%0 Journal Article
%T Chronic Urticaria: Indian Context¡ªChallenges and Treatment Options
%A Sujoy Khan
%A Anirban Maitra
%A Pravin Hissaria
%A Sitesh Roy
%A Mahesh Padukudru Anand
%A Nalin Nag
%A Harpal Singh
%J Dermatology Research and Practice
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/651737
%X Urticaria is a common condition that occurs in both children and adults. Most cases have no specific allergic trigger and the aetiology of urticaria remains idiopathic and occasionally spontaneous in nature. Inappropriate advice such as avoidance of foods (milk, egg, prawn, and brinjal) is common place in certain sections of India mostly by nonspecialists that should not be routinely recommended. It is important to look for physical urticarias such as pressure urticaria in chronic cases, which may be present either alone or in combination with other causes. Autoimmune causes for chronic urticaria have been found to play an important role in a significant proportion of patients. Long-acting nonsedating antihistamines at higher than the standard doses is safe and effective. Quality of life is affected adversely in patients with chronic symptomatic urticaria and some may require multidisciplinary management. 1. Background Urticaria is a common condition and the chronic form usually has no allergic trigger. Longacting non-sedating antihistamines at higher than the standard doses is safe and effective. Urticaria is characterized by itchy, red, raised (wheal), and flared skin reactions that last usually for a few hours (typically <24 hours). It is classified as chronic urticaria (CU) if it lasts for more than 6 weeks. The chronic spontaneous form of urticaria does not need any stimulus and sometimes it is also referred to as chronic idiopathic urticaria (CIU) [1¨C6]. It is now well recognized that CIU consists of a myriad group of diseases and development of skin lesions and/or angioedema is seen in all different types and subtypes [4¨C6]. The terms CIU and CU have been used interchangeably in the article, although strictly CIU would refer to patients without a proven autoimmune component to the urticaria [5¨C9]. The wheal has a central swelling surrounded by a reflex erythema that is itchy while the angioedema is associated with pronounced swelling of the lower dermis and subcutaneous tissue with the occasional involvement of mucous membranes (lips, tongue) in some patients. Acute urticaria appears more commonly in children and young adults of which common causes are infections, food, drugs (intravenous more than oral forms), and insect stings. It is important to take a detailed clinical history to identify whether the urticaria is chronic (or acute or chronic), as occasionally a patient may be wrongly labeled as drug allergic when it may be that the urticaria was present before the drug was started [1¨C3]. There are some drugs, however, that are notorious in
%U http://www.hindawi.com/journals/drp/2013/651737/