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Autoimmune urticaria

Last edited: 4/15/2026

Overview

Autoimmune urticaria, often characterized by chronic spontaneous urticaria unresponsive to conventional antihistamines, involves immune system dysregulation leading to mast cell activation and histamine release, causing wheals and itching. 1

Diagnosis

  • Presence of chronic urticaria lasting >6 weeks 1
  • Exclusion of physical causes through detailed history and physical examination
  • Elevated total and specific IgE levels may support autoimmune etiology 1
  • Autoantibody testing (e.g., anti-FcεRIα) can aid in diagnosis 1

    • Management

  • First-line treatments: High-dose second-generation antihistamines (e.g., up to 4 times the standard dose) 1
  • Adjunctive treatments:
    • - Omalizumab (anti-IgE monoclonal antibody), typically 300-750 mg every 2-4 weeks 1 - Systemic corticosteroids for acute exacerbations (short-term use due to side effects) 1

    Special Populations

  • Pregnancy: Limited data; cautious use of second-generation antihistamines preferred; avoid systemic steroids unless absolutely necessary 1
  • Elderly: Increased vigilance for drug interactions; consider lower starting doses of adjunctive therapies 1

    • Key Recommendations

  • Initiate high-dose second-generation antihistamines for chronic urticaria unresponsive to standard doses (Evidence: Moderate) 1
  • Consider omalizumab for patients with persistent symptoms despite optimized antihistamine therapy (Evidence: Moderate) 1
  • Use systemic corticosteroids cautiously and temporarily for severe exacerbations in autoimmune urticaria (Evidence: Expert opinion) 1

    • References

    1 Harvey NS, Mikhail WI. Seasonal hypomania in a patient with cold urticaria. The British journal of psychiatry : the journal of mental science 1986. link

    Original source

    1. [1]
      Seasonal hypomania in a patient with cold urticaria. — Harvey NS, Mikhail WI The British journal of psychiatry : the journal of mental science (1986)
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