Pathogenesis

Abstract

Urticaria is a common, mast cell-driven disease presenting with wheals or angioedema or both. In the last years, urticaria has increasingly attracted notice to clinicians and researchers, last but not least inspired by the approval of omalizumab, an anti-IgE antibody, for urticaria treatment. There is wide consensus on the clinical classification based on duration and elicitation. However, the pathogenesis is incompletely understood. This review summarizes current guidelines for the management and novel insights in the pathogenesis of urticaria with special focus on their impact on clinical praxis. The classification of urticaria subgroups is mainly based on clinical criteria: acute and chronic urticaria (CU). Chronic urticaria comprises both chronic spontaneous urticaria (CSU) and chronic inducible urticaria (CIndU) that includes physical and non-physical urticarias. Recent research focused on characterizing the role of cells and mediators involved in the pathogenesis of urticaria, identifying the mechanisms of mast cell activation, and investigating underlying autoimmune processes in chronic spontaneous urticarial. Currently, non-sedating antihistamines and omalizumab, an antiimmunoglobulin E antibody, are recommended for the therapy of chronic urticaria, as both exhibit a favorable efficacy and safety profile. Novel therapeutic strategies aim at specifically targeting cells and mediators involved in the pathogenesis of urticaria.

Natural course and prognostic factors of chronic urticaria in Korean children: A single center experience

“…Although its pathogenesis is poorly understood, mixed Th1/Th2 immune response, mast cell activation, and autoimmunity are considered to play a role in the pathogenic mechanisms of CU. 7 There are also several types of evidence supporting that autoantigen is synthesized by specific triggers leading to mast cell degranulation in patients with CIU. 8,9 In general, the duration of CSU is 1-5 years, but is likely to be longer in more severe cases.…”

Hereditary Angio-Oedema for Dermatologists

“…Abdominal attacks are very painful and might mimic acute abdomen with a risk of surgery being performed [96]. In patients with associated urticaria, the angio-oedematous lesions can be the result of an autoimmune process [97, 98]. Angio-oedema can be mistaken for anaphylaxis and vice versa, since laryngeal angio-oedema is one of the most severe manifestations of anaphylaxis [99].…”

Influence of prolonged treatment with omalizumab on the development of solid epithelial cancer in patients with atopic asthma and chronic idiopathic urticaria: A systematic review and meta‐analysis

“…Omalizumab is indicated for patients with allergic asthma whose symptoms remain uncontrolled despite conventional treatment with inhaled corticosteroids, long‐acting beta‐agonists and leukotriene receptor antagonists . In 2003 and 2005, respectively, the United States Food and Drug Administration (US FDA) and Health Canada approved the use omalizumab, a recombinant humanized monoclonal antibody, for the treatment of moderate‐to‐severe persistent asthma in individuals aged 12 years or older who develop a positive skin test, or have in vitro reactivity, to a perennial aeroallergen and are inadequately controlled with inhaled corticosteroids .…”