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Urticaria

Urticarias


Presentation

  • CASE PRESENTATION: We present a 16-year-old female patient diagnosed with anorexia nervosa binge/purge type, who presented with urticaria and angioedema shortly after binge/purge episodes that subsided when these behaviors ceased.[ncbi.nlm.nih.gov]
  • Lesions may have a purpuric appearance, but leukocytoclastic vasculitis is never present.[ncbi.nlm.nih.gov]
  • CONCLUSION: It is suggested by the present study that certain ILs might play an important role in the pathogenetic mechanism of urticaria. IL-4 and IL-10 participation seems to be relatively more significant.[ncbi.nlm.nih.gov]
  • The purpose of our review is to present basic background on urticaria and discuss classification, diagnosis, and most importantly, management.[ncbi.nlm.nih.gov]
  • A 54-year-old man with dermographism presented for spine surgery, and shortly after induction of anesthesia, he experienced severe hypotension and urticaria, resulting in cancellation of the case on suspicion of allergic reaction.[ncbi.nlm.nih.gov]
Leg Edema
  • Leg edema improved when sirolimus was stopped. She has had drug-free remission for 1 year now. In case 2, the patient had mild, self-limited alimentary symptoms after the 6 mg loading dose of sirolimus.[doi.org]
Hoarseness
  • […] breath, cough, chest tightness, or trouble breathing low blood pressure, dizziness, fainting, rapid or weak heartbeat, anxiety, or feeling of "impending doom" flushing, itching, hives, or feeling warm swelling of the throat or tongue, throat tightness, hoarse[xolair.com]
  • Hoarse voice, wheezing or persistent coughing. Loss of consciousness and/or collapse. Infants and young children appearing pale and floppy. Mild to moderate systemic allergic reaction: Swelling of lips, face or eyes. Hives or welts.[rch.org.au]
  • […] and without the wheals (hives) of simple urticaria and presents clinically as subcutaneous swelling that is generally nonpitting and nonpruritic; it can affect the mouth as well as the mucosal surfaces of the respiratory and GI tracts, manifesting as hoarseness[emedicine.medscape.com]
  • […] breath, cough, chest tightness, or trouble breathing low blood pressure, dizziness, fainting, rapid or weak heartbeat, anxiety, or feeling of “impending doom” flushing, itching, hives, or feeling warm swelling of the throat or tongue, throat tightness, hoarse[gene.com]
Lip Swelling
  • Hives can be associated with lip swelling and throat itchiness and shortness of breath, which is a medical emergency called angioedema. Call for immediate medical help for any swelling of the airway.[firstderm.com]
Urticaria
  • Chronic urticaria comprises both chronic spontaneous urticaria (CSU) and chronic inducible urticaria (CIndU) that includes physical and non-physical urticarias.[ncbi.nlm.nih.gov]
  • Sabroe, Cholinergic Urticaria and Exercise-Induced Anaphylaxis, Urticaria and Angioedema, 10.1007/978-3-540-79048-8_10, (81-89), (2010).[doi.org]
  • Urticarial vasculitis, contact urticaria, and special syndromes are also included under the broad heading of urticaria.[doi.org]
  • C Cold urticaria ‎ (10 F) D Dermatographic urticaria ‎ (10 F) P Urticaria pigmentosa ‎ (11 F) File nella categoria "Urticaria" Questa categoria contiene 45 file, indicati di seguito, su un totale di 45.[commons.wikimedia.org]
  • Michihiro Hide, Urticaria, Therapy of Skin Diseases, 10.1007/978-3-540-78814-0_25, (247-262), (2010). Bettina Wedi, Therapy of Urticaria, Urticaria and Angioedema, 10.1007/978-3-540-79048-8_15, (129-139), (2010). Nancy E.[doi.org]
Pruritus
  • Two trials demonstrated significant elimination of pruritus with second- or third-generation antihistamine treatment vs placebo (OR, 10.44; 95% CI, 4.39 to 24.84).[ncbi.nlm.nih.gov]
