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Recurrent and Persistent Urticaria

Is It Chronic Idiopathic Urticaria?

Narrative Review on Diagnosis and Management

Goldstein, Stanley; Weinberg, Jeffrey M.

Journal of the Dermatology Nurses' Association: November/December 2018 - Volume 10 - Issue 6 - p 279–289
doi: 10.1097/JDN.0000000000000439

ABSTRACT Chronic idiopathic urticaria (CIU), defined as wheals and/or angioedema lasting for ≥6 weeks without an identifiable cause, is a burdensome condition. This review provides recommendations regarding the efficient recognition and differential diagnosis of CIU from other chronic urticaria forms and discusses the importance of evaluating CIU’s impact on patients’ quality of life and assessing unmet treatment needs.

The goal of treatment is achieving complete resolution of symptoms through a systematic approach and close patient cooperation, thereby improving quality of life. The U.S. Practice Parameter describes a step-care approach to CIU management, with second-generation H1-antihistamines at approved doses as the first-line treatment. For patients with inadequately controlled symptoms, dose advancement or add-on therapies, followed by use of potent antihistamines, may be considered. Of the alternative agents available for the treatment of patients with refractory CIU, omalizumab, an anti-immunoglobulin E monoclonal antibody, is the only treatment approved by the Food and Drug Administration for use in adults and adolescents (≥12 years old) with CIU who remain symptomatic despite 1-antihistamine">H1-antihistamine therapy. Ultimately, treatment decisions should weigh the potential clinical benefit versus harm for each agent and consider the patient’s preference. By discussing available treatment options and providing evidence-based recommendations, this review aims to support aspects of decision making when managing this complex condition.

Stanley Goldstein, MD, Allergy and Asthma Care of Long Island, Rockville Centre, New York, NY.

Jeffrey M. Weinberg, MD, Mount Sinai Beth Israel and Mount Sinai St. Luke’s, Mount Sinai School of Medicine, New York, NY.

Disclosures/potential financial conflicts of interest: Stanley Goldstein has served on advisory boards for Meda and Novartis; has received funding for clinical research from Astra Zeneca, Genentech, Merck, Mylan, Novartis, Perrigo, and Teva; and has served on speakers bureau for Genentech, GSK, Meda, Merck, Mylan, and Teva. Jeffrey M. Weinberg has received honoraria and research grants from Novartis. Development of this manuscript was supported by Novartis Pharmaceuticals Corporation, East Hanover, NJ.

Reprinted from Journal of the Dermatology Nurses’ Association, 8(4): 250–260, July/August 2016.

Correspondence concerning this article should be addressed to Stanley Goldstein, MD, Allergy and Asthma Care of Long Island, 242 Merrick Road, Suite 401, Rockville Centre, New York, NY 11570. E-mail:

Copyright © 2018 by the Dermatology Nurses' Association.