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Purpose of Review <p>The relationship between acute urticaria and chronic urticaria remains conceptually important yet poorly understood. We, in this review tried to examine if acute urticaria (AU) and chronic urticaria (CU) represent sequential phases of a single disease spectrum or biologically distinct entities that share a common clinical phenotype. In the review we synthesized current evidence on pathophysiology, trigger profiles, biomarkers, natural history, disease progression, and therapeutic responsiveness to understand the relationship between AU and CU.</p> Recent Findings <p>AU and CU converge on a common effector pathway mediated by mast cell and basophil and characterized by histamine release, increased vascular permeability, and wheal formation. This common downstream biology explains the overlapping clinical morphology and the broad efficacy of second-generation H1-antihistamines. However, recent evidence highlights important upstream differences. AU is predominantly trigger (e.g. infections, drugs, foods, vaccines. etc.) driven and usually resolves in days to weeks. In contrast, CU is driven by endogenous autoimmune or autoreactive pathways. Progression from AU to CU occurs in a subset of patients, particularly among patients with autoreactive biomarkers, low basophil counts, thyroid autoimmunity, NSAID or food hypersensitivity.</p> Summary <p>Current evidence supports a hybrid spectrum model. The conventional six-week cutoff to differentiate between AU and CU remains practical for clinical classification but is insufficient to capture pathogenic diversity. Most AU requires minimal investigation and short-term symptomatic treatment, whereas CU warrants structured evaluation for autoimmune, inflammatory, and systemic associations. Biomarkers such as ASST, thyroid antibodies, basophil counts, CRP, and D-dimer may help identify patients at risk of chronicity and guide prognosis and treatment escalation. This framework supports a more nuanced approach to urticaria classification, integrating disease duration with endotype-informed assessment and personalized management.</p>

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Relationship of Acute and Chronic Urticaria: A Spectrum Disease or Two Different Entities? Relationship of Acute and Chronic Urticaria

  • 期刊论文

  • 发表日期：

    2026年6月3日

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  • Abhishek De,
  • Disha Chakraborty,
  • Anant Patil,
  • Kiran Godse

摘要

Purpose of Review

The relationship between acute urticaria and chronic urticaria remains conceptually important yet poorly understood. We, in this review tried to examine if acute urticaria (AU) and chronic urticaria (CU) represent sequential phases of a single disease spectrum or biologically distinct entities that share a common clinical phenotype. In the review we synthesized current evidence on pathophysiology, trigger profiles, biomarkers, natural history, disease progression, and therapeutic responsiveness to understand the relationship between AU and CU.

Recent Findings

AU and CU converge on a common effector pathway mediated by mast cell and basophil and characterized by histamine release, increased vascular permeability, and wheal formation. This common downstream biology explains the overlapping clinical morphology and the broad efficacy of second-generation H1-antihistamines. However, recent evidence highlights important upstream differences. AU is predominantly trigger (e.g. infections, drugs, foods, vaccines. etc.) driven and usually resolves in days to weeks. In contrast, CU is driven by endogenous autoimmune or autoreactive pathways. Progression from AU to CU occurs in a subset of patients, particularly among patients with autoreactive biomarkers, low basophil counts, thyroid autoimmunity, NSAID or food hypersensitivity.

Summary

Current evidence supports a hybrid spectrum model. The conventional six-week cutoff to differentiate between AU and CU remains practical for clinical classification but is insufficient to capture pathogenic diversity. Most AU requires minimal investigation and short-term symptomatic treatment, whereas CU warrants structured evaluation for autoimmune, inflammatory, and systemic associations. Biomarkers such as ASST, thyroid antibodies, basophil counts, CRP, and D-dimer may help identify patients at risk of chronicity and guide prognosis and treatment escalation. This framework supports a more nuanced approach to urticaria classification, integrating disease duration with endotype-informed assessment and personalized management.