[Physiopathology and management of chronic urticaria]

Chronic urticaria manifests as itchy, transient and migrating wheals and/or angioedema lasting more than 6 weeks. It can be classified as spontaneous or inducible by physical factors. It is secondary to mast cell activation due to autoallergy (type I) or autoimmunity (type IIb). While the initial work-up consists essentially in evaluating the presence of biomarkers, it can be completed according to comorbidities and factors identified with history and physical examination. Second generation antihistamines up to four-times the standard dose are the cornerstone of the management. This initial management can be undertaken by primary care physicians. Specialists should be involved in the presence of physical factors, resistance to antihistamines, or atypical lesions.