chronic urticaria

Chronic Urticaria: A Persistent Skin Condition

Chronic urticaria, also known as hives, is a skin condition characterized by the appearance of itchy welts or bumps on the body that persist for more than six weeks. These welts can arise anywhere on the body and may be red, purple, or skin-colored in people with light skin.

• Symptoms: The primary symptom of chronic urticaria is the presence of batches of welts (weals) that are intensely itchy and can appear anywhere on the body [1]. In some cases, the hives may not appear red, especially in individuals with darker skin tones [2].
• Types: Chronic urticaria can be spontaneous or inducible. Spontaneous chronic urticaria refers to hives that occur without any apparent trigger, while inducible chronic urticaria is triggered by specific factors such as cold temperatures, exercise, or stress [4].
• Prevalence: This condition affects approximately 1.4% of the general population and can be seen in both children and adults [7].

Causes and Triggers

While the exact cause of chronic urticaria is often unknown, it may be associated with underlying conditions such as autoimmune disorders, allergies, or infections [3]. In some cases, hives may be a symptom of an underlying serious internal condition.

• Autoimmune Disorders: Chronic urticaria has been linked to autoimmune disorders such as thyroid disease and lupus [5].
• Allergies: Allergic reactions can trigger chronic urticaria in some individuals [6].

Treatment and Management

While there is no cure for chronic urticaria, various treatments are available to manage symptoms and alleviate discomfort. These may include antihistamines, corticosteroids, and immunosuppressive medications.

• Medications: Antihistamines, corticosteroids, and immunosuppressive medications can help reduce the frequency and severity of hives [8].

References:

[1] - Symptoms of chronic hives include: Batches of welts, called weals, that can arise anywhere on the body. Welts that might be red, purple or skin-colored in people with light skin.

[2] - Chronic urticaria appears as red, raised bumps or circular welts on people with light skin. In people with skin of color, the hives may not appear red. Rather,

[3] - by S Sachdeva · 2011 · Cited by 103 — Chronic urticaria (CU) is a disturbing allergic condition of the skin. Although frequently benign, it may sometimes be a red flag sign of a serious internal ...

[4] - Chronic urticaria is defined as daily itchy wealing of the skin for more than six weeks. Chronic urticaria may be spontaneous or inducible, which may co-exist.

[5] - Oct 13, 2021 — Chronic urticaria, defined as urticaria that persists for longer than 6 weeks, is a frustrating condition for both patients and caregivers.

[6] - Chronic spontaneous urticaria (CSU) is the name for hives (urticaria) that are chronic, lasting six weeks or more, three to four times per week, and have no ...

[7] - This condition is known as chronic spontaneous/idiopathic urticaria (ongoing, of unknown cause). It can affect 1.4% of the general population and is seen in ...

[8] - by P SCHAEFER · 2017 · Cited by 154 — Urticaria commonly presents with intensely pruritic wheals, sometimes with edema of the subcutaneous or interstitial tissue.

Chronic Urticaria Signs and Symptoms

Chronic urticaria, also known as hives, is a skin condition characterized by the appearance of itchy, raised welts on the skin. The symptoms of chronic urticaria can vary from person to person, but here are some common signs and symptoms:

• Raised or swollen welts: Hives or wheals are the primary symptom of chronic urticaria. These welts can be red or skin-colored and may appear anywhere on the body.
• Itching: The itching associated with hives can range from mild to severe and is often described as intense and uncomfortable.
• Blanching: When pressed, the center of a red hive may turn white, a phenomenon known as blanching.
• Recurring symptoms: Hives in chronic urticaria tend to recur over time, with new welts appearing even after previous ones have faded.

According to [4], chronic spontaneous urticaria (CSU) is characterized by itchy hives that appear without any apparent cause. In some cases, people with CSU may experience additional symptoms such as:

• Headache: Severe or long-lasting CSU can lead to headaches.
• Fatigue: People with CSU may feel tired or exhausted due to the constant itching and discomfort.
• Joint pain or swelling: Some individuals with CSU may experience joint pain or swelling.
• Sudden reddening of face, neck, or other areas: In rare cases, people with CSU may experience sudden reddening of their face, neck, or other areas.

It's essential to note that the symptoms of chronic urticaria can vary from person to person and may be triggered by different factors. If you're experiencing persistent hives or other symptoms, it's crucial to consult a healthcare professional for proper diagnosis and treatment.

References: [4] - Chronic spontaneous urticaria (CSU) is a serious condition that affects approximately 1.7 million people in the United States...

Diagnostic Tests for Chronic Urticaria

Chronic urticaria, also known as hives, can be a challenging condition to diagnose. While there is no single test that can confirm the presence of chronic urticaria, various diagnostic tests can help healthcare professionals determine the underlying cause of the condition.

Recommended Screening Tests

According to recent guidelines [1], the recommended screening tests for patients with suspected chronic urticaria include:

• Complete Blood Cell (CBC) count with differential
• Erythrocyte Sedimentation Rate (ESR) or C-reactive protein (CRP)
• Thyroid-stimulating hormone (TSH)
• Urinalysis
• Liver function tests

These tests can help identify underlying conditions that may be contributing to the development of chronic urticaria, such as thyroid disorders or liver disease.

Autologous Serum Skin Test (ASST)

The Autologous Serum Skin Test (ASST) is a specific test used to investigate chronic urticaria [2]. This test has a reported sensitivity and specificity of 81% and 78%, respectively. The ASST involves injecting the patient's own serum into their skin, and observing for any reaction.

