eMedicine Specialties > Dermatology > Allergy & Immunology

Urticaria, Chronic: Follow-up

Author: Daniel J Hogan, MD, Clinical Professor of Internal Medicine (Dermatology), NOVA Southeastern University; Investigator, Hill Top Research, Florida Research Center
Contributor Information and Disclosures

Updated: Oct 23, 2009

Follow-up

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.

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.

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.27

Patient Education

For excellent patient education resources, visit eMedicine's Allergy Center and Skin, Hair, and Nails Center. Also, see eMedicine's patient education article Hives and Angioedema.

Miscellaneous

Medicolegal Pitfalls

A potential pitfall is the failure to consider a diagnosis of urticarial vasculitis in patients with lesions lasting longer than 24 hours, in patients with lesions associated with pain more than with itching, and in patients with lesions resolving with pigmentary changes or scaling.

 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author, Dr Dina Strachan, to the development and writing of this article. The authors and editors of eMedicine would also like to gratefully acknowledge the contributions of previous Chief Editor, William D. James, MD, to the development and writing of this article.



More on Urticaria, Chronic

Overview: Urticaria, Chronic
Differential Diagnoses & Workup: Urticaria, Chronic
Treatment & Medication: Urticaria, Chronic
Follow-up: Urticaria, Chronic
References
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Further Reading

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Keywords

chronic urticaria, hives, wheals, allergy, allergic reaction, anaphylaxis, anaphylactoid reaction, angioedema

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Contributor Information and Disclosures

Author

Daniel J Hogan, MD, Clinical Professor of Internal Medicine (Dermatology), NOVA Southeastern University; 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.

Medical Editor

Robert A Schwartz, MD, MPH, Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, UMDNJ-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.

Pharmacy Editor

Richard P Vinson, MD, Assistant Clinical Professor, Department of Dermatology, Texas Tech University 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.

Managing Editor

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

CME Editor

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

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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