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Update on chronic urticaria: focusing on mechanisms

Młynek, Agnieszka; Maurer, Marcus; Zalewska, Anna

Current Opinion in Allergy and Clinical Immunology: October 2008 - Volume 8 - Issue 5 - p 433–437
doi: 10.1097/ACI.0b013e32830f9119
Skin allergy: Edited by Torsten Zuberbier and Thomas Werfel

Purpose of review This review discusses some of the recent advances in basic and clinical research focused on chronic urticaria. It is a concise summary of issues that occupied researchers' attention in the previous year, and it discusses a selection of novel findings that further our understanding of the pathomechanism of this disease.

Recent findings Particular consideration is given to the role of basophils, the coagulation cascade, fibrinolysis, and hormonal pathways in chronic urticaria pathogenesis. The description of clinical data is focused on prognostic issues, disease severity, and the effects of the disease on patients' quality of life.

Summary Mast cells are the key elements in chronic urticaria pathogenesis, whereas basophils should be regarded as bystanders and serve as biomarkers in some chronic urticaria subsets. The coagulation cascade, hormonal factors, and the psychological status of the patients seem to contribute substantially to the course and activity of the disease. Nonsedating second-generation antihistamines should be considered as first-line symptomatic treatment for chronic urticaria. Of note, the dosage should be increased up to four-fold if required before switching to second-line therapies.

aPsychodermatology Department, Chair of Dermatology and Venereology, Medical University of Łódź, Łódź, Poland

bDepartment of Dermatology and Allergy, Allergie-Centrum-Charité, Charité-Universitätsmedizin Berlin, Berlin, Germany

* Member of GALEN.

Correspondence to Anna Zalewska, MD, PhD, Psychodermatology Department, Chair of Dermatology and Venereology, Medical University of Lodz, Krzemieniecka 5, 94-017 Lodz, Poland Tel: +48 42 686 7981; fax: +48 42 688 4565; e-mail:

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