Types Of Urticaria Research Articles

Soğuk Ürtikeri Olan Hastalarda Buz Testinin Provokasyon Süresini Uzatmanın Tanıya Katkısı

Objective: Cold urticaria is an uncommon type of physical urticaria. We aimed to characterize the features of patients with cold urticaria, and to investigate the effect of increasing stimulation time on the diagnostic value of the ice cube test.Materials and Methods: Twenty-nine patients diagnosed with cold urticaria in the past three years were retrospectively included. Demographic and clinical data were collected. The ice cube test was performed in all patients. During the standard ice cube test procedure the stimulation time was five minutes, and if the result was negative it was gradually increased to ten and twenty minutes. To investigate the effect of increasing the stimulation time to twenty minutes on the diagnostic value, the test was performed in twenty patients with chronic urticaria in whom cold was not a triggering factor.Results: Twenty-nine patients (F/M: 20/9, median (min-max) age:37 (17-57)) with cold urticaria were included. No secondary causes were identified. The rate of atopy was 48.0%. Three patients (10.3%) had localised cold urticaria. The frequency of systemic reactions and anaphylaxis was 48.0% and 10.3%, respectively. Twelve patients (41.4%) also had other types of urticaria, most commonly chronic spontaneous urticaria, and symptomatic dermographism. The sensitivity of the ice cube test was 58.6% when the stimulation time was five minutes and 69.0% when the stimulation time was gradually increased to twenty minutes. None of the controls showed positivity on the ice cube test with a stimulation time of twenty minutes.Conclusion: Increasing the stimulation time during the ice cube test, when necessary, increases the sensitivity of the test and does not cause false positivity in patients with chronic urticaria in whom cold was not a triggering factor. Considering the high risk of systemic reactions and coexistence of other types of urticaria, cold as a triggering factor should be questioned in all patients with urticaria.

061 Clinical features of urticaria in children

Urticaria, defined by the presence of wheals and/or angioedema, is a common skin disorder, but the etiology of urticaria in children remains incompletely understood. The aim of this study is to determine the clinical characteristics of urticaria in children. We retrospectively investigated 73 patients (range 0-14 years, female 40 patients) who suffered from urticaria and visited to our outpatient clinic more than twice from 2010 to 2013. Data were collected regarding age, sex, disease duration, severity and laboratory parameters such as total IgE, antinuclear antibodies and routine laboratory tests. From 73 patients with urticaria, there were 45 patients (61.6%) with spontaneous acute urticaria and 13 patients (17.8%) with spontaneous chronic urticaria. Mean disease duration at first visit of chronic urticaria was 5.0 months. Among the patients with spontaneous acute urticaria, infection was found as the trigger in 17 patients (37.8%). And there were 8 patients (11.0%) with allergic urticaria (food or drug), 5 patients (6.6%) with physical urticaria (solar, cold contact or heat contact), 2 patients (2.6%) with angioedema and 2 patients (2.6%) with mastocytosis. Our data showed that spontaneous acute urticaria was the most frequent type of urticaria, followed by spontaneous chronic urticaria. In addition, infections were the most frequent triggering factor of acute urticaria.

Anaphylaxis in a 4-year-old male caused by contact with grasses: a case report

Background Acute urticaria is the presence of urticaria for <6 weeks, and it is the most common type of urticaria in children. Sometimes, it may be associated with anaphylaxis, a life-threatening condition. Urticaria must be differentiated from anaphylaxis because the latter may require emergency treatment. We describe a child with anaphylaxis exposed to grasses on two occasions.Case presentation We described a 4-year-old male child with anaphylaxis exposed to grasses. Patient also suffered mild neurologic/respiratory symptoms but it is unlikely that he had anaphylaxis. Skin-prick tests were positive to Cynodon dactylis, Phalaris arundinacea and Festuca elatior. Little is known about the importance of pollens as a cause of urticaria in young children.Conclusions The case reported here is particularly interesting because, to the best of our knowledge, anaphylaxis due to pollen exposure in children aged <4 years has not been reported before. We strongly encourage all physicians searching for the cause of acute urticaria (allergists, dermatologists, primary-care physicians) to consider the possibility of pollen allergy, and to screen these patients for pollen sensitization.

