Review Article
Treatment Options for the Relief of Chronic Idiopathic Urticaria Symptoms
Abstract
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, IV immunoglobulins, and omalizumab will also be discussed.
Key Points
* 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 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.
* Treatment should begin with a course of H1-receptor antagonists, with the addition of an H2-receptor antagonist, if necessary.
* For patients who remain unresponsive, several other therapies, including doxepin, antileukotriene therapy, corticosteroids and other experimental, nontraditional therapies, such as plasmapheresis treatment, immunomodulatory agents and intravenous immunoglobulins are available.
* Referral to an allergy specialist should be considered at any point during treatment as needed.
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