Acute Urticaria Research Articles

Coronavirus disease 2019–associated urticaria with angioedema in a morbidly obese man successfully treated with glucocorticoids

The onset of severe urticaria has been linked to viral infections in both children and adults.1 Here, we describe a patient who is a morbidly obese man, smoker, with severe refractory urticaria, angioedema, and systemic symptoms requiring oral glucocorticoids, and who was subsequently diagnosed as having coronavirus disease 2019 (COVID-19) and had a successful outcome. The patient was a 36-year-old obese man who presented with a complaint of acute urticaria (Fig 1). He woke up (day 0) with generalized erythema and pruritus with gradual onset of generalized urticaria (palms and soles included).

Recomendaciones Rama de Dermatología Pediátrica, Sociedad Chilena de Pediatría. Pandemia COVID-19

The current Covid-19 pandemic (SARS-CoV-2) corresponds to a highly contagious viral zoonosis that has required to extreme measures in order to decrease the transmission of the virus in hospital settings and outside of them, requiring adoption of strict isolation methods, both contact and aerosols. This has required the adoption of multiple personal protective equipment, including eye protection, masks, face shield, medical caps, gloves, etc. The aforementioned has generated an increase in the damage of the skin barrier, and therefore, the appearance of various dermatoses, among which are irritative o alergic contact dermatitis, acneiform reactions, aggravation of previous dermatoses, and others, thus becoming vital protection and restoration of the skin barrier with measures such as the application of moisturizing or emollient products and the correct use of personal protection equipment. However, not only dermatoses are generated derived from the use of personal protection equipment, but also, within the wide spectrum of dermatological manifestations that Covid-19 disease itself can generate, including cutaneous, hairy involvement (telogen effluvium) or nail (onychomadesis). Cutaneous involvement may correspond to the first clinical expression of the disease or be a predictor of its evolution. Among the above we find acute urticaria, maculo-papular rash, chickenpox-like rash, petechial rash, perniosis-like, and livedo reticularis as the main forms of skin condition to date.

Acute Urticaria in a Young Female with COVID-19

This is the first known case of a young female (18 years old) with widespread urticaria amid active Covid-19 infection at a drive-up testing facility. Covid-19 should currently be on the differential diagnosis for urticaria seen in both the inpatient and outpatient setting.

Intravenous Cetirizine Versus Intravenous Diphenhydramine for the Treatment of Acute Urticaria: A Phase III Randomized Controlled Noninferiority Trial

Acute urticaria is a frequent presentation in emergency departments (EDs), urgent care centers, and other clinical arenas. Treatment options are limited if diphenhydramine is the only intravenous antihistamine offered because of its short duration of action and well-known adverse effects. We evaluate cetirizine injection, the first second-generation injectable antihistamine, for acute urticaria in this multicenter, randomized, noninferiority, phase 3 clinical trial. Adult patients presenting to EDs and urgent care centers with acute urticaria requiring an intravenous antihistamine were randomized to either intravenous cetirizine 10 mg or intravenous diphenhydramine 50 mg. The primary endpoint was the 2-hour pruritus score change from baseline, with time spent in treatment center and rate of return to treatment centers as key secondary endpoints. Frequency of sedation and anticholinergic adverse effects were also recorded. Among 262 enrolled patients, the 2-hour pruritus score change from baseline for intravenous cetirizine was statistically noninferior to that for intravenous diphenhydramine (-1.6 versus -1.5; 95% confidence interval -0.1 to 0.3), and in favor of cetirizine. Treatment differences also favored cetirizine for mean time spent in treatment center (1.7 versus 2.1 hours; P=.005), return to treatment center (5.5% versus 14.1%; P=.02), lower change from baseline sedation score at 2 hours (0.1 versus 0.5; P=.03), and adverse event rate (3.9% versus 13.3%). Intravenous cetirizine is an effective alternative to intravenous diphenhydramine for treating acute urticaria, with benefits of less sedation, fewer adverse events, shorter time spent in treatment center, and lower rates of revisit to treatment center.

