الفهرس 
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Abstract
chronic spontaneous urticarial (CSU), formerly also known as chronic idiopathic urticaria and chronic urticaria , is more common than previously thought. It is characterized by pruritic wheals and flare-type skin reactions with or without angioedema that usually persist for less than 24 h for a time period of at least 6 weeks. In some patients, only angioedema is present (Zubebier, et al . 2009). According to the current EAACI/GA2LEN/EDF/WAO guidelines, urticarial can be classified into spontaneous urticaria, physical urticarial and other urticarial types (Zubebier, et al . 2009).
Individuals affected by CSU have reported emotional distress, feelings of isolation and fatigue in response to their condition, similar to findings in patients with ischemic heart disease.this underscores the importance of managing CSU appropriately to minimize both physical and psychological impacts of this disease (O’Donnell, et al . 1997).
The pathogenesis of chronic urticaria has not yet been completely understood. The etiology of CU is heterogeneous. Autoimmune chronic urticaria nearly constitutes 45%. If no etiological factors are found inspite of extensive investigations the diagnosis is chronic idiopathic urticarial (Konstantinou, et al . 2009).
The diagnosis of CU is based primarily on the patient history and clinical examination which usually adequate to establish a diagnosis of chronic urticaria and laboratory investigations are done to detect any underlying disorder when history and physical examination reveal no cause. The history itself can be regarded as the most valuable diagnostic tool in differentiating CSU from other types of urticarial (Zubebier, et al . 2014).