Chronic Urticaria Follow-up

  • Author: Daniel J Hogan, MD; Chief Editor: William D James, MD   more...
 
Updated: Nov 18, 2011
 

Deterrence/Prevention

If a precipitating factor is identified, patients should be advised to avoid it. Certain medications, such as aspirin and nonsteroidal anti-inflammatory drugs, are reported to exacerbate urticaria in patients with chronic urticaria resulting from other causes.

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Complications

Lesions of urticaria should resolve without complication; however, patients with severe pruritus may develop scratch purpura and excoriations that may become secondarily infected. Additionally, antihistamine use may cause somnolence and dry mouth. Finally, patients with severe disease may be impacted by quality-of-life issues.

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Prognosis

Most patients with chronic idiopathic urticaria have resolution of symptoms within 3 years from the onset of symptoms; 86% are symptom free at 5 years. The presence of anti–immunoglobulin G or antithyroid antibodies may worsen the prognosis. Chronic urticaria impairs quality of life to the extent experienced by persons with severe coronary artery disease. Chronic urticaria can lead to significant psychological stress, and the converse is also recognized. A possible mechanism is through stress-induced release of corticotrophin-releasing hormone (CRH), which is known to be expressed in the skin. Up-regulation occurs of the CRH-R1 receptor that mediates CRH-dependent cutaneous mast cell degranulation in chronic urticaria.[30]

Chronic idiopathic urticaria may be less uncommon in children, but it appears to have a similar pathogenesis and a favorable prognosis, with resolution in half of the children within 5 years. Girls older than 10 years may have a less favorable prognosis.[31]

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Patient Education

For patient education resources, see the Allergy Center and Skin, Hair, and Nails Center, as well as Hives and Angioedema.

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Contributor Information and Disclosures
Author

Daniel J Hogan, MD  Clinical Professor of Internal Medicine (Dermatology), Nova Southeastern University College of Osteopathic Medicine; Investigator, Hill Top Research, Florida Research Center

Daniel J Hogan, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Contact Dermatitis Society, and Canadian Dermatology Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Robert A Schwartz, MD, MPH  Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, University of Medicine and Dentistry of New Jersey-New Jersey Medical School

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and Sigma Xi

Disclosure: Nothing to disclose.

Richard P Vinson, MD  Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association

Disclosure: Nothing to disclose.

Warren R Heymann, MD  Head, Division of Dermatology, Professor, Department of Internal Medicine, University of Medicine and Dentistry of New Jersey-New Jersey Medical School

Warren R Heymann, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD  Paul R Gross Professor of Dermatology, University of Pennsylvania School of Medicine; Vice-Chair, Program Director, Department of Dermatology, University of Pennsylvania Health System

William D James, MD is a member of the following medical societies: American Academy of Dermatology and Society for Investigative Dermatology

Disclosure: Elsevier Royalty Other

Additional Contributors

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author, Dr Dina Strachan, to the development and writing of this article.

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