Idiopathic nonhistaminergic acquired angioedema in a patient with coronavirus disease 2019

Idiopathic nonhistaminergic acquired angioedema in a patient with coronavirus disease 2019

Urticaria, Angioedema, and Anaphylaxis.

Urticaria and, to a lesser extent, angioedema are common occurrences in the pediatric population. There are multiple causes of acute and chronic urticaria and angioedema. Most causes are benign, although they can be worrisome for patients and their parents. An allergist should evaluate acute urticaria and/or angioedema if there are concerns of an external cause, such as foods or medications. Chronic urticaria and angioedema can severely affect quality of life and should be managed aggressively with antihistamines and immunomodulators if poorly controlled. Chronic symptoms are unlikely to be due to an external cause. Anaphylaxis is a more serious allergic condition characterized by a systemic reaction involving at least 2 organ systems. Anaphylaxis should be initially managed with intramuscular epinephrine. Patients who experience anaphylaxis should be evaluated by an allergist for possible causes; if found, avoidance of the inciting antigen is the best management. All patients should also be given an epinephrine autoinjector and an action plan. Foods are a common cause of anaphylaxis in the pediatric population. New evidence suggests that the introduction of highly allergic foods is safe in infancy and should not be delayed. In addition, the early introduction of foods such as peanuts may help prevent the development of food allergies.

Appointment characteristics in an allergy/immunology practice in the immediate aftermath of COVID-19 restrictions

Appointment characteristics in an allergy/immunology practice in the immediate aftermath of COVID-19 restrictions

Acute urticaria with angioedema in the setting of coronavirus disease 2019

This is the case of a 30-year-old female physician with no relevant past medical history except for pine seeds allergy, following a strict nut-free diet since she was diagnosed. Lipid transfer protein syndrome was ruled out at diagnosis. She did not have a family history of hereditary angioedema, and she was not on any medication. In March 2020, she presented with symptoms of odynophagia and dry cough, with rapid onset of fever. The day after the symptoms appeared, a PCR of upper-airway secretions (by nasopharyngeal swab) was performed, revealing severe acute respiratory syndrome coronavirus 2 infection.

Urticaria: Diagnosis and Treatment with Osteopathic Considerations

Urticaria is a common benign dermatologic condition. It is primarily manifested by well marginated pruritic wheals typically surrounded by erythema caused by the release of histamine into the skin. Urticaria may occur with or without angioedema and typically resolves within 24 hours. Urticaria that persists or recurs past six weeks is known as chronic urticaria. Urticaria may be caused by various medications and illnesses, though in most cases, a trigger cannot be identified. Certain forms of urticaria may be triggered by physical stimuli such as pressure, heat, cold, water, or sunlight. Antihistamines are the mainstay of pharmacotherapy for acute and chronic urticaria. Trigger avoidance should be emphasized when a trigger is identified. Other treatments include oral steroids, doxepin and omalizumab. Topical steroids are ineffective. This article reviews the presentation, diagnosis and treatment of acute and chronic urticaria.

Urticaire de l’enfant

The cumulative incidence of urticaria in children is close to 10%. Two forms are described: the superficial form and the deep form, or angioedema. In young children aged under 3 years, urticaria is commonly annular and ecchymotic, and is mistaken for erythema multiforme or acute hemorrhagic edema. Serum sickness-like reaction is a particular form of urticaria characterized by angioedema of the extremities, fever and arthralgia, and it is chiefly drug-induced (cephalosporins). With children, questioning and clinical examination are essential and, in most cases, reveal an etiology. The main causes of acute or recurrent urticaria are viral infections and/or drugs (non-specific histamine release), whereas chronic urticaria is mostly due to physical causes. In developed countries, parasitic infections are rarely the cause. Arguments in favor of a food allergy are as follows: a setting of atopy, onset within one hour of taking the suspect food, absence of fever or infection, a duration of less than 24hours, possible association with other signs of anaphylaxis, and further recurrence with each new intake of the suspect food. First-line treatment of urticaria without signs of severity consists solely of non-sedating antihistamine (associated with removal of the cause where the latter has been determined). Nearly one-third of cases of urticaria in children progress over a prolonged period of more than 6 weeks, thus constituting chronic urticaria (most often a form of mild recurrent urticaria during episodes of infection and/or medication). Chronic urticaria is very rarely due to an underlying inflammatory disease or a genetic disease such as cryopyrinopathy, and first-line etiological assessment is usually limited to the following tests: CBC, sedimentation speed and/or CRP, and transaminases.

