Classification and Treatment of Urticaria: A Brief Review

Kjetil Kristoffer Guldbakke, MD; Amor Khachemoune, MD, CWS


Dermatology Nursing. 2005;17(5):361-364. 

In This Article

Chronic Autoimmune and Idiopathic Urticaria

Chronic urticaria occurs in about 0.1% of the population (Greaves, 2000). Patients previously classified as having chronic idiopathic or "ordinary" urticaria are now divided into two groups: 40% to 50% with chronic autoimmune urticaria (CAU) and the remainder with chronic idiopathic urticaria (CIU) (Kaplan, 2004). CAU is caused by an IgG antibody to the alfa subunit of the IgE receptor (35%-40%) usually reactive with unoccupied IgE receptors, or IgG antibody to IgE (5%-10%) (Kaplan, 2004). CAU is also associated with antithyroid antibodies (27%) (Kaplan 2004), and other autoimmune conditions such as vitiligo, rheumatoid arthritis, and pernicious anemia. Patients with demonstrable histamine-releasing auto-antibodies have a very strong association with HLA-DR4 and its associated allele HLA-DQ8 (O'Donnell et al., 1999).

Urticarial lesions in chronic urticaria typically last 2 to 24 hours and can occur at any age, being most common in adult women. Systemic symptoms are minimal, but patients frequently feel fatigued and may have gastrointestinal symptoms. Pruritus is nearly always severe, especially at nighttime and may prevent sleep. Fifty percent of cases resolve spontaneously by 6 months, but of those that do not, 40% still have symptoms of urticaria 10 years later (Negro-Alvarez & Miralles-Lopez, 2001).


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