Abstract
Chronic spontaneous urticaria is the most frequent type of chronic urticarias. It was formerly called idiopathic because of its unknown cause.
In the last years, the situation changed thanks to the advances in knowledge, so that the real rate of idiopathic cases decreased by about a half. The introduction of new antihistamines and biologics has renewed the interest in chronic urticaria both in investigation and clinical practice.
The updated Guidelines of EAACI, GA2LEN, EDF and WAO represent a valuable guide for physicians in diagnostics and therapy. Taking a structured history represents the most beneficial tool to assess the type of chronic urticaria.
Non-sedating H1 antihistamines are the drugs of first choice, even in updosed regimen. Third line therapy is added on to antihistamines in refractory cases - antileukotrienes, cyclosporine A or omalizumab.
Prescription of this first biologic for treatment of chronic urticaria is limited to dermatologic centres of biologic therapy, where - after fulfillment of indication criteria - it is reimbursed by health care insurance authorities. Nevertheless, individual cases need to be solved in an individual way, including the use of less common empirical drugs.
For the general management of chronic urticaria, complex understanding, interdisciplinary collaboration and also adequate patient's education and psychosomatic attitude are important.