Urticaria and Angioedema Across the Ages

Chronic urticaria (CU) and angioedema can occur at any age. Although most CU with or without angioedema occurs in adults, it can also present in children or the elderly and can complicate pregnancy and breast-feeding. The presentations of CU and angioedema are different in children, middle-aged adults, and older patients as are the differential diagnoses. Therefore, the management of CU and angioedema in these different age groups and special populations needs to take into account the age-specific features of urticaria and angioedema. Here, we describe the evaluation, diagnosis, and treatment of CU and angioedema in children, middle-aged adults, and older patients. This review focuses on CU with or without angioedema and does not discuss acute urticaria or bradykinin-mediated angioedema.

Urticaria and silent parasitism by Ascaridoidea: Component-resolved diagnosis reinforces the significance of this association.

Urticaria remains a major problem in terms of aetiology, investigation, and management, and although parasitic diseases are considered potential causes, the absence of a consistent link between parasitic infections and skin allergy symptoms leads to the need for a deeper study of parameters that support this association. The objectives of this study were to analyse a possible relationship between parasitism by Ascarididae (Toxocara canis and Anisakis simplex) and the clinical expression of urticaria and to identify possible parasitic molecular markers for improving the diagnosis of unknown urticaria aetiology. The prevalence of Toxocara and Anisakis infestations was evaluated by measuring the levels of specific IgG (sIgG) and IgE (sIgE) antibodies against crude extracts and isolated components from whole larvae of Anisakis simplex (Ani s 1, Ani s 3 and Ani s 7) and Toxocara canis (TES-120, TES-70, TES-32 and TES-26) using immunologic and molecular diagnostic methods. A cross-sectional study was performed in a group of 400 individuals. The study group consisted of 95 patients diagnosed with urticaria (55 with chronic urticaria and 40 with acute urticaria). A control group consisted of 305 subjects without urticaria (182 diagnosed with respiratory allergy and 123 without allergy). Statistically significant differences were demonstrated in the seroprevalence of specific IgG and IgE antibodies between the urticaria patients and the healthy general population when isolated ascarid antigens were evaluated. The prevalence of IgG antibodies against Ani s 1, IgE antibodies against TES-120 and IgE antibodies against TES-70 were significantly different between the control individuals (healthy general population) and patients with urticaria. Moreover, the urticaria patient group demonstrated a higher seroprevalence of antibodies (sIgE and sIgG) against Anisakis simplex larva whole extract than the control group but just with statistically diferences when sIgE was evaluated. The presence of IgE and/or IgG antibodies against Ani s 3 (tropomyosin) can help to discriminate between patients with and without urticaria. Both ascarids seem to be associated with urticaria, although in our region, Anisakis seems to have greater involvement than Toxocara in this relationship. Molecular diagnostics can be used to associate urticaria with parasite infestations. Tropomyosin and Ani s 1 were the most relevant markers to demonstrate the association between urticaria and the most relevant Ascarididae parasites in our region.

