Home > Journals > Giornale Italiano di Dermatologia e Venereologia > Past Issues > Giornale Italiano di Dermatologia e Venereologia 2015 April;150(2) > Giornale Italiano di Dermatologia e Venereologia 2015 April;150(2):237-46



To subscribe
Submit an article
Recommend to your librarian


Cite this article as



Giornale Italiano di Dermatologia e Venereologia 2015 April;150(2):237-46


language: English

Management of chronic spontaneous urticaria: practical parameters

Marzano A. V. 1, Pigatto P. 2, Cristaudo A. 3, Ayala F. 4, Rossi O. 5, Senna G. 6, Triggiani M. 7, Asero R. 8

1 Unit of Dermatology, Department of Physiopathology and Transplantation, University of Milan, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy; 2 University of Milan, IRCCS Ospedale Galeazzi, Milan, Italy; 3 Istituto Dermatologico San Gallicano, Rome, Italy; 4 Dipartimento di Medicina Clinica e Chirurgia, Clinica Dermatologica, Università di Napoli Federico II, Naples, Italy; 5 Allergy Unit, Azienda Ospedaliera-Universitaria Careggi, Florence, Italy; 6 Unità Operativa Dipartimentale di Allergologia, Azienda Ospedaliera-Universitaria Integrata di Verona, Verona, Italy; 7 Internal Medicine, Clinic Allergology and Immunology, University of Salerno, Salerno, Italy; 8 Ambulatorio di Allergologia, Clinica San Carlo Paderno Dugnano, Milan, Italy


Chronic urticaria (CU) is a skin disorder characterized by transient, pruritic wheals persisting for longer than 6 weeks. According to the European Academy of Allergy and Clinical Immunology (EAACI) guidelines, CU can be categorized into two main types: chronic spontaneous urticaria (CSU), in which the wheals appear spontaneously, and inducible urticaria, that is triggered by physical agents. CSU may be due to triggering factors such as food allergens or infections, but in at least 40% of cases it is autoimmune in origin, caused by circulating autoantibodies anti-FcεR1 or anti-IgE, or autoreactive. In the present paper, re-evaluating the EAACI guidelines, we have developed a document containing some practical indications which are useful for diagnosis and management of CSU in the context of the Italian situation. Concerning CSU treatment, second generation antihistamines are the first-line treatment; these drugs can be used, as second-line treatment, at a higher than licensed dose in patients who do not respond adequately at licensed doses. The third-line treatment includes leukotriene receptor antagonists which, however, do not have a specific indication for the treatment of CSU, cyclosporine, whose use in this disease is still off-label, and omalizumab. The latter is a recombinant monoclonal IgG antibody that binds free IgE, down regulates mast cell function and induces eosinophil apoptosis. Recently, it has emerged as an effective and safe treatment for antihistamine-unresponsive CSU of both autoimmune/autoreactive and non-autoimmune/non-autoreactive, and has been officially approved for use against this disease.

top of page