Dr. Walter Liszewski discusses important highlights from his lecture Chronic Urticaria: Unveiling the Next Major Frontier in Dermatology at the 2nd Annual Elevate-Derm Alliance Summer Conference in Park City, Utah, at the Grand Hyatt Deer Valley.

In this video

Dr. Liszewski distinguishes chronic urticaria — hives lasting more than six weeks with daily or almost daily involvement — into two related processes: chronic spontaneous urticaria (CSU), the wheals or hives that appear on their own, versus chronic inducible urticaria (CIndU), which is triggered by things like dermatographism, cold, or heat. Both are intensely itchy, chronic conditions. On workup, he sticks to the guidelines, which are explicit that routine allergy testing is not indicated for CSU absent a very clear trigger. He takes a middle-ground approach, ordering blood work such as CBC, liver and kidney function, and thyroid to make sure nothing is missed — noting patients appreciate that he's "at least working for something," and that a negative workup helps open the door to discussing treatment.

On treatment, Dr. Liszewski maxes patients out on oral antihistamines — four per day of second-generation agents for about six to eight weeks — before moving to a systemic agent like omalizumab or dupilumab for patients who still aren't well controlled. He points to an oral option on the horizon, calling it "really exciting" that clinicians will finally have oral therapies for managing chronic urticaria.

  • Chronic urticaria lasts more than six weeks with daily or near-daily hives; CSU is spontaneous wheals, while chronic inducible urticaria is triggered by dermatographism, cold, or heat.
  • Routine allergy testing isn't indicated for CSU per guidelines unless there's a very clear trigger, which there usually isn't.
  • A targeted blood workup — CBC, liver, kidney, and thyroid — reassures patients and, when negative, opens the door to discussing treatment options.
  • Max out second-generation oral antihistamines at four per day for six to eight weeks before escalating.
  • For inadequately controlled patients, move to systemic agents like omalizumab or dupilumab — with an oral option on the horizon.