Physical Urticaria Research Articles

Dermatographia in oral cavity unveiled: A case study

Dermatographia is a form of physical urticaria, quite uncommon in oral cavity characterized by elevated skin following localized erythema, oedema, and a flare-up reaction around it. It is usually induced by any blunt object or minor trauma and usually does not affect the routine life of the patient. Here we present a case report of a 20 year old male with the chief complaint of elevation on skin from a blunt object. On his physical examination with the consent of the patient we induced the condition in the department by asking the patient to write the letter ‘D’ on his flexural arm using the blunt end of the pen. After 5 min, the elevations on his skin began to appear which raised drastically with time. It remained on the skin for about an hour and then fainted on it’s own over time. During intraoral examination we also induced similar strokes on his buccal mucosa and surprisingly a linear elevation was produced along the line of blunt pen which was reddish in colou. No treatment was provided as the condition did not affect the quality life of the patient. Pharmacological therapy may include oral antihistamines, such as cetirizine or loratadine, to alleviate pruritus and reduce the frequency of wheal formation. Topical corticosteroids, such as triamcinolone acetonide or betamethasone, can be applied to affected sites for localized anti-inflammatory effects. In Ayurveda, the use of internal Ayurvedic medicines like, ‘Aragwadha amritadi kashaya’, ‘Ayaskriti’, ‘Varanadi kashaya’ and ‘Dashamoola hareetaki’ are recommended along with dietary restrictions and life style changes.

Cold Urticaria: An Under-recognised Cause of Perioperative Anaphylaxis

Anaphylaxis is a rare but severe, potentially life threatening allergic reaction which commonly presents with cutaneous to multisystem involvement. The overall incidence rate of anaphylaxis during general anaesthesia varies greatly, ranging from 1:20,000 to 1:38. Cold urticaria, subset of chronic urticaria, is characterised with the presence of localised wheals to systemic and anaphylactic reactions. Physical urticaria can be due to physical stimuli such as friction, pressure, sun exposure and cold. Cold urticaria mainly comprises of physical urticaria rather which ranges from 3-33.8% with a higher incidence in cold climate. A case of physical cold urticaria was reported during perioperative period in a 40-year-old male who was posted in urology OT for a planned Ureteroscopy (URS). On pre-anaesthetic evaluation, patient’s medical, surgical and personal history found to be inconclusive. Patient was fit for surgery under ASA grade 1 and advised to be kept nil per orally for six hours for solid food and two hours for clear fluid. At the conclusion of surgery, patient developed shivering and was managed with warm blankets and radiant heater. After some time, patient develop wheals over chest, abdomen and lower back. Patient was managed with warm fluids, warming the patient, maintaining ambient OT temperature and drugs like injection pheniramine, epinephrine and dexamethasone to prevent catastrophic reaction. Through evaluation during preoperative period plays a key role in anticipation of these kind of untoward events. This case report describes the occurrence and management of this rare condition.

A Review on the Dermatographia and its Effects

The urticarial rash known as dermographism, also called dermographism urticaria or urticaria factitia, develops in response to pressure or skin trauma. Inscribing on the skin is the true meaning. A downward force on the skin results in the formation of a linear wave that mimics the pattern of the external force applied. Two to five percent of the population suffer from the very common form of induced or physical urticaria, known as dermatographism. Some people with dermatographism also experience itching symptoms in addition to the reddened hives. This exercise examines the diagnosis and treatment of dermatographism and the role the profession plays in coordinating care and improving patient outcomes.

A Case Report On Aquagenic Urticaria

Aquagenic urticaria (AU) is a rare form of physical urticaria that is triggered by exposure to water. Despite its rarity, it can significantly impact patients' quality of life. The underlying pathophysiology of AU is not well-understood, but diagnosis is typically based on clinical history and confirmed by skin tests. Unfortunately, avoidance of the trigger is often impossible, making symptom control the primary approach to treatment.
 The lack of awareness and understanding of AU can make diagnosis and management challenging. Therefore, this case report highlights the clinical and etiological features of AU and emphasizes the need for improved management strategies.
 The patient in this case is a 15-year-old with a well-controlled asthma background treatment of fluticasone. Since age 7, the patient has experienced urticaria when exposed to both sea and fresh water. A diagnosis of aquagenic urticaria was confirmed through skin tests and patient history. Symptomatic treatment with antihistamines and barrier creams before swimming has been effective, with a limitation on the time spent in the water to manage symptom.

