The clinical implication of physical urticaria is demonstrated by investigations showing a greater degree of disability in affected patients as compared to other types of urticaria. In most instances, the short time interval between the physical stimulus and reaction points to a causal relationship, but in delayed types the exact diagnosis may be missed without provocation tests. Physical urticaria is usually sporadic but may rarely have a familial form it is often associated with chronic urticaria.
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Localized forms restricted to the skin and mucous membranes are most common, but generalized urticaria with variable extracutaneous manifestations can also occur. The different types of physical urticaria are triggered by mechanical and thermal stimuli, as well as electromagnetic waves.
Antihistamines remain the mainstay of symptomatic treatment for both. Acute urticaria is typically due to a hypersensitivity reaction while chronic urticaria has a more complex pathogenesis. In more persistent cases, patients achieve control of their disease only with the use of more toxic medications, such as corticosteroids, and this can lead to a range of systemic complications. This uncertainty frequently results in patients enduring unnecessary lifestyle changes or extensive testing. Although many patients and physicians think that urticaria is evidence of an IgE-mediated allergic reaction, often the etiology of urticaria is unknown. Urticaria with or without angioedema is frequently encountered in primary care medicine.
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