Chronic Urticaria
Persistent hives lasting 6+ weeks requiring comprehensive evaluation and step therapy.
Overview
Chronic urticaria is defined as hives (wheals) and/or angioedema lasting 6 weeks or longer. It can significantly impact quality of life and requires a systematic approach to evaluation and treatment.
symptoms
- Raised, itchy welts (hives) that come and go
- Angioedema (swelling of deeper tissues)
- Symptoms lasting 6+ weeks
- Variable appearance and location
types
spontaneous
No identifiable trigger, often autoimmune in nature
inducible
Triggered by specific stimuli (cold, heat, pressure, exercise, etc.)
evaluation
history
Detailed symptom history, triggers, duration, and impact on quality of life
physical
Assessment of hives and angioedema
scoring
UAS7 (Urticaria Activity Score) - tracks symptoms over 7 days
testing
Limited testing unless history suggests specific triggers. Consider thyroid function, autoimmune markers if indicated.
treatment
step1
Second-generation H1 antihistamines (standard dose)
step2
Increase antihistamine dose up to 4x standard (if approved)
step3
Add H2 antihistamine or leukotriene antagonist
step4
Add omalizumab (Xolair) - highly effective for chronic spontaneous urticaria
step5
Consider cyclosporine or other immunosuppressants (rare cases)
xolair
indication
Chronic spontaneous urticaria not controlled with antihistamines
dosing
300mg subcutaneously every 4 weeks
response
Most patients see improvement within 4-8 weeks
duration
Continue for 6 months, then consider discontinuation if well-controlled
quality Of Life
Chronic urticaria can significantly impact sleep, work, and daily activities. Effective treatment is essential for patient well-being.
Ready to Get Started?
Schedule a consultation to discuss your specific needs and create a personalized treatment plan.