Additional Tests

In some cases, additional tests may be necessary to diagnose chronic urticaria. These can include:

• Allergy tests
• Blood tests to identify triggers or underlying conditions
• Skin biopsy to look for vascular destruction or neutrophilic infiltrates [3]

It's essential to note that the diagnosis of chronic urticaria is often based on a combination of clinical evaluation, laboratory tests, and patient history.

References

[1] Oct 13, 2021 - In most patients, the only screening tests that are recommended to be performed are a complete blood cell (CBC) count with differential, ...

[2] At present, an autologous serum skin test (ASST) is the most useful test for investigating chronic urticaria and has a reported 81% sensitivity and 78% specificity.

[3] If UV or an autoinflammatory disease is suspected, diagnostic tests should include a skin biopsy to look for vascular destruction or neutrophilic infiltrates.

Treatment Options for Chronic Urticaria

Chronic urticaria, also known as hives, can be a challenging condition to manage. While there is no cure for the condition, various treatment options are available to help alleviate symptoms and improve quality of life.

Medications

The primary goal of medication therapy in chronic urticaria is to reduce or eliminate hives and control itching. The following medications are commonly used:

• Antihistamines: These are the first-line treatment for chronic urticaria. They work by blocking histamine, a chemical released during an allergic reaction, which causes blood vessels to dilate and leads to symptoms like hives and itching. Examples of antihistamines include loratadine (1) [5], cetirizine (1) [5], and fexofenadine.
• Leukotriene receptor antagonists: These medications, such as montelukast, can be used in combination with antihistamines to help manage symptoms.
• Corticosteroids: In severe cases of chronic urticaria, corticosteroids may be prescribed to reduce inflammation and alleviate symptoms.

Other Treatment Options

In addition to medication therapy, other treatment options for chronic urticaria include:

• Avoidance of triggers: Identifying and avoiding triggers that can exacerbate symptoms is essential in managing chronic urticaria.
• Cool compresses: Applying cool compresses to the affected area can help reduce itching and alleviate symptoms.

Emerging Therapies

Recent studies have explored new treatment options for chronic urticaria, including:

• Omalizumab: This medication has been shown to be effective in treating antihistamine-resistant chronic spontaneous urticaria (1) [9].
• Autologous serum therapy: Autologous serum therapy involves using the patient's own blood as a treatment. It has been found to be useful in treating severe cases of urticaria (10).

It is essential to consult with a healthcare professional to determine the best course of treatment for chronic urticaria, as each individual may respond differently to various therapies.

References:

[1] Oct 1, 2024 — Treatment for chronic hives often starts with nonprescription anti-itch medicines, called antihistamines. If these don't help, your healthcare ...

[5] Oct 13, 2021 — The mainstay of pharmacotherapy for chronic urticaria is the administration of low-sedation anti-H1 antihistamines (eg, loratadine, cetirizine, ...

[9] by P Kolkhir · 2020 · Cited by 160 — Omalizumab is currently the mainstay of treatment of antihistamine-resistant chronic spontaneous urticaria.

[10] Autologous serum is a promising treatment, which has been shown to be useful in the treatment of severe urticaria.

Chronic Urticaria Differential Diagnoses

Chronic urticaria, also known as hives, is a skin condition characterized by the appearance of itchy, raised welts on the skin that last for more than six weeks. The differential diagnosis of chronic urticaria involves identifying other conditions that may present with similar symptoms.

Autoimmune Disorders

• Urticarial Vasculitis: A rare autoimmune disorder that causes inflammation of blood vessels and can lead to chronic urticaria (1, 6).
• Hypereosinophilic Syndromes: A group of disorders characterized by an overproduction of eosinophils, which can cause skin symptoms including urticaria (6).

Autoinflammatory Disorders

• Mast Cell Activation Syndrome: A condition in which mast cells are overactive and release histamine, leading to chronic urticaria (6).
• Other Autoinflammatory Disorders: Such as autoimmune disorders that may present with similar symptoms, including Hashimoto thyroiditis, systemic lupus erythematosus, and others (9).

Dermatological Conditions

• Allergic Contact Dermatitis: A skin reaction caused by an allergic response to a substance, which can present with urticaria-like symptoms (2).
• Bullous Pemphigoid: An autoimmune disorder that causes blistering of the skin and may be associated with chronic urticaria (3).

Other Conditions

• Mastocytosis: A rare condition in which mast cells accumulate in various organs, including the skin, and can cause chronic urticaria (9).
• Spontaneous or 'ordinary' Urticaria: Acute urticaria that has no specific external cause, but may be associated with chronic urticaria if it persists for more than six weeks (7).

References

1. AL Matos · 2022 · Cited by 10 — Differential Diagnosis in Chronic Urticaria
2. Oct 13, 2021 — Differential Diagnoses
3. by LA Brodell · 2008 · Cited by 51 —
4. by N Schettini · 2023 · Cited by 8 —
5. by P SCHAEFER · 2011 · Cited by 80 — Urticaria Etiologies Based on Patient History and Physical Examination
6. by AL Matos · 2022 · Cited by 10 — Differential Diagnosis in Chronic Urticaria
7. Spontaneous or 'ordinary' urticaria is divided into acute urticaria ...
8. by N Schettini · 2023 · Cited by 8 — There are several diseases, mainly autoinflammatory or autoimmune disorders, drug-induced reactions and hyperproliferative diseases, that may ...
9. by P SCHAEFER · 2017 · Cited by 154 —