Chronic Hives: When the Welts Won't Go Away
More than 6 weeks of itching: it's a disease in itself.
Dr. Nadia Kouri
Allergist-Immunologist
Chronic spontaneous urticaria is defined by the appearance of red, raised, and itchy welts for more than 6 weeks, without an identifiable cause. Contrary to popular belief, it is rarely of allergic origin.
Mechanism
Cutaneous mast cells spontaneously activate and release histamine, causing vasodilation, edema, and itching. In 30 to 50% of cases, autoantibodies directed against the patient's own cells are involved.
What is NOT Useful
- Extensive allergological assessments (in chronic spontaneous urticaria, allergic tests are normal)
- Drastic dietary elimination diets without evidence
- Systematic infection screenings
Treatment
- H1 Antihistamines: first line, up to 4 times the standard dose if necessary
- Omalizumab: anti-IgE antibody, in case of antihistamine failure. Remarkable effectiveness.
- Cyclosporine: last line for refractory cases
Evolution
The disease progresses with flares and remissions. The median duration is 2 to 5 years, with spontaneous resolution in the majority of cases.
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