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
...cute, Chronic and Physical Urticaria and Angioe...
...te Urticaria and Angioed...
...urticaria and angioedema are differenti...
...te urticaria and angioedema should be...
...ticaria and angioedema are more frequentl...
...ute urticaria and angioedema are o...
...biopsy is not indicated in most cases...
...causes of acute urticaria and angioedema, inc...
...s of Acute Urticaria, Angioedema, or Both...
...reatment...
Epinephrine should be prescribed if the dia...
...cases antihistamines are efficacious for...
...vere cases oral corticosteroids migh...
...Diagnosis and Management of Acute Urticari...
...ticaria and Angioedema...
...ined as urticaria that has been continuo...
...ration of CU varies considerably. Howe...
...ts with CU might have both urticaria and a...
...cells are the most important cells in patients wit...
...e coagulation cascade, including increa...
...luation of a patient with CU should involve consi...
...erous autoimmune disorders, including SLE, dermato...
...rology to diagnose underlying autoimmune disease...
...oid autoantibodies are frequently identifie...
...ial vasculitis, associated with low o...
...carial vasculitic lesions can sometimes be ev...
...e co-occurrence of CU with a number of condition...
...nancies, such as lymphoproliferative di...
...ely 30%–50% of patients with CUε...
...he autologous serum skin test (ASST)...
...athogenesis of autoantibody-associated urticaria...
...nts with CU who present with an otherwise unrem...
Targeted laboratory testing based...
...ial patient evaluation should be focused...
...ork-up of a patient with CU should be done, keepi...
...ugh history and physical examination, no furth...
...creening for thyroid disease is of low yield...
...though commercial assays are now availabl...
...ecurrent angioedema in the absence of coexi...
...biopsy can be performed when vasculitis is suspec...
...rsensitivity skin or serologic testing...
...ble 2. Guidelines for Diagnostic Work-up of Patien...
...2. Evaluation of Chronic Urticaria...
...ria and AngioedemaIn a subgroup of patients...
...e 3. Challenge Procedures for Physical Urt...
...Urticaria Aquagenic urticaria is a rare...
...linergic Urticaria...
...olinergic urticaria have hives that are...
...provoking factors for cholinergic urt...
...tive challenges that increase core b...
...verity of cholinergic urticaria ra...
...Urticaria...
...ith cold urticaria have pruritus and...
...s of cold urticaria can be confirmed by...
...treatment for cold urticaria is avoidance of...
...ed Pressure Urticaria/Angioedema (D...
...with DPUA have swelling (which can be painful) w...
...be confirmed by a challenge with 15 lbs of weig...
...nt of DPUA differs from other types of CU/angio...
...matographi...
...h dermatographia (also known as dermatograp...
...e-Induced Urticaria And Anaphylaxis (E...
...ia provoked by exercise can occur in...
...are 2 groups of patients with EIAn: one gro...
...wo subgroups of patients with food...
...tant to distinguish EIAn from cholinergic urti...
...pends on determining whether the patient has...
Solar Urticar...
...tients with solar urticaria promptly (ge...
...e diagnosis of solar urticaria can be confir...
...ratory Angioedema
...ients with vibratory angioedema experience p...
...ngioedema can be confirmed by demonstra...
Differential Diagnosis
Differential Diagno...
...tial Diagnosis (Table 4)
...ia is often found in many conditions that result...
...syndromes are a group of conditions that i...
...-associated periodic syndromes (also referred to a...
...mplementemic or normocomplementemi...
...temic urticarial vasculitis syndrome (HUVS) is a...
...the area in the medial portion of...
...ermatoses can occur at various stages of pregna...
...en who present with cyclical urticaria can have a...
...tacks of angioedema with weight gain are...
...lic syndrome (HES) should be considered w...
...t cell disorders that can present with urticaria-...
...activation disorders can also present with urt...
...a multiforme can resemble urticaria and might be c...
...can be associated with urticarial...
...mphigoid can present initially with u...
...istent swelling of the lips without evi...
...morphous light eruption differs from...
...a is a condition in which urticaria...
...Schnitzler syndrome caused by an IgM monoclonal...
...e 4. Common and Less/uncommon Urticaria Angioedem...
...uses of Autoantibody-associated Urticaria...
Table 6. Other Dermatologic Diseas...
...or C can be associated with urticarial vascul...
...ous pemphigoid can present initially with u...
...istent swelling of the lips without evidence...
...light eruption differs from solar urticaria in th...
...l urticaria is a condition in which urticaria is...
...ith Schnitzler syndrome caused by an I...
...le 7. Very Rare Mimickers of Urtica...
Treatment
Treatm...
...no definitive studies that demonstrate that...
...Step-care Approach to the Treatment...
...npharmacologic Therapie...
...IDs, heat, and tight clothing can exacerbat...
...eudoallergens in the diet is NOT recommended....
...al Therapies...
Potent topical corticosteroids can improve...
H1–Antihist...
...gonists are effective in the majority...
...ond-generation antihistamines are safe...
...of second-generation antihistamines might provi...
...ficacy of first-generation antihistamine...
...st-generation antihistamines can b...
...€“Antihistamines...
...histamines taken in combination with firs...
...s added efficacy might be related to pharmacologi...
...ents are well tolerated, the addition of...
...ptor antagonists have been shown in sev...
...receptor antagonists are generally well t...
Antidepressants With H1- And H2-Anta...
...atment with hydroxyzine or doxepin ca...
...ystemic Corticos...
...icosteroids are frequently used in pa...
...Therapies In Patients With CU...
...CU whose symptoms are not adequately contro...
...r of alternative therapies have been studied...
...flammatory agents, including dapsone, sulf...
...osuppressant Agents...
...mmunosuppressant agents have been use...
...ethotrexate: Experience with methotrexate in pati...
to small case reports and case se...
...use of the limited evidence and pote...
...gic Agents...
...mab: In contrast to other alternative agents...
...gic agents, IV immunoglobulin, and...
...otherapy...
...ight be effective for CIU as well as so...
...limited availability and frequency of trea...
...scellaneous Alternative Agent...
...ve been used in patients with refrac...
...e agents should be reserved for patients wit...
...ernative Agents For Treatment Of Refr...
...ltiple factors are involved in selecting an altern...
...s For Specific Conditions Associated With CU...
...ence that H. pylori eradication leads...
...hyroid Autoantibodi...
...ited data support the use of thyroid ho...
...rpes Infection...
...ta support the use of antiviral therapies in...
...Progesterone And Estrogen Dermatitis...
...available for the use of hormonal therapies in p...
...oved/Controversial Therapies
...s weak that pseudoallergen-free diets improve CU....
...en the lack of evidence and burden of adhering...
...nproved therapies for CU that are NOT r...
...Pharmacology of H1-antihistaminesHav...
...ble 9. Laboratory Monitoring of Alternati...