Advances in Chronic Urticaria

Abstract

In recent years, there have been important advances in our knowledge and management of chronic urticaria, a frequently debilitating disease. This review will be an update on the significant progress made in diagnostic and therapeutic procedures, as well as the classification, pathophysiology and assessment tools available for urticaria. Some of the latest advances will be detailed, including new findings that shed light on the mechanism of chronic urticaria. Updated information on optimal management of chronic urticaria will be discussed, including evidence on newer therapy, primarily the humanized monoclonal anti-IgE antibody, omalizumab. This is now considered to be third-line therapy after licensed doses of antihistamines and unlicensed updosing of antihistamines fourfold. Further understanding of the pathogenesis of chronic urticaria may help explain the mechanisms involved in the action of treatments. This would then aid the clinician with the appropriate diagnostic tests and therapeutic options. Extensive research on the administration of omalizumab has determined optimal dosage, the interval and duration of treatment. Recent studies have significantly advanced the treatment of chronic urticaria refractory to antihistamines, and the stepwise treatment algorithm has been updated in accordance with new evidence. Biomarkers, such as the basophil histamine release assay and autologous skin serum test, have been useful to identify chronic autoimmune urticaria, a subset of chronic urticaria, and may aid selection of third-line therapy, as well as predict speed of response and prognosis.