Cold-induced urticaria after black ant bite anaphylaxis.

Acquired cold-induced urticaria is a form of physical urticaria that is usually spontaneous. However, reports have shown that bees, wasps, or jellyfish stings can trigger it. We report the first case of cold-induced urticaria following black ant bite-induced anaphylaxis. A 41-year-old lady with no chronic illness with a known black ant bite allergy history. Three years ago, she sustained a black ant bite that required an emergency room visit to treat anaphylaxis. A few days later, she developed attacks of generalized hives on exposure to cold air and objects. She was started on desloratadine tablets which controlled her symptoms. The patient was given EpiPen and instructed to avoid black ants' approach and exposure to cold. She was then followed up in our clinic. Acquired cold-induced urticaria is a form of physical chronic inducible urticaria. Physical urticarias account for 25 % of chronic urticarias. The patient can have wheals, angioedema, or both in response to the cold exposure. Symptoms can be mild or severe, limiting the patient's quality of life. Acquired cold urticaria is idiopathic; however, cases have been reported after different triggers, such as insect stings (bees, wasps, and jellyfish). The black Samsum ant is a recognized trigger of allergic reactions in Qatar and the Gulf region. In a study done in Qatar, 23.5% of anaphylaxis cases were due to black ant stings. There are no validated or standardized skin tests or immunotherapy for the black Samsum ant, which necessitates physicians to be careful in assessing such patients and focus on taking a detailed history. The limitation of testing and immune therapy makes history the tool for diagnosis, and avoidance is the mainstay of treatment.

Delayed Onset of Symptomatic Dermatographism following COVID-19 mRNA Booster

A spectrum of cutaneous reactions has been described with COVID-19 mRNA vaccination. Since January 2022, three individual case reports have depicted COVID-19 vaccine booster-induced dermatographism one to two weeks following Moderna boosters. Presented here are thirteen cases of this type of physical urticaria following boosters with not only Moderna, but also with Pfizer-BioNTech vaccines.

Efficacy and Safety of Autologous Serum Therapy in Chronic Spontaneous Urticaria in the Pediatric Population: A Prospective Pilot Study.

Chronic spontaneous urticaria (CSU) in children is mostly spontaneous in onset (57%). Treatment comprises long-term antihistaminic therapy without need for elaborate investigations. A subset of such patients don't respond to conventional treatment and novel therapies to help reduce pill burden is the need of the hour. To determine the efficacy and safety of autologous serum therapy (AST) in pediatric patients with chronic spontaneous urticaria. All pediatric patients, aged between 6-16 years, attended to our OPD from March 2019 to March 2020 were recruited. Clinico-demographic data and baseline investigations of all patients were performed. Two-weekly AST therapy was given for 8 visits with levocetrizine tablet 5mg on an on-demand basis. Urticaria activity score (UAS) sheet was provided to record and return every 2 weeks. Statistical analysis was done using the IBM SPSS 26 software package. Autologous serum skin test (ASST) was positive in 63% patients. Both the ASST positive and ASST negative group showed significant reduction in UAS7 score at week 14 compared to baseline. The reduction in mean UAS7 score was associated with a decreased pill burden and positive response in the patient and physician global assessment scale. No statistically significant difference between the two groups in terms of mean UAS7 reduction was found. This study has explored the efficacy and safety of autologous serum therapy in the pediatric CSU patients. Both ASST positive and ASST negative group respond to AST therapy.

Severe persistent urticaria following laser hair reduction.

Laser hair reduction is a common practice that utilized light-based therapy to prevent future hair growth. Complications following laser hair reduction treatment include thermal burns, which may lead to hyper- or hypopigmentation, hair stimulation, scar, or transient erythema of treated areas. Review reports of persistent urticaria following laser hair reduction and discuss a rarely discussed laser complication. Pubmed literature review. There have been very rare reports of persistent urticaria following laser hair reduction. Similar case reports have also been described though no definitive reasoning for this reaction, nor consistent treatment has been documented. In this report, we present a patient who developed persistent urticaria with severe pruritus in the areas treated with laser hair reduction. Previous reports an association was found between allergies and post-treatment urticarial eruption, with 33/36 patients having allergies, mostly to dust mites which is similar to the patient presented. Other etiologies such as reaction to cryogen and physical urticaria are unlikely. Our report highlights a case of persistent urticaria with severe pruritus following laser hair reduction treatment, with both similarities and differences to other cases reported in the literature. While this is a rare side effect of laser hair removal, it should be monitored in patients who have a history of moderate to severe environmental allergies.

