What is the current thinking about treatment of chronic idiopathic urticaria?
—Lester N. Ploss, MD, Freeport, N.Y.
Chronic idiopathic urticaria (CIU) is defined as the daily or almost daily occurrence of wheals and itching for at least six weeks, with no obvious cause. The major advance in our understanding of CIU in recent years has been the discovery that in 30%-50% of patients, the disease is due to an autoimmune process. In autoimmune urticaria, circulating immunoglobulin (Ig) G autoantibodies react specifically with the a-chain of the high-affinity IgE receptor on dermal mast cells and basophils, evoking release of histamine and other mediators that cause urticaria and angioedema.
First-line therapy of CIU consists of using nonsedating and sedating antihistamines in combination. In fact, you can utilize several times the normal doses of these medications if necessary to obtain control of the condition. I use fexofenadine (Allegra) 180 mg in the morning and hydroxyzine (Vistaril) 25 mg in the evening as initial therapy. If antihistamines fail, courses of corticosteroids and other immunosuppressive therapies are effective, although higher-risk, options. >br>— Jeffrey M. Weinberg, MD (109-5)