Key Points

  • Urticaria is a very common disease with a lifetime prevalence of approximately 20%.
  • Individual lesions of urticaria typically present for less than 24 hours; persistence of a lesion greater than 24 hours is suggestive of a different diagnosis, such as urticarial vasculitis.
  • Urticaria ("hives") may be an acute (less than 6 weeks) or chronic (more than 6 weeks) skin condition.
  • Acute urticaria is commonly an allergic or IgE-mediated reaction.
  • The underlying etiology of chronic urticaria may remain undetermined in many cases, and extensive diagnostic workup for an underlying cause is not recommended unless indicated by specific elements of the history and/or physical. A complete history and physical examination is the most important diagnostic tool.
  • In children, bacterial infections (streptococcal and mycoplasma infections) and viral infections (gastrointestinal and/or upper respiratory infections) are a common etiology or inciting factor.
  • The mainstay of urticaria treatment include: H1- and H2- antihistamines, and other immunomodulators, often in combination. Systemic corticosteroids should be reserved for acute, severe exacerbations and used for only short periods of time (1 week). Systemic corticosteroids are not recommended for the long-term management of chronic urticaria.