Autologous Serum Skin Test in Chronic Idiopathic Urticaria

Background: Urticaria is a short-lived swelling of skin and mucosa due to plasma leakage by immune and non immune mediated activation and released of mediators from mast cell and basophil. Autoimmune urticaria tends to have a high itch and wheal score than other type of urticaria. Its diagnosis is practically relied upon clinical suspicion and autologous serum skin test. Autologous serum skin test (ASST) is the simple and cost effective test to differentiate autoimmune urticaria from the bulk of chronic urticaria patients. Objective: To compare the features of chronic urticaria in patients having positive versus negative autologous serum skin test (ASST).Materials and methods: Cross-sectional hospital based study was conducted among 90 chronic urticaria patients (CIU) attending the outpatient dermatology department of Nepalgunj Medical College, Nepalgunj, during one year period. The study was conducted after ethical approval from the institutional committee. The patients were diagnosed on the basis of the appearance of continuous or recurrent hives with or without angioedema for more than 6 weeks. Patients who suffered from either acute urticaria or urticarial vasculitis or physical urticaria or other systemic diseases known to cause urticaria were excluded. Standard tools and techniques were used to prepare antilogous serum and injection of the serum and interpretation of the result. The test result was Interpreted as positive and negative autologous serum skin test.Results: ASST was positive in 42% of the patients and negative in 58% of the patients. The ASST-positive patients had a higher mean urticaria activity score and median duration of wheals in comparison with the ASST-negative patients. Wheals lasted for significantly longer duration in patients with positive ASST. Patients with positive ASST had more frequent attacks which was statistically significant compared to the ASST-negative group. The mean urticaria activity score was significantly higher in the ASST-positive patients than that in the ASST-negative patients.Conclusions: Autologous serum skin test may be a useful screening test for autoimmune urticaria and may be used as a simple and cost-effective test for the classification of chronic urticaria.JNGMC Vol. 12 No. 2 December 2014, page: 6-10

Plasma soluble CD40 concentration in patients with delayed pressure urticaria

Very little is known about the immune-inflammatory cascade in delayed pressure urticaria (DPU). It has been suggested that increased activation/expression of CD40 may result in enhanced release of soluble CD40 (sCD40) in chronic urticaria. To investigate release of sCD40 in the course of DPU, plasma sCD40 concentration was measured using ELISA method in 18 adult patients with DPU and 27 age- and sex-matched healthy controls. Plasma sCD40 concentration did not differ significantly in the DPU group as compared to healthy subjects. The present study as well as the earlier contributions, suggest that distinct CD40-signalling activity manifested by sCD40 release may be identified in different types of urticaria. Delayed pressure urticaria is not associated with increased circulating sCD40 concentration, contrary to chronic spontaneous urticaria with positive response to autologous serum skin test.

A profile of the various forms of urticaria and how to treat them

There are various types of urticaria and, while generally easy to diagnose, it can be confusing. It is also important to recognise when to refer to secondary care.

Chronic urticaria in Chinese population: a hospital-based multicenter epidemiological study

The epidemiologic profiles of chronic urticaria (CU) vary considerably among regions, and few such data are available from China. We performed a multicenter open questionnaire investigation about the clinical and laboratory features of CU, defined as recurrent wheals with/without angioedema lasting for ≥6 weeks, among 3027 patients. Female preponderance was observed (female/male ratio, 1.46 : 1). The mean age at diagnosis was 34.7 ± 13.8 years, and the mean disease duration was 18.5 ± 46.1 months (range, 1.5-127 months). Patients were classified as having chronic spontaneous urticaria (CSU, 61.0% of patients), physical urticaria (PU, 26.2%), or other urticaria types (OU, 2.3%). Nocturnal attacks were reported by 60% of cases. The Urticaria Activity Score (UAS) in patients with CSU was 3.8 ± 1.4. The mean Dermatology Life Quality Index was 7.3 ± 3.4 (range 0-30). Induction or exacerbation of wheals with alcohol drinking was reported by 55.7% of patients. Chronic hepatitis B was less prevalent in our CU patients compared with the general Chinese population (2.7% vs 7%). Positive autologous serum skin tests (ASSTs) were observed in 66.9% of patients. Patients with positive ASST had higher UAS, greater angioedema frequencies, longer disease durations, and poorer QoL compared with patients with negative ASST (P < 0.05). In this Chinese population, CU usually affected youth, and CSU was the most common subtype. Autoreactivity and alcohol consumption were the top two triggers for CU, whereas latent infectious and chronic inflammatory diseases were not as common as in previous reports.

