Urticaria: selected highlights and recent advances.

Urticaria has been called a vexing problem and remains so today. The most important part of the diagnostic evaluation remains a comprehensive and detailed history and physical examination, supplemented with limited laboratory testing. Although acute urticaria has been relatively well understood for some time, significant and important recent advances in under-standing the pathogenesis of chronic urticaria are beginning to provide insight in this challenging field, notably the identification of many of these patients with an autoimmune etiology. Antihistamines of various types continue to represent the keystone of symptomatic treatment, with adjunctive support from medications of other classes, such as antileukotrienes, adrenergics, and immunosuppressive and anti-inflammatory agents (including steroids and cyclosporine). Although some progress has been made at improving symptomatic control of urticaria, further research and discovery are necessary before there can yet be an effective impact on the underlying course and natural history of this condition.