Management Of Urticaria Research Articles

Management of urticaria

Urticaria is predominantly due to release of mast cell mediators, mainly histamine. Chronic idiopathic urticaria, in which disease activity continues on most days for more than 6 weeks and there is no evidence of a physical urticaria or urticarial vasculitis, is common. An external cause is rarely identified even if a thorough history and appropriate investigation based on this are undertaken. However, approximately 50% of patients with chronic idiopathic urticaria (CIU) have a serum histamine releasing factor present. In one-third of patients with CIU this is an IgG autoantibody directed against the high affinity IgE receptor (FceRI) or less frequently against IgE. Patients with autoinimune urticaria, are clinically more severe. Urticaria can affect the quality of life markedly, being comparable to that of patients awaiting triple coronary by-pass surgery. The rational management of urticaria takes account of likely causes and mediators involved. However explanation and attention to general measures such as minimizing stress, overheating and alcohol are important. Aspirin, nonsteroidal anti-inflammatory drugs and opiates should be avoided if possible. Exclusion diets such as of food colourings and additives may be of some value to a limited number of patients. Second- and third-generation low sedation H1 antagonists are the treatment of choice and improve many patients. Addition of an H2 antagonist or a mast cell stabilizing drug may provide additional benefit for a few. There are reports that leukotriene receptor antagonists improve some patients. Oral steroids are reserved if possible for severe exacerbation of chronic urticaria, and disabling pressure urticaria. Third-line therapies involving immunosuppressive agents are only appropriate for patients with chronic urticaria refractory to other measures, and usually autoimmune. The encouraging results using short courses of oral cyclosporin, high dose intravenous immunoglobulin and plasmapheresis need to be confirmed in placebo-controlled trials, in patients with or without demonstrable serum histamine releasing activity.

Exposures and outcomes of children with urticaria seen in a pediatric practice-based research network: a case-control study.

(1) To determine the duration, outcome, and associated findings of urticaria in children seen by general pediatricians; (2) to compare the exposure to foods, medications, insect stings or bites, and the presence of other symptoms in children with urticaria with controls; (3) to determine general pediatricians' management of urticaria. Case-control. Children with urticaria seen by Utah Pediatric Practice Based Research Network members between August 1, 1999, and August 31, 2000. Control patients were matched for age and sex. Duration of urticaria; associated symptoms; personal and family history of atopy; medications; ingestion of peanuts, nuts, shellfish, tomatoes, strawberries, or eggs; being stung by an insect; suspected cause, diagnostic studies; treatment. Fifty-two cases and 47 controls were enrolled. The mean duration of urticaria was 8.9 days (range, 1-50 days). Seventeen patients (33%) and 1 control patient were taking antibiotics (odds ratio [OR], 22.3; 95% confidence interval [CI], 2.8-176; chi(2), P<.001). Fourteen patients and 5 controls had gastrointestinal symptoms (OR, 3.1; 95% CI, 1.02-9.4; chi(2), P =.04). There were no differences between cases and controls for other symptoms, personal or family history of atopy, ingestion of the foods listed, insect sting, or other medications. A cause was suspected in 28 patients (54%): a "viral illness" (19%), antibiotics (15%), or a combination (35%). Patients were more likely than controls to be taking an antibiotic and were more likely to have a personal or family history of atopy or to report ingesting foods commonly associated with urticaria. A viral illness was the most common cause suspected by pediatricians.

Primary care management of common dermatologic disorders in woman: Pharmacologic considerations

This article describes the clinical management of dermatologic disorders most commonly encountered in the primary care setting. The common presenting clinical signs and symptoms are reviewed, and the initial laboratory tests that may establish the diagnosis are recommended. Pharmacologic and nonpharmacologic treatments are reviewed. Diagnosis and management of disorders of the sebaceous and apocrine glands, disorders of the hair and pigmentation, fungal, viral, and bacterial infec- tions, dermatitis, and infestations are discussed. A review of the care of skin burns and wounds is included as well as the diagnosis and management of urticaria.

Book Reviews

Book reviews in this article: Arthritis and Allied Conditions, XII ed. McCarly, E. J. and Koopman, W. J., eds. Clinical Management of Urticaria and Anaphylaxis Edited by Alan L. Schocket.

The New H1 Antihistamines: Treatment of Urticaria and Other Clinical Problems

The new H1 antihistamines are a major therapeutic advancement in the treatment of allergic disorders such as urticaria and allergic rhinitis. Their efficacy combined with greatly reduced sedating and anticholinergic side effects makes the new class of H1 antihistamines the first-line treatment in the management of urticaria and mild angioedema. The choice of a particular low-sedating H1 antihistamine depends on pharmacokinetic considerations, the severity of the problem (systemic steroids and epinephrine are the first-line treatment for severe angioedema), and the requirement for limiting the frequency of administration. The efficacy of the new H1 antihistamines in the treatment of itch due to atopic eczema and systemic disease remains uncertain, and further controlled clinical trials are needed to elucidate their possible role in these conditions.

