From the Guidelines
Chronic spontaneous urticaria (CSU) is typically characterized by the presence of wheals or angioedema, and it is unlikely to occur without any skin manifestations, such as stinging or itching alone, as these symptoms alone do not meet the diagnostic criteria for CSU. According to the most recent guidelines, CSU is defined by the spontaneous appearance of wheals, angioedema, or both, lasting for at least 6 weeks 1. The guidelines emphasize the importance of assessing disease control using validated instruments, such as the Urticaria Control Test (UCT) and the Angioedema Control Test (AECT), which can help guide treatment decisions 1.
Some key points to consider in the diagnosis and management of CSU include:
- The presence of wheals or angioedema is a key diagnostic criterion for CSU, and patients with only stinging or itching without visible skin lesions should be evaluated for other conditions, such as neuropathic itch or psychogenic pruritus 1.
- The UCT and AECT are useful tools for assessing disease control in patients with CSU, and can help guide treatment decisions 1.
- The pathophysiology of CSU involves mast cell activation and release of histamine and other inflammatory mediators, which typically results in visible skin changes, such as wheals or angioedema 1.
In terms of morbidity, mortality, and quality of life, it is essential to accurately diagnose and manage CSU to prevent complications, such as anaphylaxis, and to improve patient outcomes. The use of validated instruments, such as the UCT and AECT, can help healthcare providers assess disease control and make informed treatment decisions 1.
Overall, while patients with CSU may experience a range of symptoms, including stinging or itching, the presence of wheals or angioedema is a key diagnostic criterion, and patients with only stinging or itching without visible skin lesions should be evaluated for other conditions. The diagnosis of CSU should be based on a thorough clinical evaluation, including a detailed history, physical examination, and possibly laboratory tests, and treatment decisions should be guided by validated instruments, such as the UCT and AECT.
From the Research
Definition and Symptoms of Chronic Spontaneous Urticaria
- Chronic spontaneous urticaria (CSU) is characterized by the sudden, continuous or intermittent appearance of pruritic wheals (hives), angioedema, or both for six weeks or more, with no known specific trigger 2.
- The condition is defined by the presence of wheals or angioedema, which occur for a period of six weeks or longer without an apparent cause 3.
- CSU can impair the patient's quality of life and is associated with multiple comorbidities, including chronic inducible urticaria, autoimmune thyroiditis, metabolic syndrome, anxiety, and depression 4.
Presentation of Chronic Spontaneous Urticaria
- CSU typically presents with spontaneously recurring wheals, angioedema, or both 4.
- However, there is no clear evidence in the provided studies to suggest that CSU can occur without wheal eruption or angioedema, presented only as stinging or itching without any primary skin lesions.
- The studies focus on the diagnosis and treatment of CSU based on the presence of wheals, angioedema, or both, and do not discuss the possibility of CSU presenting without these symptoms 3, 4, 2, 5, 6.
Diagnosis and Treatment of Chronic Spontaneous Urticaria
- Diagnosis of CSU is based on clinical presentation, including the presence of wheals, angioedema, or both 4.
- Treatment for CSU is mainly symptomatic, with second-generation H1-antihistamines as the first-line therapy 3, 4, 2.
- For patients who do not respond to H1-antihistamines, international guidelines recommend the addition of omalizumab, ciclosporin A, or other agents as second-line or third-line treatment 3, 4, 2.