Urticaria: recommendations from the Italian Society of Allergology, Asthma and Clinical Immunology and the Italian Society of Allergological, Occupational and Environmental Dermatology

Abstract

Background: Urticaria is a disorder affecting skin and mucosal tissues characterized by the occurrence of wheals, angioedema or both, the latter defining the urticaria-angioedema syndrome. It is estimated that 12-22% of the general population has suffered at least one subtype of urticaria during life, but only a small percentage (estimated at 7.6-16%) has acute urticaria, because it is usually self-limited and resolves spontaneously without requiring medical attention. This makes likely that its incidence is underestimated. The epidemiological data currently available on chronic urticaria in many cases are deeply discordant and not univocal, but a recent Italian study, based on the consultation of a national registry, reports a prevalence of chronic spontaneous urticaria of 0.02% to 0.4% and an incidence of 0.1-1.5 cases/1000 inhabitants/year. Methods: We reviewed the recent international guidelines about urticaria and we described a methodologic approach based on classification, pathophysiology, impact on quality of life, diagnosis and prognosis, differential diagnosis and management of all the types of urticaria. Conclusions: The aim of the present document from the Italian Society of Allergology, Asthma and Clinical Immunology (SIAAIC) and the Italian Society of Allergological, Occupational and Environmental Dermatology (SIDAPA) is to provide updated information to all physicians involved in diagnosis and management of urticaria and angioedema.

Urticaria and coronavirus infection a lesson from SARS-CoV-2 pandemic

“…Histologically, the wheal is characterized by edema of the external derma with a minor dilatation of the vessels, in the absence of wall injury, with a peri-vessel granulocytic infiltrate of neutrophils and eosinophils and a little number of lymphocytes and macrophages. Angioedema is defined as the quick onset of a non-inflammatory edema of the deep derma, accompanied by ache or itch, resolving within 72 h [1,2].…”

Prevalence of Chronic Inducible Urticaria in Elderly Patients

“…According to current guidelines, CU can be classified as chronic spontaneous urticaria (CSU) in the absence of an identifiable trigger and as chronic inducible urticarias (CIndUs), when wheal or angioedema development can be triggered through exposure to a specific stimulus [ 4 ]. CIndUs can be divided into two groups: physical urticarias (PUs) and nonphysical urticarias (NPUs) ( Table 1 ) [ 6 , 7 ].…”

“…Usually, the diagnosis is based on anamnesis. However, all CIndUs are reproducible with specific simple challenge tests (CTs) that are therefore used for the diagnosis [ 6 , 7 ].…”

“…Systemic symptoms rarely occur in CIndUs; acute respiratory involvement, hypotension, lipothymia, and anaphylaxis are occasionally reported in association with cold, cholinergic, or contact urticaria [ 8 , 9 , 10 ]. Although very rarely, these systemic symptoms may also be elicited by CTs; hence, CTs must be conducted only in health centers with resuscitation equipment and trained personnel [ 6 , 7 ]. Apart from CTs, other clinical investigations are generally not useful in CIndUs, with the exception of some forms of cold urticaria.…”

Chronic Spontaneous Urticaria and Type 1 Diabetes Mellitus—Does Quality of Life Impairment Always Reflect Health Danger?

“…Unfortunately, achieving satisfying treatment results is not being seen as often as expected. There is an increasing number of patients resistant to the standard treatment regimens of CSU [11]. They require extended diagnostics, followed by a long-term treatment process, which, at the end of treatment, may be unsuccessful.…”