Update on chronic urticaria and angioedema

PURPOSE: To review the various subtypes of angioedema and urticaria and their current standards of treatment and to highlight new therapeutic approaches to these conditions. EPIDEMIOLOGY: A group as large as 15% to 24% of the US population will experience acute urticaria and/or angioedema at some time in their lives. Approximately 50% of patients with urticaria alone will be free of lesions within 1 year, whereas 20% have involvement for more than 20 years. For patients with both conditions, 75% have continued episodes for more than 5 years and 20% for more than 20 years. REVIEW SUMMARY: Chronic urticaria and angioedema have a vast constellation of clinical presentations, triggers, and underlying causes. This article reviews the different subtypes of angioedema and urticaria and offers recommendations for diagnosis and workup. Standard treatment focuses on symptom control and rarely on avoidance of triggers that are identified through careful medical history and assessment. The cornerstone of therapy is antihistamines, but many patients do not respond to this treatment. TYPE OF AVAILABLE EVIDENCE: Systematic review, cohort studies. GRADE OF AVAILABLE EVIDENCE: Fair. CONCLUSION: Despite the unfortunate current situation in which many patients do not respond to the standard therapy of antihistamines, the future nevertheless holds hope for new therapies.