Chronic Autoimmune Urticaria: Symptoms and Treatments

Chronic autoimmune urticaria (CAU) is a perplexing and often distressing condition characterized by persistent hives and itching due to an autoimmune response. 

Unlike acute urticaria, which is usually triggered by an allergen and resolves within six weeks, CAU persists for more than six weeks and can last for several months or even years. 

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What Causes Chronic Autoimmune Urticaria?

The precise etiology of chronic autoimmune urticaria is not entirely understood, yet it is believed to be an autoimmune disorder where the body's immune system mistakenly attacks its own tissues. In CAU, the immune system produces autoantibodies—specifically, Immunoglobulin E (IgE)—that target the FcεRIα receptor on mast cells and basophils, leading to histamine release. This histamine release results in the characteristic wheals and itching associated with urticaria.

Several factors may contribute to the onset of CAU, including:

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Recognizing the Symptoms

The symptoms of chronic autoimmune urticaria can significantly impact an individual's quality of life. It is crucial to recognize these symptoms early for effective management. Key symptoms include:

Unlike acute urticaria, where symptoms appear quickly and resolve with treatment, CAU symptoms can persist and are often resistant to standard antihistamines.

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Diagnosing Chronic Autoimmune Urticaria

A comprehensive diagnosis is essential for managing CAU effectively. The diagnosis typically involves:

Clinical Evaluation

A thorough clinical evaluation is the first step, involving a detailed patient history and physical examination. The healthcare provider will inquire about the duration and frequency of symptoms, potential triggers, and family history of autoimmune diseases.

Laboratory Tests

To confirm the diagnosis, several laboratory tests may be performed, including:

Exclusion of Other Conditions

It is crucial to rule out other causes of chronic urticaria, such as infections, thyroid disorders, or systemic illnesses. In some cases, a skin biopsy may be performed to exclude other dermatological conditions.

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Treatment Options for Chronic Autoimmune Urticaria

Managing chronic autoimmune urticaria requires a multifaceted approach tailored to the individual's symptoms and response to treatment. The primary goal is to reduce symptoms and improve quality of life. Treatment options include:

Antihistamines

While standard antihistamines may be less effective in CAU, higher doses or second-generation antihistamines can provide relief for some patients. These medications work by blocking the effects of histamine, thus reducing itching and swelling.

Corticosteroids

In cases where antihistamines are inadequate, short-term use of corticosteroids may be prescribed to control inflammation. Due to potential side effects, long-term use is generally avoided.

Immunosuppressants

For severe CAU cases, immunosuppressants such as cyclosporine or mycophenolate mofetil may be considered. These medications suppress the immune system to prevent the release of histamine.

Biologic Therapies

Omalizumab, a monoclonal antibody that targets IgE, has shown promise in treating CAU. It works by reducing the levels of free IgE, thereby preventing the activation of mast cells and basophils.

Lifestyle Modifications

In addition to pharmacological treatments, lifestyle modifications can aid in managing CAU. These may include: