JAMA Clinical Reviews Diagnosis and Treatment of Chronic Spontaneous Urticaria
Sep 26, 2024
Pavel Kolkhir, MD, an expert in chronic spontaneous urticaria, teams up with Karen E. Lasser, MD, MPH, a JAMA Senior Editor, to unpack this puzzling condition. They delve into its prevalence and varied symptoms, from itchy wheals to angioedema. The conversation touches on crucial distinctions between autoimmune and autoinflammatory diseases. They also reveal effective treatment strategies, emphasizing the importance of second-generation antihistamines and advanced options like Omalizumab. The impact on patients' quality of life, including psychological challenges, is also explored.
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Chronic Spontaneous Urticaria Overview
- Chronic spontaneous urticaria is a chronic autoimmune inflammation lasting over six weeks, often years.
- It affects about 1% of the population and commonly causes itchy skin wheals and sometimes deep tissue swelling called angioedema.
Differential Diagnosis Key Points
- Rule out urticarial vasculitis, autoinflammatory disease, and isolated angioedema for differential diagnosis.
- Recognize features like long-lasting wheals, systemic symptoms, or isolated angioedema unresponsive to antihistamines to prompt referral.
Autoimmune vs Autoinflammatory Differences
- Autoinflammatory syndromes differ from autoimmune diseases by lacking autoantibodies and showing neutrophil infiltration in skin biopsies.
- Chronic spontaneous urticaria is autoimmune and frequently coexists with other autoimmune diseases like Hashimoto's.