Added in September 2018 – the Comorbidities section reviews the autoimmune, atopy and psychiatric comorbidities that have been associated with CSU. In addition, real-world data has now been added to the treatment section, providing insights into efficacy and safety outside of a clinical trial setting.
In this section of the Learning Zone, we explore the prevalence and duration of urticaria, including the risk factors for increased time with the condition. The burden of disease is also explored, with consideration of the impact on quality of life, daily functioning and socioeconomic factors.
CSU is driven by the activation of mast cells, which release histamines and other immune modulators, although the precise mechanism is not fully known. In this section we present the current understanding of the molecular and immune processes involved in urticaria.
The symptoms of chronic spontaneous urticaria (CSU) include itchy hives (wheals) and angioedema.
The symptoms of CSU may appear without warning with a variable intensity (Maurer et al., 2011; Zuberbier et al., 2018) and may profoundly impact patients' day-to-day lives (Maurer et al., 2011; O'Donnell et al., 1997; Kang et al., 2009; Barbosa et al., 2011; Engin et al., 2008). In CSU, itchy hives, angioedema or both, may occur spontaneously every day, or almost daily for 6 weeks or more (Zuberbier et al., 2018).
Diagnosis and Assessment
Since there is no definitive test for chronic spontaneous urticaria, diagnosis is based on a thorough medical history and physical examination as well as diagnostic tests.
Unfortunately for many patients with CSU, the itchy hives and/or angioedema associated with the condition is not all they have to contend with. A substantial number of patients also experience comorbidities associated with the development of CSU.
The Aim of Treatment
The aim of treatment for urticaria is quick and complete symptom control (Maurer et al., 2011; Maurer et al., 2015; Zuberbier et al., 2018).
The Recommended Treatment Algorithm
The 2013 EAACI/GA2LEN/EDF/WAO guidelines recommend the following step-wise approach to the treatment of urticaria (Zuberbier et al., 2018).
Best practice guidelines for CSU have been developed and published by a number of national and international groups, and those with major significance are described in this section. Broadly speaking they recommend second generation antihistamines of standard and then increased dose, followed by alternative agents such as anti-inflammatories, immunosuppressants or biologics.
Having explored adult urticaria, in this section of the Learning Zone, we review the available data in paediatric urticaria and establish the impact it has on younger patients and how diagnosis and management compares to the recommendations for adult patients with CSU.
Developed by EPG Health for Medthority in collaboration with Novartis Pharma AG, with some content provided by Novartis Pharma AG. An unrestricted educational grant was provided from Novartis Pharma AG for the development of the e-Learning module within this Learning Zone (Novartis were not involved in the content or development of these modules). Developed by EPG Health for Medthority in collaboration with J. Uriach y Compañía S.A, with some content provided by J. Uriach y Compañía S.A.