Idiopathic (autoimmune) chronic urticaria

A case of idiopathic chronic urticaria (CU) is described briefly. The clinical characteristics, pathogenesis, diagnosis, and management of this disease are discussed followed by clinical pearls and pitfalls for the practicing allergist as well as the immunologist. CU, defined as recurring attacks of hives lasting for >6 weeks, is a common disorder for which the cause is determined in <20% of patients. Although the pathogenesis of idiopathic CU is not certain, the immune dysregulation/disruption causing autoimmunity is blamed. The diagnosis is based principally on the patient's history. Autologous serum skin test possibly should be performed in older children as a screening test for idiopathic autoimmune CU. This test shows the availability of serum IgG autoantibodies directed against the alpha-chain of FcepsilonRI. However, basophil mediator release assay still is accepted as a gold standard. Treatment is aimed first at avoiding underlying causative factors. Medications varying from H1-antihistamines to plasmapheresis as well as immunosuppressive therapies should be considered depending on clinical improvement. Spontaneous resolution of the disease is probable also.