Urticaria … and treatment fails

According to the guidelines the treatment goal for all types of urticaria is to achieve complete symptom relief. Therefore the available literature for urticaria treatment was reviewed regarding this aim and treatment failure, respectively. Systematic studies are not available. Standard doses of H1-antihistamines are the only approved therapy. Review of the limited data where statements are made about complete alleviation of symptoms shows that standard doses of H1-antihistamines rarely achieve this. Even when the dosage is increased up to four-fold, the failure rate is high. Additional therapy with montelukast, dapsone, and cyclosporine A also often fails to produce complete control. For severe chronic spontaneous urticaria, controlled studies using omalizumab have shown low failure rates over long time periods. It has not been investigated whether up-dosing or reduced injection intervals could further improve this rate. Taken together, the small amount of available data on complete symptom relief in urticaria treatment is astonishing. Moreover, the studies can not be compared due to different inclusion criteria (severity of urticaria, allowed basic treatment) and evaluated parameters. Further controlled studies are vitally needed to achieve the goal of complete symptom relief in urticaria.

Alergia de la piel y de las mucosas. Urticaria, angioedema, anafilaxia

Urticaria is a disease defined by the eruption of hives on the skin. It can be divided into acute or chronic urticaria, depending on its clinical course. It can also be categorized ethiologically into allergic, spontaneous, physical or other types of urticaria. First line treatment are non sedative antihistamines. Angioedema is characterized by episodes of localized skin tumefaction, that usually affects deep dermis. It is important to differentiate histamine-mediated, such as allergic angioedema, from bradykinin-mediated angioedema (most importantly hereditary, acquired and angioedema due to ACE inhibitors), since the later does not respond to epinephrine, antihistamines or steroids. Anaphylaxis is a severe allergic reaction that is rapid in the onset, and that can develop a fatal outcome seamlessly. Intramuscular epinephrine is the first option treatment for anaphylaxis.

Is Delayed Pressure Urticaria Associated with Increased Systemic Release of sCD40L?

Background. Elevated levels of soluble CD40 Ligand (sCD40L) were found in serum but not in plasma of patients with chronic spontaneous urticaria (CU). What is important is that sCD40L has proinflammatory properties, and its elevated plasma level may indicate increased risk of cardiovascular events. These observations should stimulate further evaluation of sCD40L in different forms of urticaria. Aim. In the present study, sCD40L plasma level was investigated in delayed pressure urticaria (DPU). Methods. As platelets are predominant and variable sources of sCD40L, we investigated sCD40L concentration in platelet-poor plasma (PPP), which seems the best way to minimize the potential contribution of these cells to the ligand level. Results. Plasma sCD40L concentration was significantly increased in the DPU group compared to the healthy controls. Conclusions. It seems that DPU is associated with increased systemic release of sCD40L, which is believed to derive predominantly from activated platelets. The present study as well as the earlier contributions suggest that distinct cells activity, including platelets, may be identified in different types of urticaria.

Management of Childhood Urticaria: Current Knowledge and Practical Recommendations

Urticaria, defined by the presence of wheals and/or angio-edema, is a common condition in children, prompting parents to consult physicians. For its successful management, paediatric-specific features must be taken into account, regarding the identification of eliciting triggers and pharmacological therapy. This review systematically discusses the current best-available evidence on spontaneous acute and chronic urticaria as well as physical and other urticaria types in children. Potential underlying causes, namely infections, food and drug hypersensitivity, autoreactivity and autoimmune or other conditions, and eliciting stimuli are considered, with practical recommendations for specific diagnostic approaches. Second-generation antihistamines are the mainstay of pharmacological treatment aimed at relief of symptoms, which require dose adjustment for pae-diatric use. Other therapeutic interventions are also discussed. In addition, unmet needs are highlighted, aiming to promote research into the paediatric population, ultimately aiming at the effective management of childhood urticaria.

