TOPLINE

A systematic review found no consistent clinical, laboratory, or treatment-related predictors of progression from acute urticaria (AU) to chronic urticaria (CU).

METHODOLOGY

• To assess clinical, laboratory, or treatment-related factors associated with progression from AU to CU, researchers conducted a systematic review that included 16 observational studies (sample size, 57-49,129 patients) published through December 2025.
• A total of 52,564 patients were included, comprising prospective and retrospective cohorts and one large population-based study.
• Populations included pediatric cohorts (six studies), adult cohorts (seven studies), and mixed cohorts (three studies), with follow-up durations ranging from 6 weeks to 12 years.

TAKEAWAY

• Progression rates from AU to CU ranged from 5.8% to 36%, with lower rates in pediatric cohorts than in adult cohorts and in tertiary care settings.
• Associations between clinical factors (including disease severity, angioedema, allergic sensitization, and atopic status) and chronicity were inconstant across studies.
• Laboratory markers such as total immunoglobulin E, eosinophil counts, systemic inflammatory indices (neutrophil-to-lymphocyte ratio and systemic immune-inflammation index), and autoantibody profiles were not reproducibly associated with progression to CU.
• Treatment, including systemic corticosteroids during the acute phase, was not associated with a reduced risk for progression to CU.

IN PRACTICE

“This systematic review underscores that no clinical or laboratory markers are consistently associated with progression from AU to CU,” the authors of the study wrote. “Current data,” they added, “do not justify more aggressive treatment strategies to prevent CU; instead, treatment should focus on optimal symptom control and quality of life.”

SOURCE

The study was led by Enrique Gómez de la Fuente, MD, PhD, Department of Dermatology, Ramón y Cajal University Hospital, Madrid, Spain, and was published online on June 24 in JAMA Dermatology.

LIMITATIONS

All studies in the review were observational, and most were hospital- or tertiary care-based, limiting generalizability. Follow-up duration varied substantially, heterogeneity precluded meta-analysis, and several studies had moderate- to high-risk for bias.

DISCLOSURES:

The authors did not report any funding information. Gómez de la Fuente disclosed receiving personal fees from Galderma, Almirall, AbbVie, Novartis, Pfizer, and Sanofi. No other disclosures were reported by the authors.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.