What it is

➝ Chronic urticaria (CU) is defined as the presence of hives (wheals), with or without angioedema, persisting for more than 6 weeks.

➝ It may occur spontaneously (chronic spontaneous urticaria – CSU) or be triggered by physical factors (inducible urticaria: cold, pressure, cholinergic, heat, vibration).

➝ Symptoms include itchy, red, raised wheals that appear and disappear within 24 hours, often accompanied by swelling in deeper tissues.

➝ The condition is not life-threatening but significantly impairs quality of life due to itching, discomfort, poor sleep, and psychological stress.

➝ In Korea, management of chronic urticaria follows international guidelines (EAACI/GA²LEN/WAO) with structured stepwise treatment.

Why it’s done

→ To relieve itching and hives that interfere with daily life.

→ To prevent angioedema attacks, which may cause pain and swelling of lips, eyelids, hands, or airway.

→ To improve sleep, work performance, and psychological well-being.

→ To reduce unnecessary emergency visits caused by flare-ups.

→ In Korea, chronic urticaria management emphasizes long-term control with minimal medication burden.

Alternatives / Stepwise Treatment Strategy

→ Step 1: Standard therapy

• Non-sedating second-generation H1 antihistamines (cetirizine, loratadine, fexofenadine, bilastine).
• Taken once daily at standard dose.

→ Step 2: Increased dosing

• If symptoms persist, dose may be increased up to 4 times the standard dose (high-dose antihistamine strategy).

→ Step 3: Add-on therapy

• Omalizumab (anti-IgE monoclonal antibody), given as subcutaneous injections every 4 weeks.
• Cyclosporine (immunosuppressant) in resistant cases.

→ Step 4: Adjunct therapies

• Leukotriene receptor antagonists (montelukast).
• H2 antihistamines (ranitidine/famotidine, though less used now).
• Short courses of oral corticosteroids for severe flares only.

→ Lifestyle and avoidance

• Identify and avoid triggers (NSAIDs, alcohol, stress, infections).
• Treat comorbidities (thyroid disease, H. pylori if present).

Preparation

→ Clinical evaluation including history of onset, frequency, triggers, and family history.

→ Blood tests may be done in persistent or atypical cases: thyroid antibodies, infection screening, inflammatory markers.

→ Patients are counseled that most cases resolve spontaneously within 1–5 years, though some persist longer.

→ In Korea, dermatologists often use UAS7 (Urticaria Activity Score over 7 days) to monitor severity and response to treatment.

How it’s Done

→ Patients start with a daily non-sedating antihistamine.

→ If no control within 2–4 weeks, dose escalation is recommended (up to 4x standard).

→ If still uncontrolled after high-dose antihistamines, omalizumab injections are introduced.

→ For resistant patients, cyclosporine is prescribed under close monitoring.

→ Korean clinics often use stepwise algorithms, adjusting therapy every 2–4 weeks depending on control.

Recovery

→ With proper treatment, most patients achieve good symptom control within weeks.

→ Quality of life improves significantly once itching and hives are reduced.

→ Long-term remission is possible; many patients experience spontaneous resolution after months to years.

→ Patients on omalizumab often see dramatic improvement within the first 2–3 injections.

Complications

→ Uncontrolled urticaria: Persistent itching, swelling, poor sleep, anxiety, and depression.

→ Medication risks:

• High-dose antihistamines may cause mild drowsiness in some patients.
• Cyclosporine may cause kidney or blood pressure problems if used long-term.
• Corticosteroid overuse can cause systemic side effects.

→ Angioedema: Rarely, airway swelling may require emergency treatment.

Treatment Options in Korea

→ In Korea, chronic urticaria is managed in dermatology, allergy, and immunology clinics using international stepwise protocols.

→ Non-sedating antihistamines are widely available, with bilastine and fexofenadine frequently used for minimal drowsiness.

→ Omalizumab is accessible in specialized clinics and is commonly prescribed for antihistamine-resistant cases.

→ Korean hospitals emphasize structured follow-up, often using digital health tools and symptom diaries.

→ Adjunctive care includes stress management, dietary counseling, and skincare routines with gentle cleansers and moisturizers to reduce irritation.

→ With Korea’s modern treatment options, patients benefit from personalized plans combining medications, lifestyle advice, and psychological support, ensuring effective long-term control.