Chronic Idiopathic Urticaria

Chronic Idiopathic Urticaria
A Disease State Overview
A poorly understood medical condition with
a significant impact on patients
Urticaria is characterized by the spontaneous occurrence of itchy hives and is considered
chronic when it lasts 6 weeks or longer.1 Urticaria is a disease that frequently leads to
consultations with general practitioners, dermatologists, and allergists.1
Chronic idiopathic urticaria (CIU) is the most common of several subtypes of urticaria.
The exact prevalence of CIU is difficult to determine.2 However, an article published by
Maurer et al. showed a point prevalence of at least 0.5% for CIU.1 Greater awareness
of CIU may be attributable to an increased number of studies and more accurate
identification of CIU patients.
Clinical presentation of CIU
• The mean age of CIU patients is 36 years old2
• Women are twice as likely to experience CIU
as men1
Typical features of hives3
• Typical disease symptoms appear and resolve
suddenly and at unpredictable times1
• CIU usually lasts from 1 to 5 years but can last
longer in more severe cases1
•Central swelling of variable size, surrounded by a reflex erythema
•Associated itching
•Individual hives typically resolve within 1-24 hours but new ones
may form as others resolve
A small population with a large unmet need
Although millions of Americans suffer from urticaria at any given moment, the smaller CIU
population presents unique treatment challenges.
The aim of CIU treatment is symptom control, primarily focusing on the reduction of itching.
The American Academy of Allergy, Asthma & Immunology (AAAAI) published U.S. guidelines
in 2014.
Estimated incidence of CIU in the United States
*
1,2,4-6,
URTICARIA
CHRONIC URTICARIA
Americans experiencing
hives during their lifetimes
Hives lasting 6 weeks
or more
CHRONIC IDIOPATHIC
URTICARIA (CIU)
Point prevalence
estimate
20%
UP TO 1%
AT LEAST 0.5%
ESTIMATED
2014 U.S.
POPULATION
319 MILLION
100%
Factors negatively affecting rates of patient
diagnosis and treatment
*Precise data on the incidence and prevalence of urticaria, chronic urticaria, and CIU
are not widely available.
•
Rate of diagnosis: Not all cases of CIU are properly diagnosed
because the condition is not widely understood
•
Rate of treatment: The lack of treatment options for clinicians and
their patients may increase inconsistency in prescribing behavior
Mediators of CIU
The exact pathogenic mechanism of CIU is unknown.
The symptoms of CIU are believed to result from the release of multiple proinflammatory
mediators from activated mast cells and basophils.7 Histamine and prostaglandins are the
primary drivers of the vasodilation and erythema that cause hives.
In addition, activated mast cells produce a variety of cytokines and chemokines that recruit
neutrophils and further contribute to hive formation.8
Dysregulated FcεRI signaling may also play a significant role in regulating the biological
activity of mast cells and basophils in CIU.
References: 1. Maurer M, Weller K, Bindslev-Jensen C, et al. Unmet clinical needs in chronic spontaneous urticaria. A GA2LEN task force report. Allergy. 2011;66(3):317-330. 2. Zazzali JL, Broder MS, Chang E, et al. Cost, utilization, and patterns of medication
use associated with chronic idiopathic urticaria. Ann Allergy Asthma Immunol. 2012;108(2):98-102. 3. Zuberbier T, Asero R, Bindslev-Jensen C, et al. EAACI/GA2LEN/EDF/WAO guideline: definition, classification and diagnosis of urticaria. Allergy. 2009;64(10):
1417-1426. 4. United States Census Bureau. U.S. and World Population Clock. United States Census Bureau Web Site. http://www.census.gov/popclock/. Accessed December 11, 2014. 5. Nelson HS, Hipkins S, Rutkowski S, et al. Chronic urticaria (hives). Asthma and Allergy
Foundation of America (AAFA) Web site. http://www.aafa.org/display.cfm?id=9&sub=23&cont=328. Published 1995. Updated 2011. Accessed December 11, 2014. 6. Saini S. Chronic urticaria: Clinical manifestations, diagnosis, pathogenesis, and natural history. UpToDate
Web site. http://www.uptodate.com/contents/chronic-urticaria-clinical-manifestations-diagnosis-pathogenesis-and-natural-history. Updated July 28, 2014. Accessed December 11, 2014. 7. Greaves MW. Chronic urticaria. N Engl J Med. 1995;332(26):1767-1772.
8. Hogan DJ, James WD, Heymann WR, Schwartz RA, Strachan DD, Vinson RP. Chronic urticaria. Medscape Web site. http://emedicine.medscape.com/article/1050052-overview. Updated April 7, 2014. Accessed December 11, 2014.
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