A Long Term Case Series Study of the Effect of Omalizumab on Chronic Spontaneous Urticaria

.2 . According to the classification guideline spontaneous urticaria can be divided into chronic and acute urticaria depending on whether the symptoms have lasted for more or less than 6 weeks. The chronic types of urticaria are divided into physical urticaria (cold, delayed pressure, vibratory urticaria, and urticaria factitia), other urticaria types (aquagenic, cholinergic, contact urticaria and exercise induced urticaria/anaphylaxis), and finally, spontaneous urticaria. Chronic spontaneous urticarias may be idiopathic (55%) or autoimmune (45%) as defined by the presence of the immunoglobulin (Ig)G anti-IgE receptor, α subunit antibodies, or IgG anti IgE antibodies. The EAACI/GA2LEN/WAO treatment guideline recommends the use of non-sedating antihistamines up to a fourfold dosage as the first line of treatment, followed by leukotriene antagonist, and lastly systemic immunosuppressants or Omalizumab 3

Pressure-induced angioedema associated with endotracheal tube: successful treatment with epinephrine in two cases

Pressure-induced urticaria is a non-immunoglobulin E-mediated type of urticaria. Some patients only have angioedema, and the term pressure-induced angioedema (PIA) is more appropriate for them. PIA has not previously been reported in association with endotracheal tube. Here we describe two patients who developed PIA after endotracheal intubation. There were no histories of angioedema, drug and food allergy in both patients. Tests for specific aero-allergens and latex were negative. Serum total immunoglobulin E and C4 levels were in normal ranges. Antihistamines and intravenous steroid therapy were ineffective. Angioedema regressed with intravenous epinephrine infusion and did not relapse after extubation. We suggest that endotracheal tubes can cause PIA. Epinephrine therapy should be used early at treatment, especially in the patients who are at great risk for life-threatening airway problems.

Acute phase inflammatory markers in patients with non‐steroidal anti‐inflammatory drugs (NSAIDs)‐induced acute urticaria/angioedema and after aspirin challenge

Active chronic urticaria, identified as a mast cell- and basophil-dependent inflammatory disorder of the skin is able to elicit acute phase response (APR). However, systemic inflammatory response in different types of urticaria is poorly characterized. To determine APR pattern in a clearly defined group of patients with acute urticaria and/or angioedema - induced by NSAIDs. Plasma IL-6 and serum C-reactive protein (CRP) concentrations were studied in 17 patients with NSAIDs-induced acute urticaria/angioedema (NSAIDsAU) and in 20 healthy controls. Eleven patients who used NSAIDs were presented at the emergency room with acute urticaria/angioedema while the remaining six manifested the symptoms during the aspirin challenge test. Patients were examined in a dynamic manner: during the acute phase, and next, after subsidence of the symptoms. CRP and IL-6 concentrations increased significantly in patients with NSAIDsAU as compared with their asymptomatic period and the healthy subjects. In addition, NSAIDsAU patients showed elevated concentration of the biomarkers following aspirin provocation with the baseline values recovered in the asymptomatic period. These results indicate that an acute systemic inflammatory response is activated in patients with NSAIDs-induced urticaria and/or angioedema. The study supports the evidence proving that up-regulation of CRP and IL-6 in urticaria/angioedema does not necessarily reflect any concomitant infection or other inflammatory processes, but may be due to the disease itself.

