Urticaria and Angioedema

Abstract

Urticaria is a frequent skin disease. Acute spontaneous urticaria is self-limiting and easy to treat. Chronic spontaneous urticaria and chronic inducible urticaria subtypes persist for years or decades and result in a substantial reduction of quality of life. In chronic spontaneous urticaria, every attempt should be made to identify and avoid underlying triggering factors such as regular intake of NSAIDs or persistent infections, for example, with Helicobacter pylori, streptococci, or persistent yersiniosis. In principle, the urticaria should be treated until it is gone paralleled by a maximization of quality of life and a minimization of drug-related side effects. Following the current treatment algorithm of the international urticaria guidelines, second-generation H1- antihistamines in standard dose should be given at first step. If this does not result in complete symptom control at step two, the dose is increased up to fourfold considering possible side effects. If this is not effective, add-on treatment with omalizumab (approved), cyclosporine A (off-label), or montelukast (off-label) is indicated. The risk-benefit profile of each treatment approach should be carefully considered and at least every 3–6 months should be checked to see whether urticaria is in spontaneous remission.