Chronic urticaria: diagnosis and management

Chronic urticaria (CU) is a common condition faced by the practicing allergist. There is a considerable degree of variation in the evaluation of patients with CU. The intent of this article is to provide the practicing allergist with an appropriate, evidence-based strategy for diagnosis and initial management of patients with CU. A review was performed of pertinent literature of CU pertaining to its natural history, impact on quality of life, subtypes, utility of diagnostic tests, and initial treatment recommendations. The reported duration of CU varies based on the nature of the referring center; however, physical urticarias persist longer than idiopathic CU. CU has adverse effects on quality of life and is comparable with other chronic diseases. Idiopathic urticaria, autoimmune CU, and physical urticarias are the most common types of CU. A detailed history is the best diagnostic tool in determining an etiology of CU and routine laboratory tests are of little value in the evaluation of CU patients. Antihistamines, particularly first-generation antihistamines, are the preferred initial treatment for CU and higher doses may be required for adequate control. Several alternative agents exist for patients who have antihistamine-resistant CU. A detailed history is the best tool for diagnosing the etiology of CU although most patients will not have a specific etiology found. The ultimate goal should be to control urticaria to reduce its impact on the quality of life of the patient, minimize adverse effects of medications, and eliminate chronic or frequent oral corticosteroids.