Disease directory
Urticaria
Published: September 18, 2026Updated: September 18, 2026
Important: Informational content intended for healthcare professionals. It does not replace clinical evaluation or establish a doctor-patient relationship.
Overview
- Definition and synonyms
- Urticaria = sudden and recurrent appearance of wheals (hives, “wheals”) and/or angioedema, due to the release of mediators (mainly histamine) from mast cells and basophils in the skin and mucous membranes.
- It is classified by duration as:
- Acute : < 6 weeks.
- Chronic : ≥ 6 weeks.
- And by mechanism in:
- Spontaneous urticaria (acute or chronic; without an identifiable external trigger).
- Chronic inducible urticaria (CUI) : triggered by physical/chemical stimuli (cold, heat, pressure, vibration, water, cholinergic, solar, contact, etc.).
- Common synonyms: “hives”, wheals, welts; “chronic spontaneous urticaria” (CSU) = “chronic idiopathic urticaria”. Antia 2018 , Dabija 2023
- History
- The term urticaria derives from Urtica (nettle) and was formalized in nosology by William Cullen in the 18th century; clinical descriptions of similar outbreaks exist as far back as Hippocrates. Maurer 2024
- Epidemiology (very briefly)
- It is one of the most common dermatoses: up to approximately 15–25% of the population will experience at least one episode of urticaria in their lifetime; the point prevalence of chronic urticaria is around 0.5–1% in adults. (Antia 2018 , Zuberbier 2018)
- Analysis of the Global Burden of Disease 2019 : ≈65 million people affected by urticaria in 2019, with a standardized global prevalence of 842/100,000; women have higher rates than men. Liu 2023
- Peak of chronic urticaria in middle-aged adults; acute urticaria is more common in children.
- Chronic urticaria: female:male ratio ≈2:1; strong impact on quality of life (DLQI, sleep, productivity). O’Donnell 1997
- ICD-10 / ICD-11 Codes
- ICD-10 :
- Block L50.* = urticaria (e.g., L50.0 allergic urticaria, L50.1 idiopathic, L50.3 dermatographism, L50.5 cold urticaria, L50.6 contact urticaria, L50.8 other, L50.9 unspecified).
- ICD-11 (block “Urticaria”):
- EA11 Acute urticaria.
- EA12 Chronic urticaria (includes CSU and CSU), with subcodes by subtype (e.g. EA12.0 chronic spontaneous urticaria).
- ICD-10 :
- Diagnostic checklist (quick)
- Essential clinic
- Duration ≥6 weeks of hives ± angioedema.
- Each welt lasts <24 h (or is confirmed with a drawing/photo).
- Intense itching; absence of pain/persistent purpura (if present → consider vasculitis).
- Identification of possible triggers (drugs, NSAIDs, infections, stress, physical stimuli).
- Ask about systemic symptoms (fever, arthralgia, weight loss, abdominal pain, dyspnea).
- Inquiry into personal/family history of angioedema without wheals, autoimmunity, neoplasms.
- Exploration
- Document the distribution and morphology of the lesions (useful photos).
- Dermographism test; consider provocation tests if UIC is suspected.
- Vital signs and general examination for systemic signs.
- Minimal laboratory (typical UCE without red flags)
- Blood count.
- ESR and/or PCR.
- TSH (± anti-TPO if clinical presentation suggests thyroiditis).
- Creatinine, transaminases according to medication/comorbidities.
- Laboratory directed based on suspicion
- C4 and C1 inhibitor in non-wheal or refractory angioedema.
- ANA, complement, other autoantibodies if connective tissue disease is suspected.
- Infectious studies (hepatitis, H. pylori, parasites, etc.) only if there is clinical data.
- Biopsy
- Only if: lesions >24 h, painful, purpuric, blistering, systemic symptoms or poor response to standard treatment.
- Punch 4–6 mm, include full dermis; consider double biopsy for IFD if vasculitis or pemphigoid is suspected.
- Essential clinic
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