Urticaria natural history, complications and prognosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Anahita Deylamsalehi, M.D.[2]

Remission rate, complications and prognosis of urticaria is tightly related to patient characteristic (such as age and gender), subtype of urticaria and concurrent angioedema. 10% to 60% of cases go into remission within the first 5–10 years of disease diagnosis. Moreover treatments usually alleviate symptoms in most cases. Mean duration of urticaria presence is different among distinct sub-types. Urticaria patients are prone to some complications, such as superimposed bacterial infection, anaphylaxis and excoriation due to intense pruritus. Most patients improve over time, even stubborn cases. Prognosis and treatment response is better in patients younger than 19 years old, compared to older adults. Female gender, prolonged period of disease at the first visit, concurrent angioedema, subtypes such as physical urticaria and cholinergic urticaria and chronic use of non-steroidal anti-inflammatory drug are related to worse prognosis.

• Remission rate of chronic urticaria has been estimated from 10% to 60% within the first 5–10 years of disease diagnosis. Moreover, data showed higher remission rate in patients younger than 20 years old. ^[1]
• Most cases with cholinergic urticaria have mild symptoms and 80% of patient’s don’t seek medical attention.
• The following table contains mean duration of some subtypes of urticaria.^[2]

Common complications of urticaria include:^[2][3]

• Superimposed bacterial infection
• Anaphylaxis
• Excoriation due to intense pruritus
• Pressure urticaria might turn into a debilitating disease in some occupations.

• Most patients improve over time, even stubborn cases.^[4]
• Prognosis and treatment response is better in patients younger than 19 years old, compared to older adults.^[4][5]
• The following are some factors related to worse urticaria prognosis:^{[6][7][8][2][9]}
  • Female gender
  • Prolonged period of disease at the first visit
  • Concurrent presentation of angioedema
  • Physical urticaria, specially delayed pressure urticaria
  • Cholinergic urticaria
  • Non-steroidal anti-inflammatory drug use

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