A Case of Combined Cholinergic and Cold Urticaria

To the Editor, Cold urticaria is a disorder in which patients experience pruritus and urticaria within a few minutes after exposure to cold [1]. Cholinergic urticaria, which is also known as generalized heat urticaria, develops after an increase in body temperature [1]. A 34-year-old man presented with urticaria. The urticaria began following exercise and presented with pruritus followed by diffuse punctate wheals surrounded by erythema, as seen in cholinergic urticaria (Fig. 1). The patient also had pruritus and erythema after exposure to cold winds (Fig. 2). In addition, the patient's urticaria following exercise was provoked by a cold wind. His history suggested two different types of physical urticaria: 1) generalized erythema characterized by small, well-circumscribed wheals precipitated by exercise and 2) a localized type of urticaria occurring on exposure to cold, such as when he was exposed to a cold wind. He had no history of asthma, hepatitis, allergic rhinitis, or other allergic diseases. The initial physical examination revealed no abnormalities. The total immunoglobulin E (IgE) was 336 kU/L. He was positive to Dermatophagoides farinae and Dermatophagoides pteronyssinus with the pharmacia specific IgE detection system system. The venereal disease research laboratory, cryoglobulin, hepatitis B surface antigen, cold agglutinin titer, and rheumatoid factor were negative. On exercising by running in place for 10 minutes, he developed generalized pruritus and discrete urticaria 1- to 5-mm-diameter over his neck, trunk, and extremities, with no hypotension or wheezing (Fig. 1). Since the history of urticaria associated with a cold wind suggested cold urticaria, an ice challenge was performed on his forearm and hands. Within 5 minutes of removing the ice, he developed pruritus and urticaria at the challenge site. He also had pruritus, a burning sensation, and edema on the hands after removing the ice (Fig. 2). Figure 1 (A, B) The patients had punctate 1- to 5-mm wheals on the neck and arms after 10 minutes of exercise. Figure 2 The patient had a positive ice cube test. (A) The ice cube was placed on the forearm for 5 minutes and the arm observed 5 and 10 minutes later. Five minutes after removing the ice cube, the patient developed a 67 × 55 mm wheal and 68 × ... Physical urticaria constitutes 20% to 30% of all cases of chronic urticaria [2]. A few patients have multiple types of physical urticaria simultaneously [2-4]. Cholinergic urticaria constitutes 5% of all cases of chronic urticaria [4] as generalized heat urticaria seen as hives precipitated by an increase in core body temperature. Common triggers include exercise, emotional stress, and bathing in hot water. Cholinergic urticaria is characterized by numerous punctate wheals (1 to 3 mm) surrounded by large flares [4]. The mechanism underlying cholinergic urticaria is generally believed to involve an abnormal cutaneous response in the presence of cholinergic agents. Elevated histamine levels have been detected in the serum during an attack [5] with an increased number of muscarinic receptors in these areas. Confirmation involves provocation testing using a variety of methods. Our patient had pruritus and wheals induced by running. The identification and avoidance of known triggers are the first steps in controlling cholinergic urticaria. Bathing in hot water and performing strenuous exercise during hot weather should be avoided. Hydroxyzine is the classic treatment of choice and is generally believed to be more effective than other antihistamines. Cold urticaria is a form of physical urticaria that can be primary (idiopathic) or secondary to underlying hematological or infectious diseases [5]. The activation of mast cells and subsequent release of histamine and other inflammatory mediators is thought to play a central role [5]. However, the mechanism by which the cold stimulus is transformed into a signal for molecular and cellular activation has not been elucidated. Anti-IgE antibodies may play a role [5]. Typically, patients with cold urticaria develop pruritic wheals and angioedema that can be localized or generalized after cold exposure. Our patient had skin lesions including itching and erythema and wheals after exposure to a cold wind. The diagnosis is dependent on a complete history and physical examination, as well as a positive cold stimulation test. Treatment consists primarily of antihistamines.

Cross‐cultural adaptation of the Brazilian–Portuguese version of the chronic urticaria quality‐of‐life questionnaire – CU‐Q2oL

Chronic urticaria (CU) is a debilitating skin disorder that affects patients' health related quality of life and the only questionnaire prepared specifically to CU is the Chronic Urticaria Quality of Life Questionnaire (CU-Q(2)oL). The purpose of this study was to cross-culturally adapt and validate the CU-Q(2)oL Brazilian-Portuguese version. Forward and back translation by three bilingual translators followed by pre-test was used to adapt the questionnaire. The CU-Q(2)oL was self-administered along with the Dermatology Life Quality Index (DLQI) in 112 patients with CU. Disease activity was assessed using the Urticaria Activity Score. Factor analysis was used to identify scales of the Brazilian portuguese CU-Q(2)oL. Internal consistency, convergent validity and known-group validity was determined. Reproducibility was evaluated by interclass correlation coefficient (ICC). Multiple linear regression was used to determine the predicting factors of CU-Q(2)oL results. Factor analysis revealed a three-dimensional structure: sleep/mental status/eating (I), pruritus/impact on life activities (II) and swelling/limits/look (III), which explained 52.49% of the total variance. All scales showed excellent internal consistency. External construct validity was supported by correlations between the CU-Q(2)oL and DLQI. The tool was found to be able to differentiate between patients with high and low levels of urticaria activity. Test-retest reliability was good to excellent (ICC = 0.69-0.86). Disease severity and urticaria type were the only factors predicting results. The CU-Q(2)oL Brazilian portuguese version was easily filled out, well accepted by the patients, demonstrated an acceptable validity and reliability and might be used to evaluate treatment outcomes and in clinical research.

