Urticaria and angioedema

Abstract

Urticaria (hives) is a common disorder that often presents with angioedema (swelling that occurs beneath the skin). It is generally classified as acute or chronic. Second-generation, non-sedating, non-impairing histamine type 1 (H1)-receptor antihistamines represent the mainstay of therapy for both acute and chronic urticaria. Angioedema can occur in the absence of urticaria and can be broadly divided into histamine-mediated and non-histamine-mediated angioedema. Histamine-mediated angioedema can be allergic, pseudoallergic or idiopathic. Non-histamine mediated angioedema is largely driven by bradykinin and can be hereditary, acquired or drug-induced, such as with angiotensin-converting enzyme inhibitors. Although bradykinin-mediated angioedema is often self-limited, laryngeal involvement can lead to fatal asphyxiation. The mainstay of management for angioedema is to avoid specific triggers, if possible. For hereditary angioedema, there are specifically licensed treatments that can be used for the management of acute attacks, or for prophylaxis in order to prevent attacks. In this article, the authors will review the causes, diagnosis and management of urticaria (with or without angioedema) and isolated angioedema. The diagnostic and therapeutic approaches to these two conditions are considerably different, and this review is designed to highlight these differences to the reader.

Keywords: Acquired angioedema; Acute urticaria; Angioedema; Chronic spontaneous urticaria; Chronic urticaria; Hereditary angioedema; Inducible urticaria; Urticaria.

Fig. 1

Urticaria (hives)

Fig. 2

Classification of urticaria: overview. *The 48-h cut-off refers to individual lesions, while the 6-week cut-off refers to the condition as a whole

Fig. 3

Simplified stepwise algorithm for the treatment of urticaria Adapted from Zuberbier et al. 2018 [15]

Fig. 4

Hereditary angioedema (HAE)

Fig. 5

Idiopathic angioedema