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Background
Urticaria produces weals, which are itchy and can affect the quality of life and social functioning of an affected patient. There are several different subtypes of urticaria. This article focuses on chronic urticaria.
Objective
This article details the approach to assessment and management of chronic urticaria.
Discussion
Chronic urticaria is characterised by the occurrence of weals, which occur on a daily basis for more than 6 weeks. Clinical history and physical examination alone are sufficient to establish a diagnosis. Non-sedating histamine H1 receptor antagonists are the first-line treatment and are effective in 60% of patients. These may be supplemented with histamine H2 receptor antagonists. The use of secondand third-line treatments is also discussed.
Keywords
urticaria; diagnosis; general practice
Urticaria is characterised by swelling of the skin and mucosa due to plasma leakage.1
The term is often used to describe a rash that may present with weals, with or without angioedema. Urticaria can be divided into a number of subgroups listed below:
* ordinary urticaria
- acute urticaria
- chronic urticaria
* urticarial vasculitis
* physical urticaria.
These subgroups are differentiated by the time frame, clinical presentation and triggers of the uriticarial rash (Figure 1).2 The focus of this article is on chronic urticaria, which is a chronic relapsing skin disease characterised by highly pruritic weals that persist for less than 24 hours and recur on a daily basis for more than 6 weeks.3 Some consider urticarial vasculitis to be a chronic urticaria; however, the term chronic urticaria commonly refers to an ordinary urticaria. Chronic urticaria can have a negative impact on a patient's quality of life, affecting social function and emotional wellbeing.2
Evaluation and diagnosis of chronic urticaria
History
A detailed history is usually sufficient to establish a diagnosis of urticaria and the type of urticaria. Chronic urticaria persists for more than 6 weeks. An urticaria that lasts less than 6 weeks is an acute urticaria in which the characteristic weals may last less than 24 hours. If a patient describes a history of individual lesions lasting more than 24 hours, then vasculitic urticaria should be considered. For patients who are unable to estimate the time frame of the lesion, drawing around a new lesion and then recording how long this takes to...