New and Diverse Approaches to the Treatment of Urticaria
Marcus Maurer, MD
Charité - Universitätsmedizin Berlin
Urticaria is a heterogeneous group of diseases characterized by recurrent itchy wheal and flare type skin reactions and/or angioedema. Urticaria of longer than six weeks duration is classified as chronic urticaria. Urticaria with spontaneously occuring symtpoms (spontaneous urticaria) is distinguished from inducible urticaria types, in which symptoms occur in response to physical or other triggers.
What is the role of atopy or allergy in urticaria? Chronic spontaneous urticaria is often thought to be an allergy because, similar to allergic diseases, the symptoms are brought about by mediators relased from activated mast cells, and patients benefit from antiallergic treatment (e.g. antihistamines, anti-IgE). Sensitizations to environmental allergens, however, are very rarely the underlying cause of chronic spontaneous urticaria, whereas autoreactivity, chronic infections, and intolerance to food components are much more common reasons for chronic spontaneous urticaria. Sensitizations to environmental allergens are also largely irrelevant for the pathogenesis of most chronic inducible urticaria, with contact urticaria and exercise-induced urticaria being the exceptions. All in all, chronic urticaria is not an atopic disease and allergies are not a common cause.
Since chronic urticarias are different in phenotype and underlying cause, it is important to assess patients for the urticaria type(s) they exhibit and to personalize their treatment. The treatment strategy, among other factors, depends on the urticaria type, duration, and activity, and may be aimed at the elimination of underlying causes or the prevention of symptom reoccurence. In any case, freedom of symptoms should be the goal.
This presentation will review the classification of urticaria with a special focus on the role of atopy and allergies. Participants will then be given an overview of the diversity of chronic urticaria phenotypes. The last part of this presentation will consist of practical tips and tricks on how to find the optimal treatment for each and every chronic urticaria patient.