Urticaria and angioedema

Urticaria is characterized by transient itchy wheals, angioedema or both. It is a debilitating disease that places a substantial burden on patients and society. Urticaria is classified as acute (lasting <6 weeks) or chronic (persisting for >6 weeks). Chronic urticaria can be subdivided into chronic spontaneous urticaria, with no specific trigger, and chronic inducible urticaria, where there is an identifiable trigger. Chronic spontaneous urticaria can have an autoimmune basis. A detailed history and examination should be undertaken in order to make a diagnosis, with limited routine laboratory tests if indicated. H₁ antihistamines taken in standard dosage or ‘updosed’ up to 4-fold provide effective symptom control for most patients. The biological drug omalizumab is licensed for severe chronic urticaria not adequately controlled with antihistamines and is a safe and effective treatment. Ciclosporin is a fourth-line option for refractory chronic urticaria.