Treatment options for the relief of chronic idiopathic urticaria symptoms

Chronic urticaria is a cutaneous condition in which recurrent pruritic wheals (hives) manifest on the body and typically last for longer than 6 weeks. Chronic urticaria, including physically induced urticarias, such as cold, solar exposure or delayed pressure urticaria, is estimated to occur in approximately 25% of urticaria patients. Of these patients, 75% present with idiopathic disease, which is essentially an exclusionary diagnosis when no contributing factors can be determined that cause the cutaneous reaction. Chronic urticaria symptoms can have a profound effect on a patient's quality of life (QoL); therefore, treatment should address both physical symptom relief and improvements in QoL. This review will discuss the benefits and limitations of several treatment options available to relieve urticarial symptoms, including H1- and H2-receptor antagonists, doxepin, antileukotriene therapy and corticosteroids. Other experimental therapies, such as immunomodulatory agents, plasmapheresis treatment, i.v. immunoglobulins, and omalizumab will also be discussed.