  • Inducible urticaria is a heterogeneous group of skin disorders characterized by the appearance of wheals, pruritus and/or angioedema, sometimes accompanied by systemic symptoms caused by innocuous stimuli (cold, heat, pressure, etc.).[ncbi.nlm.nih.gov]
  • AQ is usually symptomatic with mild to severe pruritus and a burning sensation. The mechanism by which water produces mast cell degranulation and histamine release remains unclear.[ncbi.nlm.nih.gov]
  • Pruritus is a common symptom of primary skin diseases including allergic contact dermatitis. Less commonly it reflects a systemic reaction to drugs (e.g., NSAIDs, penicillin, and opioids) and other allergens.[dentalcare.com]
  • Additional therapy aimed at pruritogenic mediators other than histamine would be expected to improve urticarial pruritus. 1992 S.[karger.com]
Eczema
  • Atopy, past history of asthma, allergic rhinitis, and eczema (either atopic, allergic or irritant) are relevant risk factors for work-related eczema and urticaria in young farmers, along with family history of any skin disease.[ncbi.nlm.nih.gov]
  • ‘Many sufferers of allergic rhinitis have other allergies such as eczema, urticaria, or asthma.’ ‘Rashes and urticaria may be present as part of a hypersensitivity reaction.’[en.oxforddictionaries.com]
  • ., MD Clinical Interests Food allergy Eczema (atopic dermatitis) Contact dermatitis (allergic) Allergic rhinoconjunctivitis (hay fever/environmental) Asthma (adult and pediatric) Board Certifications Pediatrics, American Board of Pediatrics Allergy &[massgeneral.org]
  • We recommend diet revision to people with Moderate to severe eczema Persistent or recurrent hives of more than 4 weeks duration All skin disorders associated with digestive disorders.[nutramed.com]
Flushing
  • Sometimes flushing (redness) and small wheals (welts) may also occur. In minor cases, hives may not be visible during the reaction, and the individual may only experience minor flushing, along with the stinging and itching sensation.[cholinergicurticaria.net]
  • Symptoms of UP may include: pruritus (itching that varies in severity and intensity) flushing (redness of the skin) hyperpigmentation of lesions (very dark coloring of lesions) Adults or adolescents are more likely to have uncommon symptoms.[healthline.com]
  • ‘This usually manifests as flushing, breathlessness, rash, urticaria, and hypotension.’ ‘Other symptoms include fever, joint and muscle pain, malaise, urticaria, and pharyngitis.’[en.oxforddictionaries.com]
  • […] to drugs, food or preservatives; fever; heat; cold; exercise; sweating (cholinergic urticaria); physical pressure; dermographism is a physical urticaria where firm stroking of the skin produces a red line which swells and becomes surrounded by a red flush[mydr.com.au]
Dermatographia
  • Other causes include: infections, including viruses exercise anxiety or stress sun exposure exposure to cold, such as cold water or snow contact with chemicals scratching (dermatographia) putting pressure on the skin, such as from sitting too long or[kidshealth.org]
  • Pressure Urticaria –Pressure urticaria is a form of hives and wheals that develop in response to physical pressure (similar to dermatographia).[cholinergicurticaria.net]
  • Urticaria dermatographia Differential diagnosis [ 1 ] Erythema multiforme. Dermatitis herpetiformis. Pemphigoid. Erysipelas. Eczema. Urticaria pigmentosa. Chronic pruritus. Polymorphic eruption of pregnancy. Urticarial vasculitis (as above).[patient.info]
Facial Edema
  • Puig, Cold Urticaria Associated with Intraoperative Hypotension and Facial Edema, Anesthesiology, 90, 3, (907), (1999). M.C.[doi.org]

