Spontaneous urticaria, chronic ordinary urticaria, Primary Care Dermatology Society, UK

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Urticaria: spontaneous urticaria (formerly chronic ordinary urticaria; chronic idiopathic urticaria)

Created: 27th June 2012 | Last Updated: 19th March 2017

Introduction

Chronic urticaria is defined by symptoms lasting for more than six weeks. 60-80% of these have spontaneous urticaria, most of the rest have a physical urticaria (refer to the related chapter).

This chapter is set out as follows:

Related chapters

  • 50% of cases of spontaneous urticaria are idiopathic, the other 50% are autoimmune in nature and often have associated thyroid autoantibodies
  • Although spontaneous urticaria is not an allergy, symptoms can be exacerbated by a number of factors such as heat, stress, various medications such as aspirin and other NSAID, and in some cases pseudoallergens
  • A slight female predominance
  • Can affect any age although 50% present between the ages of 20 and 40
  • 25% of patients have an atopic background
  • Symptoms
    • Although the condition may persist for several months, or in some cases years, individual lesions generally last between 30 minutes and 4 hours
    • Can have additional elements of physical urticaria such as dermographism or delayed pressure urticaria
  • Angioedema will affect some patients but is rarely life threatening
  • Natural history – 50% of patients with spontaneous urticaria can expect to be clear in six months, but some persist for years

Clinical findings

  • Distribution
    • Can affect any part of the body
  • Morphology
    • Lesions vary in size, some can be very large
    • Wheal and flare – an irregular, elevated, blanched wheal surrounded by an erythematous flare
    • Lesions lack scale
    • The central aspects resolve to leave annular lesions

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Spontaneous urticaria – wheal and flare

Wheal (black arrow) and flare (blue arrow)

Spontaneous urticaria with dermographism

Urticarial plaque (black arrow) with dermographism (blue arrow)

Spontaneous urticaria

Copied with kind permission from Dermatoweb

Spontaneous urticaria

Copied with kind permission from Dermatoweb

Spontaneous urticaria

Copied with kind permission from Dermatoweb

Spontaneous urticaria

Copied with kind permission from Dermatoweb

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