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The Maddening Itch: An Approach to Chronic Urticaria


LP Viegas,1 MB Ferreira,1 AP Kaplan,2

1Department of Immunoallergology, Hospital Santa Maria – CHLN, Lisbon, Portugal
2Department of Medicine, Division of Pulmonary and Critical Care Medicine, Allergy and Clinical Immunology, Medical University of South Carolina, Charleston, South Carolina, USA

J Investig Allergol Clin Immunol 2014; Vol. 24(1): 1-5



Chronic spontaneous urticaria (CSU) is defined as the presence of urticaria with daily or almost daily symptoms for 6 weeks or more. CSU affects 0.1%-0.8% of the population. Its pathogenesis involves autoimmunity, abnormalities in signal transduction, and the action
of histamine on H1 receptors.
Investigation of CSU should be guided by a thorough history and physical examination. A concise laboratory evaluation, including the CU index, is recommended. This index can provide useful data on severity and response to therapy.
Initial treatment should involve increasing doses of nonsedating antihistamines until the intended effect is achieved. Only when a patient is unresponsive to high-dose nonsedating antihistamines (or sedating antihistamines) can we consider CSU refractory and consider immunomodulatory therapy. The most promising drugs are cyclosporine and, more recently, omalizumab.

Key words: Spontaneous chronic urticaria. CU index. FcεRI. Omalizumab.