Workup

  • (there is limited experimental evidence to recommend this, however); hepatitis B and C workup; chest radiograph and/or other imaging studies; ANA panel; rheumatoid factor; cryoglobulin levels; skin biopsy; and urinalysis. 7 Local urticaria can occur[mdedge.com]
  • An extensive laboratory workup for urticaria is not generally recommended. Additional testing can be performed if the presentation suggests underlying causes requiring confirmation.[aafp.org]
  • Diagnostic workup is by allergen specific IgE quantification with total serum IgE and skin prick test regarding suspected food allergens. Oral food challenges are the gold standard for diagnosis.[ijpd.in]
  • TSH), and antinuclear antibody (ANA) [4] Other studies that may be considered include the following: Imaging studies - Generally not indicated unless suggested by a specific symptom or sign [4] Punch biopsy - If urticarial vasculitis is suspected See Workup[emedicine.medscape.com]
  • Diagnostic workup of chronic urticaria.[frontiersin.org]
Cytopenia
  • Major adverse effects include headache, alimentary complaints, extremity edema, rash, tremor, arthralgias, fatigue, weight gain, dyslipoproteinaemia (probably to a lesser degree than would be expected with a regimen of cyclosporine), cytopenias, and immune[doi.org]
Small Liver
  • Carolin Blatner, Eva Maria Oppel, Andreas Wieser, Thomas Herzinger and Franziska Ruëff , The small liver fluke (Dicrocoelium dendriticum): an unusual clinical finding in chronic urticaria , Allergo Journal International , 26 , 5 , (165) , (2017) .[doi.org]
  • Carolin Blatner, Eva Maria Oppel, Andreas Wieser, Thomas Herzinger and Franziska Ruëff, The small liver fluke (Dicrocoelium dendriticum): an unusual clinical finding in chronic urticaria, Allergo Journal International, 26, 5, (165), (2017). H.[doi.org]
  • Carolin Blatner, Eva Maria Oppel, Andreas Wieser, Thomas Herzinger and Franziska Ruëff, The small liver fluke (Dicrocoelium dendriticum): an unusual clinical finding in chronic urticaria, Allergo Journal International, 26, 5, (165), (2017).[doi.org]

Treatment

  • OBJECTIVE: To perform a systematic review of the literature to determine the efficacy of second- and third-generation antihistamines in the treatment of ACU.[ncbi.nlm.nih.gov]
  • The time from initial treatment to control CIU according to initial treatment modalities is shown in Table S3.[doi.org]
  • Treatment, 10.1080/09546634.2017.1329505, 29, 1, (80-97), (2017).[doi.org]
  • Jesper Grønlund Holm, Ilya Ivyanskiy and Simon Francis Thomsen, Use of nonbiologic treatments in antihistamine-refractory chronic urticaria: a review of published evidence, Journal of Dermatological Treatment, 10.1080/09546634.2017.1329505, 29, 1, (80[doi.org]
  • Short‐term corticosteroid treatment for a maximum of 10 days may be considered.[doi.org]

Prognosis

  • Finding autoantibodies in children does not impact a disease prognosis, unlike in adult patients, where the presence of autoantibodies is associated with a more prolonged run of the disease, a more severe prognosis and more intensive treatment methods[ncbi.nlm.nih.gov]
  • , Prevention, and Complications Prognosis most resolve spontaneously Prevention avoid known triggers take second generation anti-histamine daily Complications life-threatening angioedema neutrophilic vasculitis associated with arthritis, renal disease[step2.medbullets.com]
  • Recent investigations have provided evidence that the presence of physical urticaria alone or when comorbid with chronic spontaneous urticaria is associated with a worse prognosis and duration.[springermedizin.de]

