William A. Akers

Chronic urticaria: A clinical study of fifty patients

Abstract In a series of fifty consecutive cases of chronic urticaria nearly all patients were found to have more than one etiologic mechanism contributing to perpetuation of their illness. A flexible scheme of progressive evaluation to detect drug allergy, inhalant urticaria, food allergy, infections, cholinergic skin disease, dermographism, physical allergy, collagen vascular disease and psychogenic urticaria is presented. An adequate history and physical examination will rule out other specific types of urticaria such as hereditary angioedema and urticaria pigmentosa. Extensive search for possible underlying malignancy may be necessary, especially if cold-precipitating proteins are present in the blood. The association of cryofibrinogenemia with cold urticaria is further documented. To obtain a satisfactory therapeutic response, contributing factors such as dry skin disease, contactants and thyroid disorders must be treated.