Urticaria is a common condition, in which the majority of cases are non-allergenic. A focused clinical history and physical examination are the most useful tools when diagnosing and treating urticaria. Specific triggers are often not found, therefore extensive diagnostic testing is not recommended, unless there is strong evidence to suspect a specific trigger. In some cases, urticaria may be a symptom of an underlying systemic disease and it is important to be aware of this possibility and to refer for further investigation when necessary.

Nonsedating anti-H1 antihistamines remain the mainstay of treatment for chronic urticaria. Eradication the etiologic agent is the best way to treat chronic urticaria.

I agree with Dr Ghaderi as Hi

1 blokers are still the mainstay treatment for CIU but I also agree with him that the treatment of CIU is the treatment of the possible underlying cause and as H.pylori know in some researches proved to be the most common bacteria accused so it is highly recommended to do H.pylori test to not miss possible treatable cause with erradicatve trple therapy (Bashir et al 2011 CRO)

Dr Bashir AHH, MD

Dermatologist

Institute of endemic diseases, U of K

Thanks Dr. Bashir.

Dr Ghaderi greetings nice to hear from you hope we exchange any new add as CIU is sill a miss in Dermatology which need a clue that help a wide strata of long term sufferers.

In my experience in chronic urticaria, I am completely unable to discover any underlying cause, with the exception of some cases of thyroiditis in which the treatment with thyroid hormone can control the disease. The other patients I treat them with a nonsedative antiantihistamine agent at morning and a sedative one, like oxatomide at night. With this I treat 80% of the patients. If this failed I try the more potent antihistamines disponible in the market that are the tryciclic antidepressives.

Dear prof Americo I think we are luky enough to share experience of an eminent Dermatologist like yours, we had done a reseach in H. Pylori and skin disease in 2011 published on Clinical Reviewers and Opinions CRO as Extradigedtive H. Pylori Skin manifestations EdHpSm (Bashir et al) we will be so proud to hear from you.

You can give a look on https://www.researchgate.net/publication/21015034_Mechanism_of_action_of_doxepin_in_the_treatment_of_chronic_urticaria?ev=prf_pub

Thanks

af

Article Mechanism action of doxepin in the treatment of chronic urticaria

so far there seems to be nothing called as the best treatment for CIU. It is important that you take a proper history and examination before conducting extensive tests on any patient.

Yes, the best treatment is that given after you find the possible underlying cause and erradicated otherwise whatever you give is no more than symptomatic one.

Thanks a lot.

Chronic urticaria is frequently a skin manifestation of depression, mediated by the well known immunologic induced dysfunction.

It is usefull to search for other features, mainly bodily as night awekening, tiredness, digestive troubles, multiple pains etc.

The others features are detailed in my book in french : "La dépression et son traitement : aspects méconnus" L'Harmattan Paris 2011.

I join the English version of its abstract, available on my site http://bmaroy.free.fr

http://bmaroy.free.fr

H. pylori represents 80% of bacterial causes of Chronic Idiopathic Urticaria CIA.

Clinical Reviews and Opinions Vol. 3(2), pp. 14-19, February 2011

Available online http://www.academicjournals.org/cro

ISSN 2141-2553 ©2011 Academic Journals

If possible, find and eliminate the antigen. Over 40 years I have found a huge total of only 4 cases that were eliminated by searching for a parasite in the feces and then successfully treating it, with elimination of the chronic hives. The problem is that this requires that the lab actually do stool concentration and careful microscopic search. Immunological screening testing for H. pylori, giardia and cryptosporidium is limited in scope (but simple and profitable for USA labs.)  I would have never found these responsible but non-pathogenic organisms without proper (but non-profitable and unpleasant) microscopy. Two were blastocystis hominis, one was entamoeba nana, another was entamoeba coli. All had mild (

Dr Danby very much impressed with your presentation. hearty congratulations.

Finding the antigen is a useful but difficult and symptomatic method.

Finding and treating the reason why this antigen leads to urticaria through a dysregulated immunity is also interresting.

Moreover, it leads to disappearance of other consequences of the same cause, like psychic, relational, vegetative and somatic.

It's a bit like treating tuberculosis instead of cough!

chronic urticaria  is difficult to treat easy to diagnose disease

omalizumab is by far the best but expensive treatment for this