蕁麻疹型薬疹の統計 なぜ投与6，7日目の発症がないのか?

蕁麻疹型薬疹の統計 なぜ投与6，7日目の発症がないのか?

Rapid Desensitization with Autologous Sweat in Cholinergic Urticaria

The majority of patients with cholinergic urticaria presents with strong hypersensitivity to autologous sweat. Patients with severe cholinergic urticaria are frequently resistant to H(1) antagonists which are used in conventional therapies for various types of urticaria. It has been reported that desensitization using partially purified sweat antigen was effective in a patient with cholinergic urticaria. The aim of this study is to determine the usefulness of rapid desensitization with autologous sweat in severe cholinergic urticaria, because rapid desensitization has proven to be a quick and effective immunotherapy for allergies to various allergens. Six patients with severe cholinergic urticaria who are resistant to H(1) antagonists and have sweat hypersensitivity were enrolled in a rapid desensitization protocol. In all six patients, the responses for skin tests with autologous sweat were attenuated after rapid desensitization with autologous sweat. Two of the three cholinergic urticaria patients showed reduced histamine release with autologous sweat after the rapid desensitization with autologous sweat. Further, the rapid desensitization and subsequent maintenance treatment reduced the symptoms in five of the six patients. This study provides evidence that rapid desensitization with autologous sweat is beneficial for treating cholinergic urticaria patients resistant to conventional therapy who have sweat hypersensitivity.

Failure of omalizumab in cholinergic urticaria

Cholinergic urticaria is one of the more common physical urticarias. Although it is often fairly mild, severe treatment-resistant disease may occur, with significant associated disability. Omalizumab, a monoclonal IgG anti-IgE antibody licensed for use in severe asthma, has recently been used successfully in several types of urticaria, including in one case of cholinergic urticaria. This paper reports a patient with severe cholinergic urticaria, unresponsive to antihistamines and multiple other treatments, whose disease was also unresponsive to omalizumab.

Epidemiology of urticaria: a representative cross-sectional population survey

To investigate the prevalence of urticaria with a focus on chronic urticaria (CU) in a general German population. A questionnaire survey was sent to a representative cross-sectional sample of 13,300 inhabitants of Berlin, Germany, of whom 4093 responded. All respondents who stated ever having had weals or angio-oedema (n=767) were interviewed by telephone. Any interviewees with recent symptoms (within the previous 3 years) were invited for personal investigation including allergy tests; double-blind, placebo-controlled food challenge tests; and quality of life (QOL) assessment. Reported prevalence rates were weighted with regard to age, gender and education so that they were representative of the total population of Berlin. Lifetime prevalence rate of urticaria was 8.8% (95% CI 7.9-9.7%) for all types of urticaria. Lifetime prevalence for CU was 1.8% (95% CI 1.4-2.3%), and prevalence for the 12 months before assessment was 0.8% (95% CI 0.6-1.1%), and 70.3% were female. QOL was markedly reduced for people with CU. Unlike other allergic diseases, there was no increased risk associated with higher education or social status. Prick tests found sensitization of ≥ 1 for type 1 allergens in 39.1% of patients. These were related to comorbidities such as allergic rhinitis or oral allergy syndrome, but were never the underlying cause of CU, as proven by double-blind, placebo-controlled provocation tests. Urticaria is a common disease with marked effects on QOL. The lifetime prevalence of 8.8% for urticaria must be regarded as a lower limit as it is based on conservative prevalence rate calculations, and under-reporting of previous disease can be expected in a questionnaire-based study.