Chronic Recurrent Urticaria Research Articles

Chronic recurrent urticaria in a patient with recurrent herpes labialis: complete remission after administration of aciclovir and antihistamines.

Chronic recurrent urticaria, occurring in the context of infections, represents a major challenge for clinicians. Chronic genital herpes infection has been perceived in the literature as a possible trigger of chronic recurrent urticaria. The administration of a systemic corticosteroid regimen in these cases has no long-lasting effect and the subsequent relapses are difficult to control. In these cases, treatment of the urticaria with antihistamine (as monomedication) is often not sufficient and does not suppress the symptomatology. The administration of acyclovir or valacyclovir according to a specific therapeutic regimen as monotherapy or in combination with antihistamine has been shown to be quite effective. The doses of this administration vary and can be tailored to clinical symptomatology. We present a 41-year-old female patient with chronic recurrent urticaria associated with angioedema and bronchospasm, in whom her herpes genitalis was found to be concurrent within the history and clinical examination. According to the history, the herpes was also recurrent and dated back about a year. Chlamydia trachomatis infection was also found, with serological findings corresponding to vaginal discomfort. Treatment with acyclovir 400mg thrice daily for an initial period of 7 days in combination with desloratadine 5mg daily was started as we observed complete remission of the urticarial rash. Due to worsening vaginal discharge, it was decided to temporarily discontinue systemic acyclovir therapy and treatment for the chlamydial infection was initiated with doxycycline 100 mg twice daily for 21 days. Already on day 1 after stopping acyclovir, a severe relapse with generalization of the urticarial rash was observed. Control of symptomatology was achieved by reintroduction of acyclovir according to the regimen in combination with antihistamine. Chronic infections are one of the common causes of chronic recurrent urticaria with a tendency to generalization and possible complications such as angioedema and bronchospasm. An academic, analytical approach to patients and the consistent exclusion of each possible trigger for chronic recurrent urticaria often guarantee the success of subsequent treatment.

Clinical and immunological characteristics of sensitization to tropomyosins

Tropomyosins are a family of allergenic proteins found in large quantities in all invertebrates. Tropomyosins sensitization causes a life-threatening allergic reaction up to anaphylaxis after eating seafood. Identifying the source of primary sensitization is important to predict the allergic reaction severity. This article describes a clinical case of chronic recurrent urticaria in an 8-year-old boy with tropomyosins sensitization.
 An 8-year-old boy was diagnosed with the following: controlled atopic phenotype bronchial asthma, food allergy (oral allergy syndrome), and chronic recurrent spontaneous urticaria. Component diagnostics revealed IgE-aB to tropomyosins in high concentrations from 38.79 to 43.38 kUA/l and cat and dog uteroglobin and lipocalins in high concentrations from 7.79 to 43.38 kUA/l.
 It is necessary to specify the primary sensitizer to analyze the clinical significance of allergens that provoke sensitization to various groups of allergens. In this case, sensitization to tropomyosins is most likely described as caused by either a helminthic invasion or midge bites. Therefore, food allergic reactions to tropomyosins caused from crustaceans were not observed.

The Efficacy and Safety of Primalan (Mequitasine) in the Treatment of Chronic Recurrent Urticaria

The Efficacy and Safety of Primalan (Mequitasine) in the Treatment of Chronic Recurrent Urticaria

Prevalence and Risk Factors of Urticaria With a Focus on Chronic Urticaria in Children

