Clinical Indications

Chronic urticaria is a common skin disorder affecting 0.1 to 1%
of the general population. It is characterized by recurrent,
transitory, pruritic erythematous wheals present for at least 6
weeks. The impact of chronic urticaria on the quality of life can
be significant. Kaplan and others have demonstrated that in
30–50% of these chronic urticaria patients there is an
autoimmune etiology with autoantibodies against IgE, Fc?RI or
Fc?RII (CD23). It is presumed that these
autoantibodies bind to the surface of mast cells and basophils and
initiate a signal transduction cascade that results in secretion of
histamine and other mediators. The treatment course for the
autoimmune form of the disease is often different from treatment
for acute and transient urticaria or idiopathic chronic urticaria.
Drugs that modulate the basic immunological aspects of the disease
(e.g., methotrexate, calcineurin inhibitors) may be considered if
an autoimmune etiology is established.