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Chronic urticaria is a highly prevalent, but widely misunderstood condition and falls within a spectrum of mast cell disorders. Mast cell disorders can range from urticaria with visible, yet benign, dermatographic imprints on the skin to systemic mastocytosis with internal manifestations that have the potential to be tumultuously fatal. Hives are a superficial presentation of mast cell mediator release and can serve as an initial symptom of systemic mast cell activation. No matter what side of the spectrum we find a patient, the impact of their disease on their quality of life cannot be dismissed.

For patients with these conditions, the road to diagnosis can be long; consisting of endless appointments with a range of specialists. Treatment regimens can be disjointed, incomplete, and insufficient. While, in the meantime, itch, redness, burning and other symptoms continue to demand attention. Delays in diagnosis and persistence of these symptoms can significantly impact patients’ quality of life, leading to anxiety and fear.

Hives arrive unannounced: transforming sleep into restlessness, social events into self-consciousness, and the excitement of a new experience into hesitation. An immune storm is made visible as the body is painted with discomfort and uncertainty. Symptoms can overwhelm the patient’s day-to-day activities. Without a thorough diagnosis and treatment plan, patients dread the next flare and remain uncertain of what is happening within their own bodies.

Despite these significant clinical afflictions, urticarial and mast cell disorders remain seldom taught in depth in medical training programs. Many clinicians lack adequate training in their pathogenesis, presentation, prognosis, and management of mast cell disorders. This gap leaves patients underserved and often misunderstood.

My co-authors and I aim to enhance the understanding of these conditions amongst multiple specialties with this reference guide. Improved clinical judgment, knowledge of appropriate diagnostic testing, and an understanding of the distinct patient experience will allow for the earlier recognition, more accurate diagnosis and more compassionate, comprehensive care for patients with these diseases.

We thank you in advance for your time and dedication to your patients. We hope that this booklet can advance knowledge and improve care to those suffering from mast cell disorders.