PurposeLimited data is available on the prevalence and risk factors of acute and chronic urticaria in children. Our purpose was to determine the prevalence and identify the risk factors of acute and chronic urticaria in Korean children.MethodsThis population-based study examined 4,076 children (age 4 to 13 years) who were enrolled in the 2015 prospective Seongnam Atopy Project (SAP 2015) in Korea. The parents completed an urticaria questionnaire that included questions regarding the duration, severity, and triggering factors of urticaria. Blood sampling (n=464) was performed to measure vitamin D, total eosinophil count (TEC), and total IgE levels, and skin prick tests (n=503) were done.ResultsThe prevalences of the life-time, acute, and chronic urticaria were 22.5%, 13.9%, and 1.8% (chronic continuous urticaria, 0.7%; and chronic recurrent urticaria, 1.1%), respectively. Acute urticaria was significantly associated with allergic diseases and parental history of allergy (P<0.001), but chronic urticaria was not associated with these clinical factors. There was no significant difference in the 25-hydroxyvitamin D level between subjects with chronic urticaria and controls (P=0.124). Chronic continuous urticaria was associated with living in a new residence (aOR=2.38, 95% CI=1.02-5.54, P=0.044) and belonging to a family with a high income (aOR=4.24, 95% CI=1.24-14.56, P=0.022).ConclusionsA total of 1.8% of children were found to have chronic urticaria. Living in a new residence and belonging to a family with a high income increased the risk of chronic continuous urticaria.

Challenge-proven aspirin hypersensitivity in children with chronic spontaneous urticaria.

Nonsteroidal anti-inflammatory drug (NSAID) exacerbated cutaneous disease is defined as the exacerbation of wheals and/or angioedema in patients with a history of chronic spontaneous urticaria (CSU). The objective of this study was to define 'aspirin-hypersensitive' children and adolescents in a clearly defined group of patients with CSU and to describe their clinical features. Eighty-one children with a history of CSU were enrolled over a 3-year period. The daily or almost daily (>4days a week) presence of urticaria was defined as 'chronic persistent urticaria' (CPU), while the presence of urticaria for 2-4days a week was defined as 'chronic recurrent urticaria' (CRU). Single-blind, placebo-controlled provocation tests (SBPCPTs) with aspirin were performed for children with CSU. Patients with CRU had a longer duration of cutaneous symptoms [1.6 (0.5-4) vs 0.6 (0.3-1.5) years], and stress was less frequently experienced as an eliciting factor in patients with CRU compared with the patients with CPU (P<0.016, P=0.024, respectively). SBPCPTs with aspirin revealed that 14 of 58 patients (24%) with CPU and one of 10 patients with CRU (10%) were aspirin hypersensitive. Aspirin hypersensitivity rate was 26.5% in patients <12years of age. All of the 15 aspirin-hypersensitive patients (aged between 6.6 and 17.4years), except for three, experienced an unequivocal angioedema of the lips as a positive reaction in SBPCPT. Nearly a quarter of children and adolescents with CSU were hypersensitive to aspirin. For children with chronic urticaria, determination of NSAID hypersensitivity in a well-controlled clinical setting will help to avoid severe drug hypersensitivity reactions.

Anakinra treatment in Schnitzler syndrome - results of the first retrospective multicenter study in six patients from the Czech Republic

Schnitzler syndrome is a very rare, acquired, autoinflammatory disease of mostly adult onset with characteristic combination of chronic recurrent urticaria and monoclonal immunoglobulin M or G gammopathy predisposing the patients to malignant lymphoproliferation. In this work, we analyzed the results of bio-logical therapy with anakinra on a national level aiming to supply data for effective pharmaco-economic estimates, lay the grounds of nationwide patient registry, raise awareness among professional public and optimize provided health care. The retrospective study (10/ 2006- 9/ 2013) included six males with definite Schnitzler syndrome verified by the new Strasbourg criteria. All patients were pretreated with antihistamines, nonsteroidal antiinflammatory drugs and glucocorticoids. Four patients underwent two or more treatment lines including intravenous bisphosphonates, 2- chlorodeoxyadenosine (cladribine), interferonα, PUVA photochemotherapy, cyclosporine A, thalidomide, bortezomib, chlorambucil, cyclophosphamide, colchicine and methotrexate. Anakinra monotherapy was initiated in standard dosing (100 mg subcutaneously daily). Complete and partial remissions were achieved in five (83%) and one patients (17%), respectively. Complete remission was characterized by urticaria and pain regression (within hours), normalization of inflammatory markers (with--in days) and bone metabolism improvement assessed by the markers of osteoblastic osteoformation and osteoclastic osteoresorption in one case (within weeks). With normalized inflammatory markers (including interleukin6 and interleukin18), arthralgia and sporadic exacerbations of urticaria and fevers persist in the patient in partial remission with proven Q703K polymorphism in NLRP3 gene. The median treatment followup was 30.5 months (37.2 ± 31.2 (n = 6)). The dosing interval was prolonged in one case of complete remission to 48 hours. No serious adverse reactions occurred during anakinra application. In Schnitzler syndrome, anakinra represents an effective, verified and safe medication with potentionally longterm administration not compromising its original efficacy and subjective tolerance. Anakinra, blocking autonomous inflammatory reaction of the organism via interleukin1 pathway, is a generally accepted first line treatment that should be made available in standard dosing for all Schnitzler patients.

