We describe a diagnostic and therapeutic protocol for the management of chronic urticaria. It is derived from an extensive review of current literature, with a cost-effective evaluation of laboratory investigations and therapeutic approaches. Our protocol may not represent a cornerstone for chronic urticaria: much has in fact to be clarified on pathogenetic mechanisms and aetiological factors. Nevertheless, its application should be able, in our opinion, to identify what is useful or not in the everyday management of chronic urticaria patients.
ValsecchiR.PigattoP., 1998. Chronic urticaria and Helicobacter Pylori. Acta Derm. Venereol.78:440.
6.
KozelM.M.A.MakkesJ.R.BossuytM., 1998. The effectiveness of a history based diagnostic approach in chronic urticaria and angioedema. Arch. Dermatol.134:1575.
7.
KaplanA.P.FinnA., 1999. Autoimmunity and the etiology of chronic urticaria. Can. J. Allergy Clin. Immunol.4:286.
8.
SchuyderB.HelblingA.PichlerW.J., 1999. Chronic idiopatic urticaria: Natural cause and association with H. Pylori infection. Int. Arch. Allergy Immunol. 119:60.
9.
LeznoffA.JosseR.G.DenbergJ., 1983. Association of chronic urticaria and angioedema with thyroid immunity. Arch. Dermatol.119:636.
10.
MonroeE.W.1998. Urticaria new therapeutic approaches. International Symposium on Urticaria, Bari 29–30/05, Italy.
11.
GreavesM.2000. Chronic Urticaria. J. Allergy Clin. Immunol.105:664.
12.
LeahachJ.G.RosenstreichD.L., 1992. Clinical aspects of chronic urticaria. Clin. Rev. Allergy.10:281.
13.
FreedbergI.M.EisenA.WolffK., 1995. Fitzpatrick's Dermatology in General Medicine, ed. Mc Graw HillVI edition, p. 28.
14.
SabroeR.A.GrattanC.H.E.FrancisD.M., 1999. The autologous serum skin test: A screening test for autoantibodies in chronic idiopatic urticaria. Br. J. Dermatol.140:446.
15.
WüthrichB.1993. Adverse reactions to food additives. Ann. Allergy71:379.
16.
OrtolaniC.Bruijnzeel-KoomenC.BengtssonU., 1999. Position paper on controversial aspects of adverse reactions to food. Allergy54:27.
17.
RingJ.BrockowK.OllertM., 1999. Antihistamines in urticaria. Clin. Exp. Allergy29:31.
18.
MonroeE.W.1985. Chronic Urticaria: Review of drug management. In “The urticarias”. ChampionR.H.GreavesM.W.BlackA. KobzaPyeR.J., ed. Edinburgh, Scotland. Churchill Livingstone, p. 205.
19.
NorrisJ.G.SullivanT.J., 1998. Leukotriens and cytokines in steroid dependent chronic urticaria. J. Allergy Clin. Immunol.101:128.
20.
BagenstoseS.E.LevinL.BernsteinJ.A., 2004. The addition of zafirlukast to cetirizine improves the treatment of chronic urticaria in patients with positive autologous serum skin test result. J. Allergy Clin. Immunol.113:134.
21.
FradinM.S.EllisC.N.GoldfarbM.T., 1991. Oral cyclosporine for severe chronic idiopathic urticaria and angioedema. J. Am. Acad. Dermatol.25:1065.
22.
CuratoliG.D'ArgentoV.FiordalisiF., 1996. Trattamento dell'orticaria cronica: Chetotifene versus cetirizina in schema sequenziale con ciclosporina A. Boll. Dermatol. Allerg. Profess.11:113.
23.
ToubiE.BlantA.KesselA., 1997. Low-dose cyclosporin A in the treatment of severe chronic idiopatic urticaria. Allergy52:312.
24.
GrattanC.H.E.O'DonnelB.F.FrancisD.M., 2000. Randomized double-blind study of cyclosporin in chronic ‘idiopathic’ urticaria. Br. J. Dermatol.143:365.
25.
BaskanE.B.TunaliS.TurkerT., 2004. Comparison of short and long-term cyclosporine A therapy in chronic idiopatic urticaria. J. Dermatol. Treat.15:164.
BergR.E.KantorG.R.BergfeldW.F., Urticarial vasculitis. Int. J. Dermatol.27:468.
29.
WormM.MucheM.SchulzeP., 1998. Hypocomplementemic urticarial vasculitis: Successful treatment with cyclophosphamide-dexamethasone pulse therapy. Br. J. Dermatol.139:704.
30.
StackP.S.1995. Methotrexate in urticarial vasculitis. Ann. Allergy72:36.
31.
RusselJ.R.BhogalB.DashA., 1999. Urticaria and vasculitis: A continuum of histopathological and immunopathological changes. Br. J. Dermatol.108:110.
32.
FiebigerE.MaurerD.HolubH., 1995. Serum IgG autoantibodies directed against the α chain of Fc ε RI: A selective marker and pathogenetic factor for a distinct subset of chronic urticaria patients. J. Clin. Invest.96:2606.
33.
FiebigerE.HammerschmidF.StinglG., 1998. Anti Fc ε RI autoantibodies in autoimmune mediated disorders: Identification of a structure-function relationship. J. Clin. Invest.101:243.
34.
JuhlinL.VengeP., 1991. Eosinophilic cationic protein (ECP) in skin disorders. Acta Dermatol. Venereol.71:495.
35.
ContinoR.CassanoN.RossigniM., 1997. Mast cell subpopulations in chronic idiopatic urticaria. Int. J. Immunopathol. Pharmacol.10:65.
36.
HydeM.FrancisD.M.GrattanC.E.H., 1993. Autoantibodies against the high affinity IgE receptor as a cause for histamine release in chronic urticaria. N. Engl. J. Med.328:1599.
37.
SabroeR.A.SeedP.T.FrancisD.M., 1999. Chronic idiopatic urticaria: Comparison of the clinical features of patients with and without anti-Fc ε RI or anti-IgE antibodies. J. Am. Acad. Dermatol.40:443.
38.
VenaG.A.CassanoN.MastrolonardoM., 1997. The mechanism of action of cyclosporin A in the treatment of chronic urticaria. Seminars Clin. Immunol.1:21.
39.
WongR.L.WinslowC.M.CooperK.D., 1993. The mechanism of action of Cyclosporin A in the treatment of psoriasis. Immunology Today14:69.
40.
FloriM.L.MolinuA.PiangianiE., 1996. Preliminary experience on the use of cyclosporin in chronic urticaria. International Congress on Immunointervention. The role of Neoral in Immune Based Diseases. Rome 20–22 June, Italy.
41.
KaufmanA.RosenstreichD.L., 1990. Mast cell heterogeneity in chronic idiopatic urticaria. Ann. Allergy65:367.
42.
WershilB.K.FurutaG.T.LavigneJ.A., 1995. Dexamethasone and cyclosporin A suppress mast cell-leukocyte cytokine cascades by multiple mechanism. Int. Arch. Allergy Immunol. 107:323.
