Etiopathogenesis and diagnosis of chronic urticaria

Urticaria in its acute form has been recorded among as much as 45% of the population while the presence of chronic symptoms affect 0.1-3% of people. Acute urticaria is manifested predominantly in children while its chronic form is mostly the disease of adults. The key role in urticarial processes is played by mediators released by mast cells and basophils, among those - mainly by histamine. Moreover, local and systemic inflammatory responses are developed - the acute-phase response. Such acute-phase response is manifested by increased circulating IL-6, which varies along with CRP changes, and may be related to the disease severity and activity. The etiopathogenesis of chronic urticaria is complex and has not been yet completely recognized. The disease creates some remarkable diagnostic and therapeutic difficulties and significantly reduces the patients' life quality. Diverse factors, including the environmental, immunological as well as hormonal ones, are pointed to as those triggering and sustaining the urticarial reaction. Despite highly detailed diagnostic procedures, in most cases the reasons have not been accounted for, and such form of the disease is referred to as an idiopathic one. The diagnostic panel comprises: 1) the autologous serum skin test - ASST, performed as a screening for autoreactive/autoimmune urticaria, 2) testing for Hashimoto disease due to frequent co-occurrence of the disease with urticaria, 3) elimination of the infection foci, taking into account H. pylori, however different opinions have been expressed on the role of this bacteria in etiopathogenesis of urticaria, 4) other tests depending on the clinical picture as well as the results of the basic tests. Recommendations should include a pseudoallergen-free diet. Such procedure may bring alleviated symptoms in 1/4 - 1/3 of patients. As shown by my own experience such dietary restrictions should be introduced gradually and followed throughout the demanded time.