Dermatology and Therapy (May 2024)

A Practical Approach to Diagnosing and Managing Chronic Spontaneous Urticaria

  • Adam Friedman,
  • Shawn G. Kwatra,
  • Gil Yosipovitch

DOI
https://doi.org/10.1007/s13555-024-01173-5
Journal volume & issue
Vol. 14, no. 6
pp. 1371 – 1387

Abstract

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Abstract Chronic spontaneous urticaria (CSU) is an unpredictable inflammatory skin condition characterized by the spontaneous onset of itchy wheals, angioedema, or both, which occurs for longer than 6 weeks overall. Despite the relatively straightforward diagnostic algorithm for CSU, relying primarily on a detailed medical history and only limited laboratory tests, patients often wait years to be diagnosed, with many cycling through different healthcare practitioners before a diagnosis is made. Even then, current treatment options for CSU are limited, with approximately half of patients resistant to standard-of-care second-generation antihistamines at standard or higher doses. As such, there is an unmet need for improved, streamlined management for patients with CSU. Here, we review the evidence-based diagnostic algorithm for CSU, consider the required steps of the diagnostic workup, and provide practical, real-world advice on the management of CSU to improve the timely diagnosis and care of patients with this debilitating disease.

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