Dermatite atopique et urticaire avec allergie précoce au cheval chez un nourrisson : ne pas oublier d’interroger les parents !

The authors report the case of a 4-months-old infant with chronic eczema and recurrent urticaria initially diagnosed as “allergy to cow's milk resistant to Néocate ®”. The history revealed several important elements, including the presence of horses in the infant's environment. The allergy workup confirmed early onset IgE-dependant allergy to horse dander (prick-test strongly positive and the presence of specific serum IgE), which led us to consideration of the mechanism of sensitization, via air-borne or garment-bearing particles, probably by both means. This observation brings up three themes for discussion: (i) allergy to cow's milk proteins, (ii) allergy to horse dander, (iii) steps to take to avoid horse dander.

Adjunctive treatment of chronic idiopathic urticaria and angioedema with sulfasalazine

Rationale Urticaria is a common condition that affects as many as 25% of people at some time in their lives. Chronic recurrent urticaria and angioedema can be frustrating and often refractory to conventional treatment. The purpose of this study was to evaluate the efficacy of Sulfasalazine in the treatment of unremitting recurrent urticaria and angioedema. Methods We performed a retrospective chart review of 20 patients with chronic idiopathic urticaria/angioedema (CIU) treated with Sulfasalazine as adjunctive therapy at the Winnipeg Health Science Centre from 2005-2009. We recorded demographic data, response to Sulfasalazine, presence of the IgE receptor antibody, and side effects. Results 20 patients were treated with Sulfasalazine as adjunctive therapy and 1 patient was lost to follow up. The patient’s ages ranged between 27-75 years with a mean of 48 years and 10 (50%) were female. IgE receptor antibody status was determined in 12 patients and 6 patients were positive. Out of the 19 patients who are still being followed, 10(52.6%) failed to respond to the Sulfasalazine, and 9 (47.4%) responded to Sulfasalazine with 2 partial responders and 7 complete responders. Side effects noted included: increased liver function tests, leucopenia, dyspepsia, flatulence nausea, pyrosis and a rash. Conclusions

Drug allergy

Drug allergy is one type of adverse reaction to drugs and encompasses a spectrum of hypersensitivity reactions with heterogeneous mechanisms and clinical presentations. A thorough history is essential to the management of drug allergy. Laboratory testing has a very limited role in the management of drug allergy. Graded dose challenges and procedures to induce drug tolerance might be required in patients with drug allergy when there is a definite need for a particular agent. Management of reactions to specific agents, including beta-lactam antibiotics, sulfonamides, local anesthetics, radiocontrast media, angiotensin-converting enzyme inhibitors, nonsteroidal anti-inflammatory drugs, and biologic modifiers, will be discussed in further detail.

