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
...ic and Physical Urticaria and Angioede...
...e Urticaria and Angioedema...
...urticaria and angioedema are different...
...and angioedema should be differentiated from ana...
...ticaria and angioedema are more frequently...
...cute urticaria and angioedema are o...
...hough skin biopsy is not indicated in most cases...
Common causes of acute urticaria and a...
...auses of Acute Urticaria, Angioedema, or...
...reatment...
...uld be prescribed if the diagnosis of a...
...most cases antihistamines are efficacious for the...
...oral corticosteroids might be necessary...
...sis and Management of Acute Urticaria...
...rticaria and Angioedema...
...is defined as urticaria that has been...
...on of CU varies considerably. However,...
...ome patients with CU might have both urticari...
...cells are the most important cells in patients wit...
...the coagulation cascade, including increased pro...
...f a patient with CU should involve considerati...
...une disorders, including SLE, dermat...
...ogy to diagnose underlying autoimmune diseases...
...roid autoantibodies are frequently ide...
...arial vasculitis, associated with low or...
Urticarial vasculitic lesions can s...
...co-occurrence of CU with a number of...
Malignancies, such as lymphoproliferat...
...tely 30%–50% of patients with CUε p...
...utility of the autologous serum skin te...
...athogenesis of autoantibody-associa...
...r patients with CU who present with an...
...d laboratory testing based on history o...
...ial patient evaluation should be focused to de...
...l work-up of a patient with CU should...
...orough history and physical examinati...
...g for thyroid disease is of low yield...
...mmercial assays are now available, the ut...
...tients with recurrent angioedema i...
...in biopsy can be performed when vasculitis is...
...ensitivity skin or serologic testing for food or...
.... Guidelines for Diagnostic Work-up o...
...Evaluation of Chronic Urticaria...
Physical Urticaria and AngioedemaIn a subgro...
...llenge Procedures for Physical Urticaria/Angio...
...rticaria Aquagenic urticaria is a rare cond...
...olinergic Urti...
...holinergic urticaria have hives that are "pinp...
...g factors for cholinergic urticaria include exer...
...challenges that increase core body tem...
...cholinergic urticaria ranges from mild pruritus t...
...Urticaria...
...h cold urticaria have pruritus and swe...
...s of cold urticaria can be confirmed by...
...atment for cold urticaria is avoidance...
...Pressure Urticaria/Angioedema (DP...
...DPUA have swelling (which can be painful...
...onfirmed by a challenge with 15 lbs of weight...
...DPUA differs from other types of CU/angioedema...
...ermatographia
...h dermatographia (also known as dermatograp...
...ise-Induced Urticaria And Anaphylaxis (EIAN)...
...ed by exercise can occur in patients wit...
...ps of patients with EIAn: one group can experi...
...of patients with food-dependent EIAn have been d...
...to distinguish EIAn from cholinergic urticaria....
...ment depends on determining whether the p...
...r Urticaria...
...s with solar urticaria promptly (ge...
...s of solar urticaria can be confirme...
...ratory Angioed...
...s with vibratory angioedema experience pruritus...
...ibratory angioedema can be confirmed by d...
Differential Diagnosis
...fferential Diagnos...
...al Diagnosis (Table 4)...
...ulinemia is often found in many condi...
...lammatory syndromes are a group of conditions that...
Cryopyrin-associated periodic syndro...
...entemic or normocomplementemic urticari...
...ementemic urticarial vasculitis synd...
...ling of the area in the medial portion of...
...ia-like dermatoses can occur at various st...
...resent with cyclical urticaria can...
...ttacks of angioedema with weight gain are...
...reosinophilic syndrome (HES) should be consid...
...us mast cell disorders that can pre...
...st cell activation disorders can also pres...
...iforme can resemble urticaria and mi...
...r C can be associated with urticarial...
...llous pemphigoid can present initiall...
...nt swelling of the lips without evidence of ecze...
...morphous light eruption differs from solar...
...a is a condition in which urticaria...
...nts with Schnitzler syndrome caused by an IgM...
...4. Common and Less/uncommon Urticar...
...es of Autoantibody-associated Urticaria, An...
...r Dermatologic Diseases Presenting w...
...or C can be associated with urticarial v...
...phigoid can present initially with urticaria-l...
...swelling of the lips without evidence of e...
...phous light eruption differs from solar urticaria...
...ll urticaria is a condition in which...
Patients with Schnitzler syndrome caused by...
...Rare Mimickers of Urticaria, Angioedema...
Treatment
...eatmen...
...o definitive studies that demonstrate that patie...
...3. Step-care Approach to the Treatment for...
...armacologic Therapies...
...Ds, heat, and tight clothing can exace...
...pseudoallergens in the diet is NOT recommended. (...
...cal Therapies...
...opical corticosteroids can improve sy...
H1–Antihista...
H-antagonists are effective in the majority of...
...n antihistamines are safe and effective ther...
...ses of second-generation antihistamines might...
...of first-generation antihistamines is similar...
...antihistamines can be considered in patie...
...“Antihistamines
...ihistamines taken in combination with first- a...
...his added efficacy might be related to pharm...
...use these agents are well tolerated,...
...receptor antagonists have been shown in several,...
...riene receptor antagonists are generall...
...ssants With H1- And H2-Antagonist...
...nt with hydroxyzine or doxepin can be con...
...Corticosteroids
...temic corticosteroids are frequently used...
...herapies In Patients With CU...
...th CU whose symptoms are not adequately con...
...of alternative therapies have been...
...atory agents, including dapsone, sulfasal...
Immunosuppressant Agents...
...eral immunosuppressant agents have b...
...thotrexate: Experience with methotrexate in pa...
...eports and case series. ( C )564...
...e limited evidence and potential for...
...ogic Agent...
...izumab: In contrast to other alternative agent...
...ogic agents, IV immunoglobulin, and anti-TNF...
...otothera...
...otherapy might be effective for CIU a...
...e of limited availability and frequency of...
...scellaneous Alternative A...
...her agents have been used in patients wi...
...agents should be reserved for patients with r...
...oosing Alternative Agents For Treatment Of R...
...iple factors are involved in selecting...
...r Specific Conditions Associated Wit...
The evidence that H. pylori eradication leads to...
...yroid Autoantibodie...
...cause limited data support the use of thyroid h...
...s Infection...
Very limited data support the use o...
...immune Progesterone And Estrogen Dermatitis...
...re available for the use of hormonal therapi...
...ved/Controversial Therapie...
...vidence is weak that pseudoallergen-free diets imp...
...k of evidence and burden of adhering to thes...
...roved therapies for CU that are NOT r...
...armacology of H1-antihistaminesHaving tr...
...Laboratory Monitoring of Alternative Agent...