Chronic urticaria and allergy immunotherapy

This is a little complex to answer. By definition CIU is idiopathic and there would be no indication for skin testing to aeroallergens. As such, there is no indication for AIT in CIU. I have included below to small studies that looked at the question of AIT in CIU. Overall there is no preponderance of evidence to support AIT use in CIU.

Rarely have I seen patients with seasonal allergy that will have urticaria and this can last through their pollen season. These patients present with a very clear seasonal pattern to their urticaria and skin testing is helpful and insightful. Since these patients have a “cause” for their urticaria they would not be CIU patients. I have not used AIT in patients with "seasonal" urticaria only for several reasons: I am not aware of clear data that AIT would be of benefit and more importantly if the patient were to start AIT and is having hives I would have a very difficult time discerning if this is AIT related reaction or seasonal urticaria related. If they have other seasonal allergy symptoms, along with hives, and AIT is indicated then once could consider AIT but the same caution as discussed above.

Vaccine. 2009 Dec 9;27(52):7240-1. Remission of chronic urticaria in the course of house dust mite immunotherapy--mere coincidence or something more to it?
Kasperska-Zajac A, Brzoza Z.

Hum Vaccin. 2011 Apr;7(4):417-8. Epub 2011 Apr 1.
Exacerbation of chronic urticaria in the course of house dust mite immunotherapy.
Kasperska-Zajac A1.

I hope this is helpful

Andrew Murphy, MD FAAAAI