Successful Treatment of Chronic Idiopathic Urticaria and Angioedema with 5-Aminosalicylic Acid

RATIONALE: Urticaria is a common condition that affects as many as 25% of people at some time during their lives. Chronic recurrent urticaria and angioedema can be frustrating and often refractory to conventional treatment. The purpose of this study was to evaluate the efficacy of 5-aminosalicylic acid in the treatment of unremitting recurrent urticaria and angioedema.METHODS: We performed a retrospective chart review of nine chronic idiopathic urticaria/angioedema (CIU) patients treated with 5-aminosalicylic acid (5-ASA) as adjunctive therapy at the Winnipeg Health Science Centre from 2006 to 2008. We recorded demographic data, response to 5-ASA, presence of autoimmunity and/or the IgE receptor antibody, steroid use and side effects.RESULTS: The patients' ages ranged between 16-61 years with four patients(44%) being female. Seven patients (77.8%) had either a personal history of hypothyroidism (4/9), hyperthyroidism (1/9) or a first degree relative with hypothyroidism (2/9). 22% of patients were found to have an IgE receptor antibody, one of whom had hypothyroidism and the other hyperthyroidism. Five patients (55.6%) showed complete response, two (22%) had partial response and two (22%) failed to respond to 5-ASA adjunctive therapy. Only two patients required occasional use of prednisone. The only side effect noted was constipation in one patient.CONCLUSIONS: 5-aminosalicylic acid is an effective adjunctive therapy for patients with CIU, resulting in partial or total remission of symptoms in 77.8% of patients. Blinded, placebo controlled trials are required to confirm its efficacy. RATIONALE: Urticaria is a common condition that affects as many as 25% of people at some time during their lives. Chronic recurrent urticaria and angioedema can be frustrating and often refractory to conventional treatment. The purpose of this study was to evaluate the efficacy of 5-aminosalicylic acid in the treatment of unremitting recurrent urticaria and angioedema. METHODS: We performed a retrospective chart review of nine chronic idiopathic urticaria/angioedema (CIU) patients treated with 5-aminosalicylic acid (5-ASA) as adjunctive therapy at the Winnipeg Health Science Centre from 2006 to 2008. We recorded demographic data, response to 5-ASA, presence of autoimmunity and/or the IgE receptor antibody, steroid use and side effects. RESULTS: The patients' ages ranged between 16-61 years with four patients(44%) being female. Seven patients (77.8%) had either a personal history of hypothyroidism (4/9), hyperthyroidism (1/9) or a first degree relative with hypothyroidism (2/9). 22% of patients were found to have an IgE receptor antibody, one of whom had hypothyroidism and the other hyperthyroidism. Five patients (55.6%) showed complete response, two (22%) had partial response and two (22%) failed to respond to 5-ASA adjunctive therapy. Only two patients required occasional use of prednisone. The only side effect noted was constipation in one patient. CONCLUSIONS: 5-aminosalicylic acid is an effective adjunctive therapy for patients with CIU, resulting in partial or total remission of symptoms in 77.8% of patients. Blinded, placebo controlled trials are required to confirm its efficacy.

Chronic urticaria caused by Hymenolepis nana in an adopted girl

AllergyVolume 62, Issue 7 p. 821-822 Chronic urticaria caused by Hymenolepis nana in an adopted girl G. L. Marseglia, Corresponding Author G. L. Marseglia Dipartimento di Scienze Pediatriche - Fondazione IRCCS Policlinico San Matteopiazzale Golgi 227100 Pavia ItalyTel: +390382502583Fax: +390382527976E-mail: gl.marseglia@smatteo.pv.itSearch for more papers by this authorA. Marseglia, A. MarsegliaSearch for more papers by this authorA. Licari, A. LicariSearch for more papers by this authorA. M. Castellazzi, A. M. CastellazziSearch for more papers by this authorG. Ciprandi, G. CiprandiSearch for more papers by this author G. L. Marseglia, Corresponding Author G. L. Marseglia Dipartimento di Scienze Pediatriche - Fondazione IRCCS Policlinico San Matteopiazzale Golgi 227100 Pavia ItalyTel: +390382502583Fax: +390382527976E-mail: gl.marseglia@smatteo.pv.itSearch for more papers by this authorA. Marseglia, A. MarsegliaSearch for more papers by this authorA. Licari, A. LicariSearch for more papers by this authorA. M. Castellazzi, A. M. CastellazziSearch for more papers by this authorG. Ciprandi, G. CiprandiSearch for more papers by this author First published: 15 June 2007 https://doi.org/10.1111/j.1398-9995.2007.01362.xCitations: 6 Hymenolepis nana: an unusual cause of chronic urticaria in an adopted Bolivian girl Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume62, Issue7July 2007Pages 821-822 RelatedInformation

