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Official Journal of the Italian Society of Dermatology and Sexually Transmitted Diseases
Indexed/Abstracted in: EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 1,014
Online ISSN 1827-1820
Wedi B., Kapp A.
Department of Dermatology and Allergology Hannover Medical University, Hannover Germany
Chronic urticaria remains a major problem in terms of pathogenesis, diagnostic work-up and management. During the last years several new concepts regarding the disease have been developed. Some of these aspects resulted in a different management of patients with chronic urticaria whereas others still need research activities for confirmation or clarification of details. Symptoms are the result of the degranulation of mast cells and basophils. Possible mechanisms include autoimmune mechanisms, infectious diseases, pseudoallergic mechanisms and others such as internal diseases/malignancies. A detailed history plays a main role in the diagnostic program. Further diagnostic procedures depend on the urticaria subtype. Whereas in acute urticaria routine diagnostic is not recommended, in chronic urticaria a diagnostic programm considering associated infections (particularly with Helicobacter pylori, staphylococci, streptococci, yersinia), autoreactivity and non-allergic hypersensitivity reactions is reliable and successful. Special considerations are indicated in the case of recurrent angioedema without whealing and in childhood urticaria. In most cases a targeted diagnostic program leads to the identification of potential triggering factors and after their adequate treatment long-lasting and life quality impairing urticaria disappears or improves within several weeks. With regard to treatment non-sedating H1 antihistamines should be given regularly and daily, most often increased dosage is needed. Data on alternatives are insufficient but in selected cases cyclosporin A, leukotriene receptor antagonists, or hydroxychloroquine may be useful. Several questions have to be addressed in the future and there is hope that during the next years new therapeutic strategies will be developed to facilitate the management of this long-lasting and life-quality restricting disease