Chronic Urticaria: understanding the beast within you.

Chronic Urticaria (CU) is an incapacitating condition that can persist for a few months to many years.  Understanding the individual presenting lesions helps with planning treatment.  Chronic Urticaria affects up to 30% of the population at sometime in their lives, and women are 6 times more likely than men to develop this disease. Management usually involves high dose antihistamines and short courses of oral steroids. Up to 80% of cases have no apparent cause leading to a great deal of frustration with long-term management. Some people respond rapidly to simple antihistamines, and others not at all.  A diagnostic skin biopsy may help with long-term management.  Inflammatory infiltrates in the skin composed of neutrophils and eosinophils indicate severity and responsiveness to treatment.  Increased coagulation markers, eosinophils and neutrophils are a feature of the damaged skin in CU, contributing to the typical tissue swelling with hives and angioedema.

Applying Zuberbier’s skin biopsy criteria may help with management: Presence of eosinophilic infiltrates indicates a more severe clinical manifestation of the disease, while neutrophilic infiltrates showed a relation with milder disease and good responsiveness to simple treatment involving antihistamines. A raised D-dimer blood test indicates more severe and unresponsive urticaria with more aggressive long-term immune suppressant treatment likely to be necessary.

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