Chronic urticaria – which clinical parameters are pathogenetically relevant? A retrospective investigation of 339 patients

Urticaria is a clinical reaction pattern triggered by many factors causing liberation of vasoactive substances such as histamine, prostaglandins and kinins. It presents as transient itching wheals which are either limited to the local stimulus area or more widespread. Urticaria is classified according to its duration into acute (duration > or = 6 weeks) and chronic (duration 6 weeks) forms. Various clinical investigations may be initiated to diagnose the cause. This study critically evaluates the relevance of frequently performed laboratory investigations and searches for infectious foci, as well as the results of physical provocation testing and oral provocation with food additives. The laboratory and clinical data of 339 patients who had been treated for urticaria at the Christian-Albrechts-University in Kiel over a period of four years were collected in a data entry form and statistically evaluated. Nominal values were analyzed by their relative and absolute quantities, quantitative parameters with the help of statistical data such as minimum, maximum, median and 25th and 75th percentiles. Chronic recurrent urticaria was most common, accounting for 52% of cases. Women were affected 1.8 times more often than men. One-third of the patients also had angioedema. The medians of all laboratory parameters evaluated were within normal values. Only rarely were elevated antinuclear antibody titers, abnormal thyroid function tests or active infections such as hepatitis B or borreliosis detected. The search for infectious foci identified tonsillitis or sinusitis in almost 50% of analyzed patients. Positive reactions to physical testing occurred in 30% of patients and in 11% to oral provocation with various food additives. This study of a large patient group stresses the relevance of individually-tailored evaluations in patients affected with urticaria rather than an expensive initial broad diagnostic testing. More specific searches should be based on individual clues.

Beta 2-integrins in different forms of urticaria.

As urticarial lesions involve tissue invasion by inflammatory cells, and as beta 2-integrins play a central part in adhesion of leucocytes to endothelia, allowing their migration into the tissues, we have explored the distribution and sequential expression of these molecules in tissue sections from different forms of urticaria. Prick test weals (of 10 min duration) to common inhalant allergens showed only a minor increase of CD18, whereas in a case of cold urticaria CD11b and CD18 molecules were increasingly upregulated within the first 30 min after elicitation of the lesions. Skin test sites in delayed pressure urticaria, and urticarial lesions (> 6 h duration) of acute and chronic recurrent urticaria also showed marked upregulation of CD11b and CD18, and to a lesser extent of CD11a, but this did not strongly correlate with the intensity of the mixed cellular infiltrate. Non-lesional skin showed expression of beta 2-integrins in chronic urticaria, delayed pressure urticaria, and less so in acute urticaria, suggesting generalized leucocyte activation. This analysis of integrins thus suggests an early and extensive involvement of these molecules in the pathological events associated with the evolution of urticarial lesions.

Muckle–Wells syndrome: Report of six cases with hyperpigmented sclerodermoid skin lesions

Muckle-Wells syndrome (MWS) is a rare syndrome, characterized by chronic recurrent urticaria, often combined with fever, chills, rigors, malaise, and arthralgia. Progressive sensorineural deafness, and, in approximately one third of the patients, amyloidosis of the kidneys as well as of other organs may occur. It was first described in 1962 by Muckle and Wells. Herein we describe six cases of MWS showing, in addition to the classic features of MWS, unique skin lesions that to the best of our knowledge have not been described before in association with MWS.

