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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
PubMed
Summary
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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.

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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.