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CME: Chronic Urticaria (CU): Therapeutic Updates, Best Practices, and Barriers to Care

Activity Description / Statement of Need:

In this online CME self-learning program:


Urticaria refers to a heterogeneous group of diseases characterized by flares, which are raised areas in the dermal tissue surrounding an inflamed focal point, and the pinker, flatter wheals that present during flare resolution. There is an estimated 20% lifetime prevalence of developing some degree of urticaria, and while wheals and flares typically resolve within 24 hours, the consistent emergence of new flares in some individuals can considerably impact quality of life and contribute to: difficultly sleeping, decreased energy, depression, anxiety, and social isolation. Chronic urticaria (CU) is defined as symptoms of urticaria that are present most days of the week for longer than 6 weeks.  While data on the prevalence of CU in the U.S. is not readily available, a European estimate suggests that the prevalence is approximately 0.6%, and the etiology is thought to be idiopathic in a majority of cases.


There are several gaps in the care of patients with CU.  On the diagnostic side, there is some debate about the subclassifications of CU, potentially leading to variable treatment.  CU can often take on a fluctuating and unpredictable pattern of recurrence that may complicate diagnosis.  Several publications recommend further exploration into CU to help guide treatment decisions.




Definition of urticaria, subsets, and differential diagnosis

  • Urticaria: acute vs. CU
  • Contact/idiopathic/allergic
  • Brief discussion about overlaps in classifications

Pathophysiology and characteristics of CU

Concise immunology review

  • Clinical presentation

Complications of CU

  • Physiologic complications
  • Presence of comorbid conditions
  • Patient case(s)

Treatment of CU: current guidelines and up-to-date best practice

  • Relation of treatment to pathophysiology
  • Detailed review of antihistamine therapy
  • When first line fails: what to do
  • Patient case(s)

Barriers to optimal care in patients with CU

  • Evidence of variable practice
  • Referrals from the primary care environment

Target Audience:

Healthcare professionals specializing in: allergy, dermatology, immunology, internal and family medicine, and those who otherwise may treat patients with CU.

This program is supported by an educational grant from Genentech.

Release Date: May 14, 2014 -- Expiration Date: May 14, 2016

Faculty: Luz Fonacier, MD, FACAII, FAAAAI


Learning Objectives

By the end of the session the participant will be able to:

  • 1. Describe the characteristic appearance, etiologies, and pathophysiology of CU, illustrating how it definitively differs from acute urticaria
  • 2. Understand variances in definitions of subsets of CU
  • 3. Recognize presentation of complications due to CU in the setting of patient cases
  • 4. Formulate appropriate action plan for patients resistant to initial antihistamine therapy
  • 5. Describe barriers to care that may contribute to substandard outcomes



Faculty Disclosure and Resolution of COI

 As a provider of continuing medical education, it is the policy of ScientiaCME to ensure balance, independence, objectivity, and scientific rigor in all of its educational activities. In accordance with this policy, faculty and educational planners must disclose any significant relationships with commercial interests whose products or devices may be mentioned in faculty presentations, and any relationships with the commercial supporter of the activity. The intent of this disclosure is to provide the intended audience with information on which they can make their own judgments. Additionally, in the event a conflict of interest (COI) does exist, it is the policy of ScientiaCME to ensure that the COI is resolved in order to ensure the integrity of the CME activity. For this CME activity, any COI has been resolved thru content review ScientiaCME.


Faculty Disclosures:  


Luz Fonacier, MD has received Research and Educational Grants from Baxter, Genentech, and Merck


Disclosures of Educational Planners: Charles Turck, PharmD is an officer and part owner of ScientiaCME, LLC.


Commercial Support Disclosure: This program is supported by an educational grant from Genentech.


  • Read the learning objectives above
  • Take the Pre-Test (optional). Completion of the pre-test will help us evaluate the knowedge gained by participating in this CME activity.
  • View the online activity. You may view this is in more than one session, and may pause or repeat any portion of the presentation if you need to.
  • Take the post-test
  • Complete the activity evaluation and CME registration. A CE certificate will be emailed to you immediately.

Cultural and Linguistic Competence

System Requirements

Windows 7 or above
Internet Explorer 8
*Adobe Acrobat Reader
Mac OS 10.2.8
Safari or Chrome or Firefox
*Adobe Acrobat Reader
Internet Explorer is not supported on the Macintosh

*Required to view Printable PDF Version

Perform Pre-Test (optional)

Please take a few minutes to participate in the optional pre-test. It will help us measure the knowledge gained by participating in this activity.