Management of Chronic Urticaria

Abstract

The management of urticaria, although complex, relies on two postulates: • Recognition and eradication of the triggering factor(s) • Provision of symptomatic relief Recognition and eradication of the triggering factors(s) Factors known are drugs, food, infections, and physical stimuli. Drugs: Analgesics and NSAIDs can exacerbate already present urticaria and are also recognized triggers of new-onset urticaria.2 When suspected, they should be withdrawn entirely or can be replaced. ACE inhibitors can cause angioedema. Eradication of infectious agents Infections and infestations should be treated where suspected, including infections of the GI tract e.g., H Pylori associated gastritis3, nasopharyngeal bacterial infections, and intestinal worms.8 Management of diet The allergens in food need to be avoided if a patient has type I hypersensitivity to any one of these allergens. Pseudo-allergic reactions5 which are not IgE mediated have been described for organic foods and food additives.9-13 Physical stimuli They are usually recognized and controlled, e.g., in chronic pressure urticaria patients are advised to use bags with a wide handle and similarly, in symptomatic dermographism, simple avoidance of friction can give relief from symptoms.15 Symptomatic therapy One of the objectives of symptomatic therapy is to mask the effects of histamine, platelet-activating factor, and other mast cell mediators. Histamine plays a primary role in inducing the symptoms associated with urticaria. The activation of receptors on endothelial cells by histamine results in wheals whereas this histamine receptor activation on sensory nerves results in itching. Different guidelines have been proposed for managing chronic urticaria including the EACCI [5] and BSACI [4].