Urticaria is a skin condition characterized by the sudden appearance of itchy, red, raised welts on the skin. These lesions may resolve within hours to days but can persist for months or years in chronic cases. Urticaria is often accompanied by angioedema—deep swelling of the eyelids, lips, hands, or feet. It most frequently affects individuals aged 20–40, with a slightly higher prevalence in women.
Symptoms persist for >6 weeks (chronic urticaria).
Angioedema is present.
Signs of anaphylaxis: Difficulty breathing, swallowing, or dizziness (requires immediate emergency care).
1. Identify and Avoid Triggers:
Common triggers: Allergens (foods, medications), stress, infections, heat/cold, or autoimmune factors.
Allergy testing (blood/skin tests) may be recommended.
2. First-Line Therapy:
Non-sedating antihistamines (e.g., cetirizine, loratadine):
Start with standard dose; increase up to 4x the dose if symptoms persist.
Long-term use is safe for chronic cases.
3. Short-Term Systemic Corticosteroids:
Prednisone/prednisolone (10–15 days) for severe flares.
Not recommended for prolonged use due to side effects.
4. Biologic Therapy for Refractory Cases:
Omalizumab (anti-IgE monoclonal antibody):
Administered via monthly subcutaneous injections.
Proven efficacy in chronic spontaneous urticaria unresponsive to antihistamines.
Well-tolerated with a strong safety profile.
5. Additional Options:
Leukotriene receptor antagonists (e.g., montelukast) for combination therapy.
Immunosuppressants (e.g., cyclosporine) in severe autoimmune-driven cases.
Chronic urticaria can significantly impact quality of life and may signal underlying autoimmune or systemic conditions.
A dermatologist can:
Rule out mimics (e.g., vasculitis, thyroid disorders).
Tailor stepwise therapy to minimize side effects.
Monitor for complications like anaphylaxis.