Urticaria: reassessed

Urticaria is a common symptom--it is not a single disease. Patients present knowing what caused their "hives" or not knowing the cause of their hives. The latter patients present to the physician expecting to find a cause--but it is extremely rare that a single cause is discovered; however, a search for identifiable "triggers" should be sought in the history. Routine laboratory investigations are consistently disappointing (unless appropriate testing is suggested by the history). The term idiopathic can be added only when a single putative cause is not discovered. Fortunately, all urticarias eventually resolve (spontaneously). All treatment is palliative. Antihistamines remain the first-line of therapy, the more H1-receptors blocked, the better the results (the majority of patients with urticaria are "undertreated"). Rarely are steroids warranted for management. A review of the evaluation and management of patients with persistent urticaria without an identifiable cause is presented.