OMALIZUMAB: A POTENTIAL LONG-TERM THERAPEUTIC ALTERNATIVE FOR REFRACTORY DELAYED PRESSURE URTICARIA?

<h3>Introduction</h3> Delayed pressure urticaria (DPU) can go unrecognized due to its delayed onset. While most are antihistamine resistant, this case illustrates a complete response to omalizumab as a potential long-term therapeutic alternative. <h3>Case Description</h3> A 44 year-old man who works at a weapons disposal arsenal presents for chronic spontaneous delayed pressure urticaria. Exam reveals lesions on his trunk and extremities with redness and oozing blisters. Triggers include using his hands, wearing a respirator backpack, or leaning against an object for longer than 5 minutes. Skin biopsy reveals nonspecific eosinophilic infiltrate and labs showed mildly elevated CRP. He is treated with cephalexin for presumed cellulitis and high dose antihistamines, famotidine, and montelukast without relief. Given recurrent episodes, the patient is started on monthly omalizumab with complete resolution after the first injection. <h3>Discussion</h3> DPU is a physical urticaria that presents with erythematous, pruritic painful swellings, occasionally with blisters, after prolonged pressure on the skin. The incidence is 2% and occurs in up to 37% of patients with chronic spontaneous urticaria (CSU). Pathophysiology is due to late phase reaction from mast cell activation and upregulation of E selectin leading to an inflammatory response with cytokines and cellular infiltrates. Management is generally unsatisfactory and consists mainly of antihistamine, NSAIDs, colchicine, TNF-a blocker, IVIG, and montelukast. Oral steroids are the most effective treatment, but should not be used long-term. This case illustrates a favorable response to omalizumab, normally used in CSU. Proposed mechanism in a bullous DPU case involves inhibition of cutaneous mast cells, resulting in decreased eosinophil degranulation.

A CASE SERIES: CHRONIC INDUCIBLE URTICARIA FOLLOWING COVID-19 INFECTION AND MRNA VACCINE

<h3>Introduction</h3> Chronic inducible urticaria (CIndU) is a subgroup of chronic urticaria triggered by an environmental stimulus. While skin manifestations following COVID-19 infection and vaccination have been discussed, there is sparse literature documenting CIndU associated with COVID-19. We present two cases of CIndU, one following COVID-19 infection and the other following a COVID-19 mRNA vaccine. <h3>Case Description</h3> The first patient is a forty-seven-year-old male who presented with pruritic urticaria after being diagnosed with COVID-19. Identified triggers included scratching his skin and hot showers. Physical urticaria testing revealed dermatographism with light scratch. The patient was treated with cetirizine 10 mg daily and symptoms improved. Based on his clinical history, the patient was diagnosed with CIndU. The second patient is a fifty-year-old female who presented with urticaria triggered by physical touch for 7 months. Symptoms began 2 weeks after her third dose of a COVID-19 mRNA vaccine and have persisted despite daily cetirizine at 10 mg. A fourth booster resulted in a 1 week increase in symptoms. <h3>Discussion</h3> We present two cases in which patients report new onset CIndU. The first patient reported CIndU at the onset of a COVID-19 infection and the second patient reported CIndU 2 weeks after a COVID-19 mRNA vaccine. A review of the literature revealed only limited reports of new onset CIndU after COVID-19 infection or vaccination. This case series adds to the current literature with continued demonstration of an association between COVID-19 and CIndU. Further investigation could aid in better understanding the pathophysiology and ideal treatment of CIndU.