Remission of Delayed Pressure Urticaria after Eradication of Blastocystis hominis

Sir, Blastocystis hominis is one of the most common human intestinal protozoans in the world, especially in developing countries. Nevertheless, current knowledge about this parasite is incomplete and, despite recent progresses, several issues are still controversial and much debated, such as the clinical relevance and pathogenicity (1–4). B. hominis has been found in patients with gastrointestinal symptoms as well in asymptomatic individuals. It has long been considered a harmless commensal but growing evidence seems to support its role as a pathogenic parasite. In the absence of conclusive data, it could be hypothesized that the pathogenic potential and virulence of Blastocystis are conditioned by other concomitant factors, such as the host response, and depend on the number of organisms or the type of strains, considering that a remarkable antigenic and genetic heterogeneity among isolates has been demonstrated (4). Extra-intestinal manifestations of B. hominis infection have rarely been reported and include infectious or reactive arthritis (5–7) and skin disorders (8–11), such as palmoplantar or diffuse pruritus and chronic urticaria. A 32-year old woman with a history of allergic rhinitis had since October 1998 suffered from chronic recurrent urticaria which was almost controlled by treatment with H1-receptor antagonists. Whealing subsided after 4 years, when cutaneous manifestations were replaced by painful swellings in pressure sites. For this reason, she was examined in November 2002, where a delayed pressure urticaria (DPU) was diagnosed. Treatment with systemic corticosteroids gave only partial benefit. Subsequently, dapsone was introduced at a dose of 25 mg/day. Symptoms gradually ameliorated over a 3-month period without disappearing. After dapsone discontinuation, her symptoms became severe and disabling within 1 month, despite regular treatment with H1-receptor antagonists. Skin lesions on the feet were sometimes associated with marked pain, which was so intense that it induced the patient to wear larger shoes than usual. Whealing of common urticaria or angioedema never occurred. The only concomitant symptoms reported by the patient were mild ponderal loss and persistent asthenia. Pressure challenge tests confirmed the diagnosis of DPU. Laboratory investigations failed to disclose any systemic diseases, including malabsorption, endocrinological, autoimmune and rheumatological disorders. Full blood count, including eosinophil count, erythrocyte sedimentation rate, C-reactive protein, cryoglobulins, circulating immune complexes, C3, C4, C1-INH, IgE and other immunoglobulins were all within the normal range. Chest radiography, radiographic examination and laser Doppler flowmetry of the limbs revealed unremarkable findings, as well as serological investigations, oropharyngeal swabs and faecal antigen test with Helicobacter pylori. Stool examinations on three consecutive samples were positive for B. hominis. The patient was then treated with metronidazole 1.5 g/ day for 10 days. DPU began to improve 2 weeks after

Mutation of a New Gene Encoding a Putative Pyrin-Like Protein Causes Familial Cold Autoinflammatory Syndrome and Muckle-Wells Syndrome

Purpose of the Study. To identify the genes for familial cold autoinflammatory syndrome (FCAS) and Muckle-Wells syndrome (MWS).Study Population. Three families with FCAS and 1 family with MWS.Methods. Genomic DNA isolation, identification of coding region, DNA sequencing, and mutation detection. Protein prediction programs were also performed.Results. Four distinct mutations of the CIAS1 Gene on chromosome 1q44 were identified. The gene encodes a newly identified protein called cryopyrin.Conclusion. Mutations of the CIAS1 Gene encoding cryopyrin cause at least two distinct but similar cold-sensitive diseases, including FCAS and MWS.Reviewers’ Comments. This exciting discovery has led to the identification of a new protein, aptly named “cryopryin,” that links cold temperature exposure to inflammation. In this report, mutations of the cryopyrin gene were identified in family members with 2 rare autosomal dominant conditions that are “autoinflammatory” disorders (ie, conditions with recurrent inflammatory symptoms in the absence of autoantibodies): FCAS and MWS. Recently, FCAS—also known as familial cold urticaria and familial polymorphous cold eruption—has been well-described by the same authors. The FCAS clinical picture includes: skin rash (100%), arthralgia (96%), fever (93%), conjunctivitis (84%), disease onset in the first 6 months of life (95%), an average time delay between cold exposure and the onset of symptoms of 2.5 hours, and an average episode duration of 12 hours (Hoffman HM, et al. J Allergy Clin Immunol. 2001;108:615–620). In contrast, MWS leads to progressive sensorineural deafness, amyloidosis of the kidneys and other organs, fevers, chills, rigors, malaise, and chronic recurrent urticaria. The reason for the 2 distinct clinical entities associated with mutations in the same gene still need to be explored. For more discussion, see a brief editorial entitled “A fever gene comes in from the cold” by Kastner and O’Shea on pages 241–242 of the same issue.

