Urticaria and hepatitis.

Acute urticaria is commonly observed in the prodromic stage of hepatitis A and B infection as well as in hepatitis C infection, although only rare cases have been published regarding the latter. Urticaria is considered one of the pre-icteric symptoms of viral hepatitis and is related to immune-complex deposits; subsequently, it may be associated with arthritis and headache (Caroli's triad). The absence of specific presentation of acute urticaria in patients with viral hepatitis is not surprising because many other viral infections can induce similar cutaneous symptoms. On the other hand, no convincing evidence exists in which hepatitis virus infection caused chronic urticaria. Data are lacking for hepatitis B, but several series and one controlled study showed the absence of a link between hepatitis C and chronic urticaria. Systematic hepatitis virus investigations in patients with chronic urticaria probably are not cost-effective. Hepatitis B or C can occasionally induce urticarial vasculitis, but this is probably related more to vasculitis than to true urticaria.