Burning urticarial plaques in a middle-aged woman

Burning urticarial plaques in a middle-aged woman

Anxiety and depression in patients with chronic urticarial

Urticaria is an allergic and dermatological disease caused by the degranulation of mast cells and clinically manifested by wheals and angioedema [1]. Acute urticaria lasts for six weeks, while chronic urticaria for more time [2]. Chronic Spontaneous Urticaria (CSU) deserves special attention from physicians and researchers as it impacts a person’s quality of life and often lasts for several years [3]. This condition is accompanied by itching and psycho-neurological problems [4], which negatively affect a person's daily activities, mood and appearance. Recent studies have shown that 35-60% of patients with chronic urticaria have sleep disorders, anxiety, depression, and other psychiatric disorders [5-8]. This study aimed to assess the association between CSU and anxiety and CSU and depression while employing a data mining approach to match CSU patients to gender and age control participants. Were used the database of the Allergology and clinical immunology department clinics of TSMU (Tbilisi State Medical University). This assessment considered demographic and clinical factors (thyroid disease, diabetes, physical urticaria, obesity and smoking). Anxiety and depression rates were assessed using the GAD-7 (Generalized Anxiety Disorder) and PHQ-9 (Patient Health Questionnaire) questionnaires [25].

Urticaria in a Pediatric Population: A Portuguese Single-Center Cohort Report.

BackgroundUrticaria typically involves the skin and mucosa and is characterized by the development of wheals, angioedema, or both. According to the temporal evolution of the lesions, urticaria is classified as acute (AU) or chronic (CU), depending on whether the episodes last for fewer or more than six weeks, respectively. This study aimed to characterize a group of children and adolescents with urticaria and describe its subtypes, associated comorbidities, treatment, and evolution.MethodologyThis retrospective, observational study included patients aged <18 years who were diagnosed with urticaria in a tertiary teaching hospital in Portugal, and followed up in a Pediatric Allergy Unit, between January 2019 and December 2021.ResultsA total of 43 patients, aged nine months to 16 years were included. Of these, 22 (51%) were males. AU was identified in 12 (28%) cases, chronic spontaneous urticaria in 21 (63%), and physical urticaria (to cold) in four (9%). Autoantibodies were detected in four patients with spontaneous urticaria. In 6% of patients with CU, the episodes were associated with angioedema. Most CU episodes were successfully managed with the recommended or double the recommended dose (48%) of H1 antihistamines. Three patients requiring fourfold higher than the recommended dose of H1 antihistamines remained unresponsive and were started on omalizumab. Associated autoimmune thyroiditis was diagnosed in four patients.ConclusionsIn this cohort of patients, urticaria was equally distributed between the genders and the first-line therapy was second-generation antihistamines, consistent with current guidelines. Universal screening for autoimmune diseases in patients with chronic spontaneous urticaria revealed four cases of thyroiditis, which supports the relevance of this approach when managing CU.

Tea-induced chronic urticaria: A case report and review of the literature

Sir, Urticaria is an immunologically mediated hypersensitivity reaction developing in both sexes. Although it may occur at any age, young females are more frequently affected [1]. Acute urticaria, shorter than six weeks, is generally self-limited. In contrast, a patient with urticaria lasting more than six weeks is classified as having chronic urticaria. Patients with chronic urticaria may be classified into either chronic inducible urticaria or chronic spontaneous urticaria (CSU). Urticaria may be either a true IgE mediated allergic reaction or a non-IgE mediated pseudo-allergic reaction by releasing prostaglandins and leukotrienes [2]. A routine test usually includes CBC, ESR, and infection screening. Provocation tests for physical urticaria and immunological tests are performed to identify autoimmune urticaria. Skin prick tests and oral provocation tests are employed to differentiate allergic and pseudo-allergic reactions [3]. In contrast to physical urticaria, in which the triggering physical stimuli is usually easy to identify, it is often cumbersome to determine the trigger of chronic spontaneous urticaria. The following case represents an example of such a hidden trigger of CSU.

