Pomphi, itching (often nocturnal) and swelling of certain parts of the body, sometimes disfiguring, with no known cause and disappearing only to recur suddenly and unpredictably. These are the symptoms of the chronic spontaneous urticaria, a particular form of urticaria unrelated to allergic factors that mainly affects individuals between the ages of 20 and 40 years (women twice as frequently), though it can appear at any time of life, and lasts on average for 3-4 years but sometimes even for decades. Although it affects 1 percent of the population, it is underestimated in both frequency and impact, leading to repercussions on school and work performance, social relationships, and psychological well-being.
This problem negatively affects quality of life to a greater extent than patients with even more serious skin problems, such as psoriasis. The presence of autoimmune diseases, especially thyroid disease, such as Hashimoto’s thyroiditis present in 10% of cases, celiac disease, and type 1 diabetes appears to correlate with an increased risk of chronic spontaneous urticaria. For the reasons explained above, it is easy to see why recognition of the disease is often delayed.
Diagnosis and treatment
The diagnostic pathway first proceeds with the search for any pathology associated with urticaria. Second step is to try to avoid factors that can aggravate urticaria, such as stress and especially the use of nonsteroidal anti-inflammatory drugs capable of inducing a flare-up or aggravation of urticaria in 20-30% of patients. The pharmacological approach involves the use of second-generation antihistamines at standard dosage, which can be doubled or quadrupled if symptoms persist after 2-4 weeks of therapy.
As a next step, omalizumab, a biologic drug that can improve symptoms in many cases and probably change the course of the disease, is used. If necessary, the fourth line of treatment relies on immunosuppressants, such as cyclosporine A, and the fifth on montelukast, an antileukotrienic. Unlike other chronic diseases, there is still no national patient registry and an organized network of services, and there are still numerous interregional disparities and limits to the Health Service’s coverage of treatment with antihistamines (in fact, they are reimbursed only at the standard dosage) and omalizumab, which is provided in the treatment plan for only 6 months.
