Urticaria--an allergologic, dermatologic or multidisciplinary disease?

Urticaria is a frequent disease, with complex etiopathogeny, raising important problems in clinical practice. The life-time prevalence for any subtype of urticaria is about 20%. Urticaria and/or angioedema is a heterogeneous group of diseases that result from a large variety of underlining causes, are elicited by a great diversity of factors and present clinically in a high variable way. In the past few decades an increasing understanding of the pathomechanisms involved in urticaria has highlighted the heterogeneity of different subtypes. According to the clinical picture and associated signs and symptoms, urticaria can be a simple, self-limited disease or a very complicated and debilitating one. Urticaria is frequently caused by allergic reactions, but there are also many nonallergic causes. The majority cases of chronic urticaria have unknown (idiopathic) causes, with about 30-40% possibly having an autoimmune substrate. An autoimmune subset of chronic spontaneous urticaria is increasingly being recognized internationally, based on laboratory and clinical evidence that accrued over the last 20 years. Urticarial rash may be part of clinical picture of autoinflammatory diseases, a group of rare disorders of the innate immune system, mediated by Interleukin-1. Since urticaria is an early and prominent symptom of a complex clinical picture, the awareness of these disorders may help the diagnostic in early stages and prevent severe long-term complications. Management of urticaria is based on recommendations of EAACI/GA2LEN/EDF/WAO Guideline published in 2009 and updated during the 4th International Consensus Meeting on Urticaria (Berlin, November 2012).