Urticaria. Interdisciplinary diagnostic and therapeutic recommendations of the Polish Dermatological Society and the Polish Society of Allergology

Urticaria has a complex aetiology and pathogenesis, and is characterized by the presence of wheals with accompanying pruritus or skin burning sensation. In 40% of cases, urticaria may be accompanied by angioedema. Depending on the duration, urticaria may be classified as acute or chronic. Acute urticaria is common (25% of the population). Its most common causes include food, drugs, infections, hymenoptera venom, and plant pollen. Acute urticaria does not usually require diagnostic tests. Chronic urticaria is less common (1% of the population), and due to its diverse causal factors may cause considerable diagnostic and therapeutic difficulties. Chronic urticaria is divided into induced urticaria and spontaneous urticaria. Diagnosis of chronic urticaria includes detailed medical history, laboratory as well as imaging tests, and consultations with specialists. Therapeutic procedures in urticaria include avoidance of triggering factors, treatment of concomitant diseases, and pharmacological treatment of symptoms. Second-generation antihistamines, used in the doses in compliance with summary of product characteristics, are the treatment of choice in urticaria. When the therapeutic results fail to be satisfactory, an antihistamine drug may be changed to another one. In patients who do not react to standard doses, the dose may be increased four-fold. If there is no improvement after 2– 4 weeks of treatment, it is recommended to administer a second-generation antihistamine with omalizumab at the dose of 300 mg every 4 weeks. Also, cyclosporine is recommended in treatment of chronic urticaria. Furthermore, a short-term general treatment with corticosteroids may be considered