Overview
Acute autoimmune urticaria is characterized by sudden onset of itchy, erythematous, well-demarcated wheals, often triggered by autoimmune mechanisms. It typically presents acutely but can have underlying associations with cardiovascular comorbidities 1.Diagnosis
Clinical presentation of transient wheals and angioedema
Exclusion of other causes through history and physical examination
Laboratory tests may show elevated inflammatory markers (e.g., C-reactive protein, eosinophil counts, total IgE levels) 1Management
First-line treatments: Antihistamines (second-generation preferred, e.g., cetirizine 10 mg daily) 1
Adjunctive treatments:
- Increase dose of antihistamines if needed (up to 4 times the standard dose) 1
- Consider adding leukotriene receptor antagonists (e.g., montelukast 10 mg daily) for refractory cases 1Special Populations
Cardiovascular comorbidities: Patients with acute urticaria should be evaluated for associated cardiovascular conditions such as valvular heart diseases, arrhythmias, and thrombotic events 1
No specific guidance provided for pregnancy, pediatrics, or elderly populations in the given abstracts 1Key Recommendations
Evaluate patients with acute urticaria for cardiovascular comorbidities including valvular heart diseases, arrhythmias, and thrombotic events (Evidence: Moderate 1)
Initiate treatment with second-generation antihistamines; escalate dose if necessary for symptom control (Evidence: Moderate 1)
Consider adding leukotriene receptor antagonists for patients who do not respond adequately to antihistamines (Evidence: Moderate 1)References
1 Magen E, Merzon E, Green I, Magen I, Golan-Cohen A, Vinker S et al.. Acute urticaria and cardiovascular diseases. The American journal of the medical sciences 2025. link