From the Guidelines
Episodes of chronic urticaria typically last longer than six weeks, with individual hives usually resolving within 24 hours but new ones continuing to appear. The overall duration of chronic urticaria varies significantly between individuals, with most cases lasting 1-5 years 1. However, approximately 20% of patients may experience symptoms for more than 5 years, and some cases can persist for decades.
Key Characteristics of Chronic Urticaria
- Individual hives usually resolve within 24 hours but new ones continue to appear
- The overall duration of chronic urticaria varies significantly between individuals
- Most cases last 1-5 years, but approximately 20% of patients may experience symptoms for more than 5 years
Treatment Approach
Treatment typically begins with second-generation H1 antihistamines like cetirizine (10mg daily), loratadine (10mg daily), or fexofenadine (180mg daily), which may be increased up to four times the standard dose if needed 1. For resistant cases, omalizumab (300mg subcutaneous injection every 4 weeks) is often effective. Cyclosporine (3-5mg/kg/day) may be used for severe cases unresponsive to other treatments.
Disease Control Assessment
The Urticaria Control Test (UCT) and the Angioedema Control Test (AECT) are recommended for assessing disease control in patients with chronic urticaria, with the UCT used for patients with wheals and the AECT used for patients with angioedema 1. Regular follow-up with a healthcare provider is important to adjust treatment as needed and monitor for any underlying conditions that might be contributing to the urticaria.
From the Research
Duration of Chronic Urticaria Episodes
- The duration of chronic urticaria episodes can vary, but it is defined as lasting longer than 6 weeks 2.
- On average, the duration of chronic urticaria is around two to five years 3.
- Disease severity has an association with disease duration, with more severe cases potentially lasting longer 3.
- More than one-half of patients with chronic urticaria will have resolution or improvement of symptoms within a year 4.
Characteristics of Chronic Urticaria
- Chronic urticaria is characterized by recurring episodes of spontaneous transient dermal wheals and pruritus, with or without angioedema 5.
- It is a common disorder, estimated to affect around 1% of the population 2.
- The pathogenesis of chronic urticaria has not yet been completely understood, and it is considered a heterogeneous group of disorders 2.
Treatment and Management
- The mainstay of treatment is reassurance, patient education, avoidance of known triggers, and pharmacotherapy 3.
- Second-generation H1 antihistamines are the drugs of choice for initial therapy due to their safety and efficacy profile 3, 5.
- If satisfactory improvement does not occur, the dose of second-generation H1 antihistamines can be increased, or other treatments such as omalizumab or cyclosporine can be added 6, 3.