Background Chronic urticaria is a common condition encountered in general practice and a frequent
source of referral to the clinical immunologist, allergist and dermatologist.
Objective This article discusses the assessment and management of chronic urticaria in the
general practice setting.
Discussion Chronic urticaria is defined as the occurrence of transient wheals lasting more than
6 weeks in duration. In 80% of cases, a cause is not identified and this is classified
as chronic idiopathic urticaria. A physical trigger, vasculitis or systemic disease
account for a smaller proportion of cases. Allergic causes are rarely responsible. A
detailed history provides the most useful information in determining the presence
of chronic urticaria and a possible aetiology. Apart from thyroid function tests and
thyroid autoantibodies, other investigations should only be performed if clinically
indicated. Second generation antihistamines are the mainstay of treatment and usually
twice daily regimens are required for adequate control. H2 antagonists, doxepin and
immunomodulation may be necessary in some patients.
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