Chronic urticaria

Urticaria also known as hives,  is a common skin disorder among people across the world. Patients with urticaria present with itchy, red and edematous wheals (fluid collection below skin surface). The disease is characterized by waxing and waning of these skin lesions rapidly. Urticaria is classified into acute and chronic urticaria.

It has been estimated that chronic urticaria affects up to 1% of the population at some point in life. The condition can be seen in both adults as well as children. However, the condition is more commonly seen in adults than children. In chronic urticaria, wheals are recurrent and appear on most days of the week and occur for at least six weeks.

Chronic urticaria is further subdivided into:

    • Idiopathic (also known as spontaneous)
    • Physical (also known as inducible) urticaria

Among the patients with chronic urticaria, most have idiopathic (spontaneous) types of urticaria.

In spontaneous types of urticaria, symptoms occur spontaneously without any known physical or environmental trigger.

In inducible types of urticaria, specific trigger factors are responsible for the symptoms. These triggers can be:

    • Medicines
    • Cold
    • Heat
    • Stress
    • Sweating
    • Exercise
    • Water
    • Pressure or other physical stimuli.

It is possible that the same patient has both types of urticaria (spontaneous and inducible). In some patients, chronic urticaria may be a manifestation of other diseases such as auto-immune or auto-inflammatory disease. Chronic urticaria can significantly impair the quality of life of patients.

In most patients, chronic urticaria is diagnosed by detailed medical history and clinical examination. Inducible urticaria can be confirmed by performing some tests.  Blood tests such as C-reactive protein, erythrocyte sedimentation rate, and complete blood cell count are useful to rule out other underlying conditions. Other specific tests may also be required based on the patient profile and clinical presentation.

The objectives of the treatment include providing relief from the symptoms and preventing further recurrence of symptoms. Symptomatic treatment is provided to the patients with urticaria. Treatment of chronic urticaria is done in a stepwise manner by the doctors. In step one, a type of medication known as antihistamines (non-sedating) is recommended. In the second step, an increase in dose of antihistamine (up to 4-fold) is recommended if there is no response to the standard dose. Patient education and reassurance are integral part of management of chronic urticaria.