As with acute urticaria, anyone with difficulty breathing, shortness of breath, swelling of the lips or throat, tightness of the chest, or dizziness, should seek immediate medical attention. As in acute urticaria, avoiding triggers such as food, changing offending medications is imperative in the course of gaining control. Psychological considerations are also important. Stress and psychiatric illnesses are associated with chronic spontaneous urticaria. Treating these problems is very important in gaining control of disease. In addition, chronic spontaneous urticaria can, because of its unpleasantness, lead to heightened stress or anxiety itself. Stress and sleep loss, which eventuates in a worsening cycle of disease. Obviously addressing both conditions therapeutically will also afford better control. Correcting low levels of vitamin D three has been found to reduce the severity and duration of urticaria and wheals. Pharmacological treatment, antihistamines either as monotherapy or combined with another antihistamine is first-line defense. Approaching therapy from least side effects to greater side effects, most commonly drowsiness or sedation, is the way to go. If there is failure of the anti-histamine, treatment with omalizumab, Xolair, is usually attempted. This anti IgE monoclonal antibody is well tolerated and highly effective. The newest therapy is ligelizumab which binds to IgE, a key factor in chronic spontaneous urticaria. Because of its higher binding affinity to IgE than already mentioned with Xolair, ligelizumab has the potential to be more effective than Xolair. This has been proven out by patients having more complete symptom free results.
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