Intradermal testing in healthy horses and horses with chronic obstructive pulmonary disease, recurrent urticaria, or allergic dermatitis.

To compare responses to a variety of intradermally injected allergens among healthy horses and horses with chronic obstructive pulmonary disease (COPD), recurrent urticaria (RU), and atopic dermatitis-insect hypersensitivity (allergic dermatitis [AD]). Case-control study. 86 horses. Results of intradermal testing for horses with COPD, RU, or AD were compared with results for healthy horses. Compared with healthy horses, horses with COPD, RU, and AD were significantly more likely to have positive (> or = 3+) reactions to intradermal allergens (molds, weeds, trees, grasses-crops, and insects) 30 minutes (immediate reaction), 4 hours (late-phase reactions), and 24 hours (delayed-phase reactions) after exposure. In addition, diseased horses reacted to a significantly higher number of allergens in each allergen group than did healthy horses. Reactions to individual allergens should not be used to determine that horses have hypersensitivity. Overall patterns of reactivity to intradermal allergens may be helpful in management when used in conjunction with a compatible history and evidence of potential exposure to allergens in horses with conditions associated with hypersensitivity to environmental allergens.

Upregulation of TNF-α and IL-3 expression in lesional and uninvolved skin in different types of urticaria

Background: Although mast cells are known to secrete a broad spectrum of proinflammatory and immunomodulatory cytokines, the role of these molecules in mast cell–dependent cutaneous inflammation is not clear. Objective: We decided to study biopsy specimens from lesional and nonlesional skin of patients with acute, chronic recurrent, delayed pressure, and cold urticaria; from fleeting wheals of prick test reactions to allergens; and from normal skin of nonallergic subjects. Methods: Cryostat sections were stained by immunohistochemistry with antibodies against IL-3, IL-8, TNF-α, and mast cell–specific tryptase. In serial sections with tryptase and each cytokine, reactivity of mast cells was studied as well. Results: Compared with normal skin and prick test reactions, immunoreactivity for TNF-α and IL-3 was significantly increased on endothelial and perivascular cells of the upper dermis in all urticaria lesions. In nonlesional skin comparable upregulation was noted on endothelial cells and for TNF-α on perivascular cells of patients with delayed pressure urticaria. In addition, TNF-α was expressed throughout the epidermis in lesional and nonlesional skin of patients with all types of urticaria, but not in normal control subjects. Sequential biopsy specimens from patients with cold urticaria showed upregulation of TNF-α and IL-3 on endothelial cells 30 minutes after elicitation of lesions with an ice cube. In contrast to these findings, epidermal immunoreactivity, as well as endothelial and perivascular cell expression of IL-8, were only slightly altered in urticaria compared with normal skin. In sequentially stained sections, few tryptase-positive mast cells reacted to TNF-α, few reacted to IL-3 in pressure urticaria only, and practically none stained for IL-8. Conclusion: These findings suggest that the cytokines studied here are involved in the pathology of urticaria, possibly by inducing subthreshold inflammation in endothelial cells of uninvolved skin. (J Allergy Clin Immunol 1999;103:307-14.)

Gastrointestinal barrier in patients with chronic recurrent urticaria: Effect of a low-pseudoallergen diet

Gastrointestinal barrier in patients with chronic recurrent urticaria: Effect of a low-pseudoallergen diet

Chronic recurrent urticaria/angioedema

Urticaria is a common condition which affects all age groups. Up to 20% of the population will have at least one episode. The majority of cases in children are acute lasting from hours to a few weeks but a small proportion have recurrent or chronic urticaria which has been arbitrarily defined as urticaria lasting longer than 6-8 weeks. 1 Infections, particularly acute viral infections, are the most commonly recognised cause of acute urticaria in children. In approximately 70% of patients with chronic recurrent urticaria no cause is identified.