Treatment of Urticaria

In conclusion, although the treatment of urticaria, especially chronic urticaria, is often unsatisfactory, considerable progress has been made in this area over the past few years. As we learn more about the pathogenic mechanisms and mediators involved in the production of urticarial lesions, we will be better able to develop more effective treatment modalities. Currently, several medications exist to block the effects of already released histamine on the target organ receptor sites on the cutaneous blood vessels, to prevent the release of histamine from the mast cells, and to interfere with the release or production of other potential mediators of urticaria. Various combinations of these different therapeutic approaches will probably prove most helpful in treating different clinical patterns of urticaria.

Clinical Observation of the Patient who recieved Blood Transfusion

It is a well known fact that the test method of determining need for transfusion is the accurate measurement of blood loss related to the patient`s status and surgical maneuvers during operation. There are many complications of blood transfusion and their pathophsiologic mechanism, and theprevention and management has been discussed. Among the complications of blood transfusion, urticaria is the most common symptom, The pathophyaiologic mechanism of urticaria is understood in some degree at the present time but there are many different opinions as to its prevention and management. Furthermorr antihistamine has been widely use6 for the prevention of urticaria but there are many debatable events about the use of antihistamine. This study was undertaken to investigate the recent reports concerning the use of antihista mine for the prevent in and management of urticaria. Two hundred eighty eight transfuser patients among the total of six thousand four hundred forty eight surgical cases done at the Hanyang University Hospital from January 1at to December 31th 1983. were reviewed. The result are as follows : 1) The incidence of urticaria was 28 cases(9.72%) among the 288 transfused cases an(there was no sex difference. 2) The age distribution was 10 cases(12%) in the 2nd decade and 9 cases(11.9%) in the 4th decade. 3) The lowest incidence of urticaria was 5 cases(5.3%) with A blood type and high of incidence with 3, 0 and AB blood types. 4) The Physical status of class 3 was seen in 10 cases(43.5fl) as the most common occurrence of urticaria. 5) The highest incidence of urticaria was observed in 9 (45%) of 20 obstetric cases. 6) There was no significant difference of urticaria incidence between the group3 whic] did an4 did not use antihistamine. Also in the group which recieved histamine 10 minute before transfusion there was a significant decrease 6 cases(3.41%) among the 178 transfuse cases. 7) There was no significant statistical difference between blood loss and transfused blood volumes. 8) There was no significant statistical change in the mean values of hemoglobin and hematocrit which were measured preoperatively, in recovery room and 24 hours after operation. 9) In the patient`s who were transfused with more than 10 pints of whole blood, urticaria develpped in 9 cases(50%) among 18. From the results of this study, 1 consider the most effective method for the prevention of urticaria to he the administration of histamine 10 minutes before transfusion. Further investigation of this method will be carried out.

Allergy and immunology: an annotated bibliography of recent literature. Allergy and Immunology Committee, American College of Physicians.

Allergy and immunology: an annotated bibliography of recent literature. Allergy and Immunology Committee, American College of Physicians.

The vexing urticaria problem: Present concepts of etiology and management

The recognition and symptomatic management of urticaria and angioneurotic edema usually are quite simple. Good long-range results, however, in the treatment of such cases require the physician to exert every effort to determine the etiology of the hives in each individual case. The recent literature (since 1945) has been reviewed in an attempt to find new, helpful information which might be of aid in evaluating the more difficult cases. A procedure for the management of these patients has been described.

The management of urticaria due to penicillin: D. M. Pillsbury, H. P. Steiger, and Thomas E. Gibson. J. A. M. A. 133: 1255, April 26, 1947

The management of urticaria due to penicillin: D. M. Pillsbury, H. P. Steiger, and Thomas E. Gibson. J. A. M. A. 133: 1255, April 26, 1947

Status of allergy teaching as indicated in medical school announcements: Tumpeer, I. H: J. A. M. A. 105: 744, 1935

This report describes the 2014 consensus of the Taiwanese Dermatological Association regarding the definition, classification, diagnosis, and management of urticaria. This consensus is distributed to practices throughout Taiwan to provide recommendations for diagnostic and therapeutic approaches for common subtypes of urticaria, in order to improve the quality of life of urticaria patients. The consensus, thus, serves as an important reference for dermatologists throughout Taiwan.All the consensus contents were voted on by the participating dermatologists, with approval by no less than 75% being required for inclusion. The consensus provides a comprehensive overview of urticaria, including recent advances in identifying its causes and the processes by which it develops.All the consensus meeting attendees agreed to a definition of urticaria, which states that it is characterized by the sudden appearance of wheals (also known as hives), angioedema, or both. Most of the experts (16 out of 19, or 84.2%) agreed that chronic urticaria is defined as the sudden occurrence of wheals and/or angioedema for a period of ≥ 6 weeks. In addition, the consensus attendees also approved the Urticaria Activity Score system or the Urticaria Activity Score for 7 days system as the recommended method for assessing disease activity in spontaneous urticaria.It was also determined that the treatment goal for patients with any form of urticaria should be complete cessation of suffering from all urticaria symptoms. The recommended treatment algorithms for chronic spontaneous urticaria and acute urticaria were finally proposed and approved by 100% (19/19) and 84.2% (16/19) of the consensus attendees, respectively.