Steroids Found Not Beneficial in Acute Urticaria (Again)

Steroids are commonly prescribed for acute urticaria, although a recent randomized, controlled trial showed no benefit with their use (NEJM JW Emerg

Chronic urticaria and thyroid pathology

Urticaria is defined as the sudden appearance of erythematous, itchy wheals of variable size, with or without angioedema (AE) (swelling of the deeper layers of the skin). Its classification depends on time course of symptoms and the presence of eliciting factors. When it lasts less than 6 weeks it is classified as acute urticaria (AU), and if the symptoms persist for more than 6 weeks, it is classified as chronic urticaria (CU). Current International Guidelines also classify CU as chronic spontaneous urticaria (CSU) and inducible urticarial, according to the absence or presence of environmental triggering factors. CSU is defined as urticaria and/or angioedema in which there is no evidence of a specific eliciting factor. CSU is associated with autoimmunity in 30–45% of the cases, sharing some immunological mechanisms with other autoimmune diseases, and is associated with autoimmune thyroid disease (ATD) in about 4.3%–57.4% patients. Several studies suggest that adequate therapy with anti-thyroid drugs or levothyroxine in early stages of ATD and CSU, may help to remit the latter; but there is still a lack of double-blind, placebo-controlled studies that support this hypothesis in patients without abnormal thyroid hormone levels. The objective of this review is to describe the pathophysiology of chronic spontaneous urticaria and its association with autoimmune thyroid disease.

A randomized controlled trial of adding intravenous corticosteroids to H1 antihistamines in patients with acute urticaria.

Acute urticaria is a common dermatological condition in emergency departments (EDs). The main therapy involves controlling pruritus with antihistamines. Although guidelines have promoted the use of corticosteroids in addition to H1 antihistamines, well-designed clinical trials evaluating this approach are scarce. Adult ED patients with acute urticaria and a pruritus score > 5 on a visual analog scale (VAS) were randomized into three groups: (i) IV chlorpheniramine (CPM) treatment, (ii) IV CPM and IV dexamethasone (CPM/Dex) and (iii) IV CPM and IV dexamethasone with oral prednisolone as discharge medication for 5 days (CPM/Dex/Pred). The primary outcomes were self-reported pruritus VAS scores at 60 min after treatment. We also evaluated 1-week and 1-month urticaria activity scores for 7 days and adverse events. Seventy-five patients (25 per group) were enrolled. The VAS scores of all groups decreased, but no significant difference was found in the VAS scores at 60 min after treatment between patients in the CPM group (n = 25) and those who received both CPM and dexamethasone (n = 50). At the 1-week and 1-month follow-ups, active urticaria (indicated by the urticaria activity score at 7 days) was more prevalent in the CPM/Dex/Pred group (n = 25) than in the control group. The present study did not find evidence that adding IV dexamethasone improves the treatment of severe pruritus from uncomplicated acute urticaria. Oral corticosteroid therapy may be associated with persistent urticaria activity. Due to the lack of clinical benefits and the potential for side effects, using corticosteroids as an adjunctive treatment is discouraged.

Medical thermography in evaluation of results of skin testing by prick test method in patients with IgE-mediated allergic diseases

Objective — to study the aspects of use of medical thermography to evaluate the results of skin testing with allergen solutions in patients with allergic rhinitis, atopic asthma and acute allergic urticaria.Materials and methods. During our study, 40 patients with bronchial asthma and/or allergic rhinitis and/or acute allergic urticaria were examined using a skin prick-test with solutions of diagnostic allergens, followed by visual and thermographic evaluation. The study was open-ended, comparative. Skin testing was performed by standardized prick-test method with domestic allergens manufactured by ME Immunolog (Vinnytsya, Ukraine). Immediately after the visual assessment, an instrumental evalua­tion was performed using a thermograph with a locked image in the memory of the device for further processing.After the initial admission and testing procedure, the antihistamine preparation of bilastine was administered at an average recommended daily dose of 20 mg one tablet per day. After three days (72 hours), all patients were retested with a prick-test method and its visual and thermographic evaluation was performed to determine the degree of suppression of the skin reaction by an antihistamine drug.Results and discussion. Analyzing the comparison of results of visual and thermographic measurements of papule size, we found a high coefficient of correlation between test scores (r = 0.9), but the difference between papule sizes averaged 1.6 mm. However, when analyzing the results, the coincidence of visual analysis by the allergist and thermographic measu­rement accounted for only 70 % of cases.Conclusions. As a result of the analysis and further statistical processing, it was found that the average diameter of the papules of the positive test during the re-examination after taking bilastine decreased by 55.6 % (95 % CI 0.50—0.59). At the same time, in the vast majority (87.2 %) of patients (95 % CI 0.83—0.91), the positive test disappeared completely.