Etiology

  • The etiology of the disease varies as well as its clinical manifestations which extend from the presence of urticarial hives to the potentially mortal angioedema.[ncbi.nlm.nih.gov]
  • Urticaria has many etiologies and different pathophysiologies, having acute and chronic forms. The chronic form is by far the more difficult clinical problem, and is the subject of most of the following.[allergyweb.com]
  • Evaluating of etiologies Quality Allergy testing and allergy treatment Immune modulators, immunosuppressants or other non-steroid sparing agents for symptom control Xolair injection in case of failure to control symptoms due to all of those treatments[texasallergygroup.com]
  • This is known as idiopathic urticaria, [2] although most of these are chronic autoimmune urticaria as defined by a positive autologous serum skin test (ASST). [9] Etiology In 50% of patients with acute urticaria, a specific etiology can be identified.[emedicine.com]
  • The etiology could be established by the physical tests in only 37% patients. Most patients with physical urticarias were younger (24.5 8.8 years).[ijdvl.com]

Epidemiology

  • This group of disorders compromises people's quality of life and most of the literature in this regard comes from case reports and case series since its epidemiology has been poorly studied and some cases are very rare.[ncbi.nlm.nih.gov]
  • Ferrer M (2009) Epidemiology, healthcare, resources, use and clinical features of different types of urticaria. J Investig Allergol Clin Immunol 2:21–26 Google Scholar 9. Gaig P, Olona M, Muñoz LD et al (2004) Epidemiology of urticaria in Spain.[doi.org]
  • As of now, the epidemiology, duration, course, response to treatment and underlying causes of chronic urticaria are still ill defined. While a registry would be an appropriate tool to assess these features, this was, until recently, not available.[urticaria-registry.com]
  • […] different age groups have distinct features, Clinical & Experimental Allergy , 2017 Wiley Online Library 2 Atsushi Fukunaga , Ken Washio , Mayumi Hatakeyama , Yoshiko Oda , Kanako Ogura , Tatsuya Horikawa , Chikako Nishigori , Cholinergic urticaria: epidemiology[onlinelibrary.wiley.com]
  • Citing Literature Number of times cited according to CrossRef: 50 Jeong-Hun Seo and Jae-Woo Kwon, Epidemiology of urticaria including physical urticaria and angioedema in Korea, The Korean Journal of Internal Medicine, 10.3904/kjim.2017.203, 34, 2, (418[doi.org]
Sex distribution
Age distribution

Pathophysiology

  • While clinical symptoms are due to the release of histamine by cutaneous mast cells, the underlying pathophysiology is still unknown. However, previous studies indicate that basophils might be of relevance.[ncbi.nlm.nih.gov]
  • The aim of this review is to show an up-to-date overview of the available literature for various types of inducible urticarias, always beginning with an illustrative case and then describing their pathophysiological mechanisms, clinical manifestations[ncbi.nlm.nih.gov]
  • New data in the medical bibliography support the participation of interleukins (ILs) in the pathophysiology of urticaria.[ncbi.nlm.nih.gov]
  • As the pathophysiologic mechanisms responsible for chronic urticaria are better defined, more effective therapeutic agents should become available.[ncbi.nlm.nih.gov]
  • The pathophysiology of urticaria is an inflammatory reaction in the skin, causing leakage of capillaries in the dermis, resulting in an edema which persists until the interstitial fluid is absorbed into the surrounding cells.[allergydoc.us]

Prevention

  • Diagnosis is clinical, and management focuses on prevention, avoiding triggers, and treating the itching and inflammation that accompany these conditions.[ncbi.nlm.nih.gov]
  • A doctor will likely prescribe antihistamines to help prevent allergic reactions. These medications will help prevent a person's body overreacting to triggers.[medicalnewstoday.com]
  • Can exercise-induced urticaria be prevented or avoided? You cannot avoid exercise-induced urticaria. However, you can help prevent flare-ups. Avoid food, products, or types of exercise that trigger hives and other symptoms.[familydoctor.org]
  • The second patient presented with severe symptoms of DPU, which first of all prevented any daily activities of the professional routines. Both patients showed a complete remission of urticaria after the first injection of omalizumab.[ncbi.nlm.nih.gov]
  • There is no sure way to prevent UP. The inherited form is very rare, and even when the child has the abnormal gene, they may not ever develop UP. However, you can prevent the disorder from getting worse.[healthline.com]

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