Urticaria: Diagnosis and Treatment with Osteopathic Considerations

Urticaria is a common benign dermatologic condition. It is primarily manifested by well marginated pruritic wheals typically surrounded by erythema caused by the release of histamine into the skin. Urticaria may occur with or without angioedema and typically resolves within 24 hours. Urticaria that persists or recurs past six weeks is known as chronic urticaria. Urticaria may be caused by various medications and illnesses, though in most cases, a trigger cannot be identified. Certain forms of urticaria may be triggered by physical stimuli such as pressure, heat, cold, water, or sunlight. Antihistamines are the mainstay of pharmacotherapy for acute and chronic urticaria. Trigger avoidance should be emphasized when a trigger is identified. Other treatments include oral steroids, doxepin and omalizumab. Topical steroids are ineffective. This article reviews the presentation, diagnosis and treatment of acute and chronic urticaria.