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Progression From Acute to Chronic Urticaria: A Systematic Review
Enrique Gómez de la Fuente1, Francisco Javier Ortiz de Frutos2, Noelia Álvarez-Díaz3
1Department of Dermatology, Ramón y Cajal University Hospital, Madrid, Spain.
JAMA Dermatology
|June 24, 2026
Summary
No single factor reliably predicts progression from acute urticaria (AU) to chronic urticaria (CU). Current evidence does not support aggressive acute-phase treatments solely to prevent chronicity, emphasizing clinical evaluation and follow-up.
Area of Science:
- Dermatology and Immunology
- Allergy and Clinical Immunology
Background:
- Progression from acute urticaria (AU) to chronic urticaria (CU) occurs in a subset of patients.
- Identifying prognostic factors for AU to CU progression is challenging due to heterogeneous and uncertain evidence.
Purpose of the Study:
- To systematically review clinical, laboratory, and treatment-related factors associated with progression from AU to CU.
Main Methods:
- Systematic search of MEDLINE, Embase, and Web of Science for observational studies up to December 31, 2025.
- Independent screening, data extraction, and risk of bias assessment (Newcastle-Ottawa Scale).
- Certainty of evidence assessed using the GRADE approach; findings synthesized qualitatively due to heterogeneity.
Main Results:
- Sixteen studies (52,564 patients) reported AU to CU progression rates from 5.8% to 36.0%.
- Clinical factors (severity, angioedema, sensitization, atopy) and laboratory markers (IgE, eosinophils, inflammatory indices, autoantibodies) showed inconsistent associations.
- Systemic corticosteroids in the acute phase were not linked to reduced progression risk.
Conclusions:
- No single marker consistently predicts AU to CU progression.
- Aggressive acute-phase treatment is not supported solely for preventing chronicity; clinical evaluation and follow-up are crucial.
- Further well-designed, multicenter prospective studies with standardized outcomes and longer follow-up are needed.
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