Urticaria
Key Points
Key Points
- Acute urticaria and angioedema are differentiated from chronic urticaria (CU) based on the duration of illness. Urticaria and angioedema with duration of <6 weeks is termed acute urticaria.
- If urticaria of <6 weeks' duration has features suggesting it might progress to a chronic illness, such patients should be periodically re-evaluated until a diagnosis is clarified.
- Acute urticaria and angioedema should be differentiated from anaphylaxis.
- Urticaria/angioedema associated with signs and symptoms in organs other than the skin, such as the pulmonary tract (wheezing and cough), gastrointestinal system (vomiting and diarrhea), nervous system (dizziness and loss of consciousness), or cardiac system (changes in blood pressure or heart rate), can occur in patients with anaphylaxis.
- Epinephrine should be prescribed if the diagnosis of anaphylaxis has not been excluded.
Acute, Chronic and Physical Urticaria and Angioedema
...Acute, C...
...Acute Urticari...
...icaria and angioedema are differentiated from chr...
...a and angioedema should be differentiate...
...ticaria and angioedema are more frequently assoc...
...cute urticaria and angioedema are often but...
...hough skin biopsy is not indicated in most c...
...of acute urticaria and angioedema, i...
...Causes of Acute Urticaria, Angioedema,...
Tr...
...should be prescribed if the diagnosis o...
...ases antihistamines are efficacious fo...
...oral corticosteroids might be necessary to...
...agnosis and Management of Acute Urticaria...
...Chronic Urtic...
...defined as urticaria that has been conti...
The duration of CU varies considerably. Howeve...
...s with CU might have both urticaria and...
...mast cells are the most important cells i...
...the coagulation cascade, including increased...
...f a patient with CU should involve consider...
...rous autoimmune disorders, including SLE, de...
...logy to diagnose underlying autoimm...
...ntibodies are frequently identified in p...
Chronic urticarial vasculitis, associated...
...icarial vasculitic lesions can sometimes be ev...
...e of CU with a number of conditions, includi...
..., such as lymphoproliferative diseases a...
...ly 30%–50% of patients with CUε...
The utility of the autologous serum...
...pathogenesis of autoantibody-associa...
...r patients with CU who present with an ot...
...ted laboratory testing based on history o...
The initial patient evaluation should be focuse...
...dical work-up of a patient with CU should b...
...fter a thorough history and physical...
...reening for thyroid disease is of low yi...
...ial assays are now available, the ut...
...atients with recurrent angioedema in the...
...an be performed when vasculitis is suspected, suc...
...ersensitivity skin or serologic testing for food...
...ines for Diagnostic Work-up of Patients with...
...igure 2. Evaluation of Chronic U...
...icaria and AngioedemaIn a subgroup...
...lenge Procedures for Physical Urticari...
...quagenic Urticaria Aquagenic urtica...
...Cholinergic Urticari...
...h cholinergic urticaria have hives that are "pi...
...ng factors for cholinergic urticaria inclu...
...ovocative challenges that increase...
...ity of cholinergic urticaria ranges fr...
...Cold Urticari...
...old urticaria have pruritus and swelling with exp...
...osis of cold urticaria can be confirmed by apply...
...ary treatment for cold urticaria is avoid...
...Delayed Pressure...
...DPUA have swelling (which can be...
...e confirmed by a challenge with 15 lb...
...of DPUA differs from other types of CU/angio...
...Dermatographia...
Patients with dermatographia (also known as der...
...aria provoked by exercise can occur in pa...
...here are 2 groups of patients with EIAn:...
...oups of patients with food-dependent...
...ant to distinguish EIAn from choli...
...agement depends on determining whether the patien...
...Solar...
...solar urticaria promptly (generally within...
...e diagnosis of solar urticaria can be confir...
...Vibratory Angioede...
Patients with vibratory angioedema experience...
...ory angioedema can be confirmed by demonstrating a...
Differential Diagnosis
...Differential Diag...
...Different...
...a is often found in many conditions that...
...tory syndromes are a group of conditions that...
...rin-associated periodic syndromes (also referr...
...lementemic or normocomplementemic urticari...
Hypocomplementemic urticarial vasculitis...
...f the area in the medial portion of the upper eye...
...ermatoses can occur at various stages of pregn...
...t with cyclical urticaria can have autoimmune pr...
...acks of angioedema with weight gain are...
...philic syndrome (HES) should be conside...
...eous mast cell disorders that can presen...
...tion disorders can also present wit...
...ma multiforme can resemble urticar...
...or C can be associated with urticarial...
...lous pemphigoid can present initially with...
...swelling of the lips without evidence...
...hous light eruption differs from s...
...a is a condition in which urticaria is observed...
...ents with Schnitzler syndrome caus...
...and Less/uncommon Urticaria Angioedema o...
...ses of Autoantibody-associated Urticaria...
.... Other Dermatologic Diseases Presenting with...
...can be associated with urticarial vasc...
...llous pemphigoid can present initially with urt...
...ing of the lips without evidence of eczematous...
...hous light eruption differs from solar urticaria...
...ia is a condition in which urticaria is obser...
...Schnitzler syndrome caused by an I...
...Very Rare Mimickers of Urticaria,...
Treatment
...Treatment...
...efinitive studies that demonstrate th...
...care Approach to the Treatment for CU...
...Nonpharmacologic T...
..., heat, and tight clothing can exacerbate CU i...
...udoallergens in the diet is NOT recommended....
...Top...
...otent topical corticosteroids can improve...
...H1–...
...tagonists are effective in the majority of patient...
...-generation antihistamines are safe and...
...second-generation antihistamines might provide...
...fficacy of first-generation antihistamines i...
...eneration antihistamines can be considere...
H2–Antih...
...mines taken in combination with first- and sec...
...added efficacy might be related to pharm...
...e agents are well tolerated, the addition of...
...ptor antagonists have been shown in...
...ukotriene receptor antagonists are generall...
...Antidepressa...
...nt with hydroxyzine or doxepin can...
...Syste...
...corticosteroids are frequently used in patien...
...Alternative...
...CU whose symptoms are not adequately controlled...
...rnative therapies have been studied for t...
...ti-inflammatory agents, including dapsone,...
...Immunosu...
...al immunosuppressant agents have been used in...
...Experience with methotrexate in patients wit...
...small case reports and case series. ( C )56...
...the limited evidence and potential for mor...
...Biologic Agents...
...contrast to other alternative agents for refracto...
...biologic agents, IV immunoglobulin,...
P...
...ototherapy might be effective for CIU a...
Because of limited availability and frequenc...
...Miscellaneous A...
...e been used in patients with refract...
...er, these agents should be reserved for p...
...Choosing Alternativ...
Multiple factors are involved in selec...
...Th...
...e that H. pylori eradication leads to...
...Thyroid Autoantibodies...
...se limited data support the use of t...
He...
...ata support the use of antiviral t...
...Autoimmune Progesterone...
...data are available for the use of ho...
...ontroversial Therapies...
...evidence is weak that pseudoallerge...
...lack of evidence and burden of adhering...
...d therapies for CU that are NOT recommended in...
Table 8. Pharmacology of H1-antihista...
...able 9. Laboratory Monitoring of Alte...