Chronic Idiopathic Urticaria (CIU) Treatment, commonly known as chronic hives or chronic urticaria, is a condition characterized by the appearance of hives or wheals on the skin lasting for more than six weeks. While in many cases an underlying cause can be identified including allergies, food, medications, infections, physical stimuli etc., in over 50% of the cases no clear cause can be determined and such cases are termed as chronic idiopathic urticaria.
Causes of Chronic Idiopathic Urticaria
As mentioned earlier, in a majority of CIU cases, no definitive cause can be found despite thorough investigations and such cases are deemed as ‘idiopathic’. However, certain potential causes that are considered but often remain unestablished include food additives, preservatives, emotional stress, thyroid disorders etc. Autoimmunity where the body’s own immune system attacks mast cells in the skin leading to histamine release and wheal formation is considered an important pathogenic mechanism in CIU.
Signs and Symptoms
The most prominent symptoms of CIU include sudden appearance of round bumps or raised welts on the surface of the skin known as hives or wheals. These hives can vary in size from few millimeters to several centimeters. They are often accompanied by itching and a burning sensation. The hives or urticarial lesions usually disappear within hours but keep recurring. Areas commonly affected include the neck, chest, limbs, back and abdomen. Angioedema which manifests as swelling of the face, mouth or extremities can occur in few cases.
Diagnosis
Diagnosis of CIU involves thorough history taking and physical examination by a dermatologist to rule out other medical conditions. A skin prick test or blood tests may be done to detect allergies but are often unremarkable in CIU. A complete blood count, thyroid function tests, tests for infections etc. are conducted to exclude secondary causes. A urticaria activity score is used to monitor disease severity and treatment response. Diagnosis of CIU is made if hives or angioedema lasting over 6 weeks remain unexplained despite investigations.
Chronic Idiopathic Urticaria (CIU) Treatment Options
The mainstay of treatment for CIU is oral antihistamines such as cetirizine, levocetirizine or fexofenadine. As CIU is mediated by histamine release from mast cells, antihistamines help reduce the itching and hives. If symptoms aren’t controlled, a higher dose or second generation antihistamines like desloratadine may be added. For moderate-severe uncontrolled cases, leukotriene receptor antagonists like montelukast, H2 receptor blockers like ranitidine or doxepin can also be useful as add-on therapies. Short-term systemic corticosteroids are prescribed during flare-ups. Omalizumab, cyclosporine are reserved for difficult-to-treat cases of CIU refractory to above therapies. Phototherapy, plasmapheresis have also shown benefit. Surgical interventions like plasmapheresis are rarely needed.
Prognosis
The prognosis of CIU is variable. Symptoms often improve gradually over months to years. Symptoms usually persist for 2 years or longer in over 50% cases. Spontaneous long-term remission occurs in others. However a small proportion have chronic persistent disease even after 5 years of treatment. Leading a less stressful lifestyle, managing triggers, and adhering to medical treatments usually helps achieve better control over symptoms and shorter duration of disease. While not life-threatening, CIU significantly impacts quality of life if uncontrolled. Overall, CIU has a good prognosis if treated adequately.
Chronic Idiopathic Urticaria (CIU) Treatment is a complex allergic disease characterized by recurring hives and angioedema for over 6 weeks due to unknown or multifaceted causes. Thorough history, physical exam, targeted lab tests help exclude secondary causes and establish the diagnosis. Antihistamines remain the first-line treatment with numerous add-on options available based on severity. While usually persistence for months to years, following medical advice can help minimize symptoms and achieve faster remission. With the various effective Chronic Idiopathic Urticaria (CIU) Treatment modalities available today, patients are now better able to control their CIU condition.
*Note:
1. Source: Coherent Market Insights, Public sources, Desk research
2. We have leveraged AI tools to mine information and compile
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