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Yvonne Deng, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
Amir Gohari, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.
Joseph Lam, MD FRCPC, Department of Pediatrics, Department of Dermatology and Skin Sciences, University of British Columbia, Vancouver, British Columbia, Canada.
Abstract
Urticaria is a common, mast cell-driven disorder that presents with transient wheals, angioedema, or both. Clinically, it is classified into acute or chronic, depending on the duration of symptoms, and further classified by the presence or absence of inducible stimuli. Although urticaria is rarely life-threatening, it can reduce quality of life and carry significant socioeconomic burden on patients. While there is no cure to the disease, the treatment algorithm for urticaria focusses on the control of symptoms with antihistamines as the mainstay of therapy and immunosuppressive/immunomodulating therapies for severe cases.
Key Words: urticaria; pediatric urticaria; angioedema; acute urticaria; chronic spontaneous urticaria.
Introduction
Urticaria is a common pruritic skin condition characterized by erythematous wheals with or without angioedema.1 Urticaria may be idiopathic or inducible and can be acute or chronic. Acute urticaria (AU) lasts less than six weeks and can be caused by contact with allergens, infection, drugs, food, or be idiopathic.2 Chronic urticaria (CU) is defined as the occurrence of wheals for a total duration of six weeks or more and is most often idiopathic. It can be further classified as spontaneous when there is no definite trigger, known as chronic spontaneous urticaria (CSU), or inducible when a specific trigger is identified, known as chronic inducible urticaria (CIU).2,3 Chronic inducible urticaria represents a subset of urticaria exclusively induced by specific stimuli and is further classified into physical urticaria (i.e. symptomatic dermographism, cold urticaria, delayed pressure urticaria, solar urticaria, heat urticaria, and vibratory angioedema) and non-physical urticaria (i.e. cholinergic urticaria, contact urticaria, and aquagenic urticaria).2 Due to its pruritic nature, urticaria can be very uncomfortable. This paper provides an overview on the epidemiology, pathophysiology, clinical presentation, diagnosis, and current guidelines for management of acute and chronic urticaria.