Acute and Chronic Urticaria: Evaluation and Treatment

Area of Science:

• Dermatology
• Allergy and Immunology
• Pharmacology

Background:

• Urticaria is a prevalent dermatologic condition mediated by histamine release from mast cells.
• It presents as acute (less than 6 weeks) or chronic, affecting skin anywhere on the body.
• While acute urticaria is often self-limited, chronic urticaria warrants further investigation.

Purpose of the Study:

• To outline diagnostic and treatment strategies for acute and chronic urticaria.
• To emphasize the role of H1 antihistamines as first-line therapy.
• To discuss alternative and advanced treatment options for refractory cases.

Main Methods:

• Review of current guidelines and literature for urticaria management.
• Classification of urticaria into acute and chronic forms.
• Description of pharmacologic treatments, including antihistamines, corticosteroids, and other agents.

Main Results:

• Second-generation H1 antihistamines are preferred for acute and chronic urticaria due to fewer sedating effects.
• A stepped treatment approach is recommended for chronic urticaria, potentially increasing antihistamine dosage or adding leukotriene receptor antagonists or immunosuppressants.
• Omalizumab is an approved option for refractory chronic urticaria.

Conclusions:

• Second-generation H1 antihistamines are the cornerstone of urticaria treatment, suitable for all age groups and conditions like pregnancy.
• Chronic urticaria management requires a stepwise approach, reserving long-term corticosteroids and considering advanced therapies for persistent symptoms.
• Limited investigation is needed for acute urticaria, while chronic forms benefit from a structured diagnostic and therapeutic plan.