Acute urticaria in the pediatric emergency department: Management and possible triggers

Acute urticaria in the pediatric emergency department: Management and possible triggers

Гуморальный статус у детей с острыми аллергическим заболеваниями кожи в Киргизской Республике

The article presents the results of a survey of children with acute allergic diseases with regard to hospital admissions, which made it possible to obtain information about the links of pathogenesis when the allergic process starts. Showing information for acute urticaria, angioedema, urticaria, combined with acute angioedema and toxic epidermal necrolysis. An association was established between the severity of the disease and significant changes in immunological protection.

Prevalence and potential risk factors of urticaria in the Polish population of children and adolescents.

IntroductionUrticaria is a frequent, mast cell driven disease of great social significance as it may lead to disablement, impair quality of life and affect performance at work and school.AimA study on the prevalence and potential risk factors for acute and chronic urticaria in the population of children and adolescents living in Krakow, one of the major cities in Poland.Material and methodsIn this paper we present a study on the prevalence and potential risk factors of acute and chronic urticaria in the population of children aged 7–8 years old and adolescents aged 16–17 years old living in Krakow, one of the major cities in Poland. The relation of urticaria prevalence and exposure to polluted air was also investigated. In the period of 3 years between 2016 and 2018 we enrolled 17082 participants (9287 children and 7795 adolescents).ResultsLifetime occurrence of at least one episode of urticaria was reported by 3.3% of respondents (3.6% in the children group and 2.8% in adolescents). The most frequently mentioned causative agent was medicines in children and food in adolescents. Chronic urticaria occurred in 2.1% of children and 1.1% of adolescents. We found no relationship between the volume of traffic and the distance of residence from the high-traffic street to the frequency of urticaria.ConclusionsA higher incidence of urticaria in the younger age group may suggest an upward trend in the incidence of this disease in the near future. The incidence of chronic urticaria in children turned out to be higher than in the European population. As our research results show, the incidence of urticaria in children and adolescents does not depend on exposure to polluted air.

Cutaneous manifestations of coronavirus disease 2019 in 458 confirmed cases: A systematic review.

Background:The coronavirus disease 2019 (COVID-19) pandemic has affected the whole world for a short span of time. As it is a novel virus, its manifestations have been slowly revealed. Cutaneous manifestations of COVID-19 have gradually been reported from different regions of the world. However, their significance in diagnosis, as well as predicting prognosis, remains to be established.Objective:This review describes the cutaneous manifestations of COVID-19 patients from diverse regions with the aim of highlighting any important associations.Methods:A literature search was conducted using “PubMed” for original articles, case series, and case reports using the search terms “cutaneous manifestations” and “skin manifestations” in combination with “COVID-19” published up to 31 May.Results:Nine original research articles and 35 case series or case reports were identified, including 458 confirmed COVID-19 cases. The ratio of male to female patients was 0.94, and the patients’ age ranged from 2 months to 84 years. In 10% of cases, skin lesions appeared before systemic manifestations. The most common cutaneous manifestation was macular/maculo-papular rash (42.5%), followed by acute urticaria (17.9%), vesicular rash (15.3%), pseudo-chilblain or acral purpuric lesions (15.1), and livedo-reticularis (4.4%). The majority of reported cases were located in Spain, Italy, and France. These manifestations do not seem to be sex-, age-, or country-specific.Conclusion:It is necessary to conduct worldwide registries and prospective studies to assess the true incidence of cutaneous manifestations of COVID-19 and to streamline their categorization based on their pathogenesis. There appears to be no specific manifestation at present, but a high index of suspicion can help in the diagnosis of patients presenting with cutaneous lesions as the first manifestation.