Background: Up to 1% of the general population in the USA and Europe suffer from
chronic urticaria (CU) at some point in their lifetime. CU has an adverse effect on the quality of life.
Objective: This study aims to provide an update on the epidemiology, pathogenesis, clinical manifestations,
diagnosis, aggravating factors, complications, treatment and prognosis of CU.
Methods: The search strategy included meta-analyses, randomized controlled trials, clinical trials,
reviews and pertinent references. Patents were searched using the key term "chronic urticaria" at the
following links: www.google.com/patents, www.uspto.gov, and www.freepatentsonline.com.
Results: CU is a clinical diagnosis, based on the episodic appearance of characteristic urticarial lesions
that wax and wane rapidly, with or without angioedema, on most days of the week, for a period of six
weeks or longer. Triggers such as medications, physical stimuli, and stress can be identified in 10 to
20% of cases. C-reactive protein/erythrocyte sedimentation rate, and complete blood cell count with
differential are the screening tests that may be used to rule out an underlying disorder. The mainstay of
therapy is reassurance, patient education, avoidance of known triggers, and pharmacotherapy. Secondgeneration
H1 antihistamines are the drugs of choice for initial therapy because of their safety and efficacy
profile. If satisfactory improvement does not occur after 2 to 4 weeks or earlier if the symptoms
are intolerable, the dose of second-generation H1 antihistamines can be increased up to fourfold the
manufacturer’s recommended dose (all be it off license). If satisfactory improvement does not occur
after 2 to 4 weeks or earlier if the symptoms are intolerable after the fourfold increase in the dosage of
second-generation H1 antihistamines, omalizumab should be added. If satisfactory improvement does
not occur after 6 months or earlier if the symptoms are intolerable after omalizumab has been added,
treatment with cyclosporine and second-generation H1 antihistamines is recommended. Short-term use
of systemic corticosteroids may be considered for acute exacerbation of CU and in refractory cases.
Recent patents for the management of chronic urticaria are also discussed. Complications of CU may
include skin excoriations, adverse effect on quality of life, anxiety, depression, and considerable humanistic
and economic impacts. On average, the duration of CU is around two to five years. Disease
severity has an association with disease duration.
Conclusion: CU is idiopathic in the majority of cases. On average, the duration of CU is around two to
five years. Treatment is primarily symptomatic with second generation antihistamines being the first
line. Omalizumab has been a remarkable advancement in the management of CU and improves the
quality of life beyond symptom control.