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Therapeutic Approach

Urticaria, commonly known as hives, is characterized by the episodic appearance of pruritic, erythematous papules, or plaques with superficial swelling of the dermis. Angioedema often coexists with urticaria and results from a deeper swelling of the dermis, subcutaneous, or submucosal tissue. Urticaria is classified as either acute or chronic based on symptom duration of less than 6 weeks or more than 6 weeks, respectively. Chronic urticaria, defined by symptom duration of greater than 6 weeks, can be further classified as chronic inducible urticaria (CIndU) or chronic spontaneous urticaria (CSU). CIndU is comprised of many subtypes in which a specific trigger can quickly induce hives, while the majority of hives in CSU do not occur as a result of a known trigger. Therapy is based on reducing pruritus and lesion severity and includes trigger avoidance where applicable. In the authors’ experience, therapy is usually initiated with H1 antihistamines; omalizumab is often first-line systemic therapy for antihistamine-refractory cases while immunosuppressants are usually reserved for recalcitrant cases. See Table 26-1.

Table 26-1Urticaria Treatment Table

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