Inhibition of TRPV2 Channel Activation by NK-4, a Cryptocyanine Dye

Transient receptor potential vanilloid 2 (TRPV2) channels are expressed and play functional roles in various immune cells. Physical stimuli leading to TRPV2 activation causes mast cell degranulation. Besides their roles in immune cells, it has been shown that TRPV2 channels are pathophysiologically relevant to degenerative muscular diseases such as dilated cardiomyopathy and muscular dystrophy. Hence, development of drug candidates that inhibit human TRPV2 activation is an urgent matter. NK-4, a cryptocyanine dye, inhibited agonist-induced TRPV2 activity in mouse TRPV2-transfected HEK293 cells. However, it remains unclear whether NK-4 exerts regulatory effects on the activation of human TRPV2 channels. In this study, we show that NK-4 inhibits intracellular Ca2+ increase in human TRPV2-transfected HEK293 cells preactivated with a TRPV2 agonist. The inhibitory effect of NK-4 (IC50=0.27 μM) on human TRPV2 activation was 74-fold stronger than that on mouse TRPV2 activation (IC50=20 μM). NK-4 also inhibited the agonist-induced TRPV2 expression at the plasma membrane, when the human TRPV2-expressing cells were stimulated with the agonist in the presence of NK-4. These results suggest that NK-4 abrogates the agonist-induced signaling events leading to human TRPV2 activation. Furthermore, TRPV2 agonist caused degranulation of RBL-2H3 cells, which represents a phenomenon related to physical urticarias. NK-4 suppressed the release of β-hexosaminidases upon degradation with IC50 of 1.9 μM, 35-fold lower than that determined with an anti-allergic drug, Epinastine. Our results suggest that NK-4 would be a potential therapeutic strategy to resolve dilated cardiomyopathy and its associated heart failure as well as physical urticarias.

Chronic inducible urticaria: Clinical presentation, diagnosis, and management

Chronic inducible urticaria (CIndU) is a subtype of chronic urticaria characterized by recurrent itchy wheals and/or angioedema for more than 6 weeks. CIndU has a longer disease duration than chronic spontaneous urticaria (CSU) and wheals are shorter lasting than CSU. CIndU incudes physical and non-physical urticaria. Triggers and diagnosis of subtypes of CIndU differ from each other. Patient education for avoiding triggers is an important aspect of the treatment of CIndU. There is no significant difference in the treatment approach for CIndU and CSU. In this article, we have discussed different types of CIndU, their clinical features, diagnosis, and management.

Cold Urticaria and Anaphylaxis Due to Ice Cube Challenge Test

Cold urticaria (CU) is a subtype of physical urticaria characterized by the development of urticaria and angioedema after cold exposure. Symptoms typically ocur minutes after skin exposure to anything cold like air, liquid or an object. Ice cube challange test is commonly used method to confirm the diagnosis of CU. The major complication of CU is anaphylaxis. In all CU cases, even in testing, it is important that anaphylaxis should be kept in mind, and special precautions should be taken. We wanted to report as the first known case of anaphylaxis which is occured in during the ice cube challenge test in the published literature.

M095 TAKING CYCLOSPORINE TO NEW HEIGHTS- DELAYED PRESSURE URTICARIA ASSOCIATED WITH ALTITUDE CHAMBER RESPONSIVE TO CYCLOSPORINE

Delayed pressure urticaria/angioedema (DPU) is a form of physical urticaria characterized by wheals with or without deeper tissue swelling which erupt following localized pressure. We present a military service member with DPU following a rapid decompression in an altitude chamber.

Aquagenic Urticaria Treated with Omalizumab

Aquagenic urticaria is a rare form of physical urticaria in which a 1-2 mm wheal is produced by contact with water. Treatment options include antihistamines, ultraviolet monotherapy, topical barrier creams, and acetylcholine antagonists. Despite these pharmacologic measures, the symptoms are frequently refractory to therapy. Aquagenic urticaria lowers the patient’s quality of life and causes daily discomfort. Recently, a patient with aquagenic urticaria treated with omalizumab was reported. Here, we describe a 22-year-old man with a 3-year history of aquagenic urticaria confirmed by a water immersion test. Because he showed no improvement with antihistamines, the patient began omalizumab treatment and demonstrated an excellent response. This case provides new information for clinicians.

Anaphylaxis Caused by Swimming: A Case Report of Cold-induced Urticaria in the Emergency Department.

IntroductionCold-induced urticaria is a subset of physical urticaria that presents as wheals or angioedema in response to cold exposure. While most cases are idiopathic, secondary associations with infections, medications, and certain cancers have been described.Case ReportWe discuss the case of a 50-year-old male with recent episodes of urticaria from cold air exposure following a flu-like illness six months prior, who presented with symptoms of anaphylaxis upon jumping into a lake.ConclusionWhile the majority of patients develop localized symptoms, understanding this disease entity is imperative as up to one-third of patients can develop severe symptoms including anaphylaxis, particularly from water submersion during activities such as swimming.