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To the Editor.—
Chronic urticaria (CU) is a challenge for the dermatologist. In most instances, a cause for it is not elicited, but when an associated condition is found that may account for CU, patients are best managed with an etiologic approach. A lot of factors have been reported as potentially causative, and they may be difficult to bear in mind. We think this could be no longer an obstacle if one considers CU as a METAPHYSICAL matter.M for Medications and chemicals.E for Endocrinopathy (thyroid disease or autoimmune progesterone urticaria).T for Thymic (psychologic, neurologic, or affective disorders).A for Allergenic (foods or inhalants).P for Paraneoplastic (leukemia, lymphoma, or myeloma).H for Hereditary (hereditary angioedema, or Muckle-Wells syndrome).Y for Yeasts and parasites.S for Systemic diseases (lupus erythematosus or rheumatic fever).I for Infections (viral or bacterial).C for Contactants.A for Additives (dyes or preservatives).
Torrelo A, Allegue F, Harto A. Metaphysical Urticaria. Arch Dermatol. 1992;128(7):999. doi:10.1001/archderm.1992.01680170135032