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Updated: Jul 9, 2026
07:22
Basophil Activation Test for Allergy Diagnosis
Published on: May 31, 2021
Chronic urticaria: recent advances.
Malcolm W Greaves1, Kian Teo Tan
1St Johns Institute of Dermatology, St Thomas' Hospital, London, UK. mwatsong@hotmail.com
Clinical Reviews in Allergy & Immunology
|December 21, 2007
Summary
Chronic urticaria encompasses various types, including autoimmune forms. Differentiating these conditions is crucial for effective treatment, with antihistamines being a primary therapy.
Area of Science:
- Dermatology
- Immunology
- Allergy
Background:
- Chronic urticaria is a complex condition with diverse subtypes, including physical urticarias, chronic idiopathic urticaria, and urticarial vasculitis.
- Recognizing distinct subtypes is critical as diagnostic and therapeutic approaches vary significantly.
- Urticarial vasculitis, though uncommon, necessitates histological confirmation and evaluation for systemic involvement, particularly renal disease.
Purpose of the Study:
- To differentiate between various chronic urticaria subtypes, emphasizing the diagnostic and therapeutic distinctions.
- To explore the autoimmune basis of chronic "idiopathic" urticaria, including autoantibodies against the high-affinity IgE receptor (FcεRI).
- To review current and emerging diagnostic tools and treatment strategies for chronic urticaria.
Main Methods:
- Review of existing literature on chronic urticaria classification, diagnosis, and management.
- Discussion of diagnostic methods such as autologous serum skin test and basophil activation markers (e.g., CD203c).
- Evaluation of therapeutic options including H1 antihistamines, systemic steroids, leukotriene antagonists, and cyclosporine.
Main Results:
- Chronic "idiopathic" urticaria may have an autoimmune etiology involving autoantibodies.
- The autologous serum skin test has limitations in specificity for detecting anti-FcεRI antibodies, necessitating confirmation through histamine-releasing activity.
- Second-generation H1 antihistamines are generally safe and effective, while the role of leukotriene antagonists is debated, and cyclosporine shows efficacy in specific cases.
Conclusions:
- Accurate classification of chronic urticaria subtypes is essential for appropriate patient management.
- Further research is needed for improved diagnostic tests and understanding the association between autoimmune thyroid disease and autoimmune urticaria.
- Current treatment relies on H1 antihistamines, with other agents reserved for specific or refractory cases.
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