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, Chronic...
...Acute Urticari...
...and angioedema are differentiated f...
...te urticaria and angioedema should be...
...te urticaria and angioedema are more frequently...
...e urticaria and angioedema are oft...
...skin biopsy is not indicated in most...
...es of acute urticaria and angioedema,...
...s of Acute Urticaria, Angioedema, or B...
...Treatment...
...rine should be prescribed if the dia...
...ses antihistamines are efficacious fo...
...n severe cases oral corticosteroids mig...
...sis and Management of Acute Urticaria...
...Chronic Urticaria and Angi...
...defined as urticaria that has been cont...
...of CU varies considerably. However, physical ur...
Some patients with CU might have b...
...cells are the most important cells in...
...ivation of the coagulation cascade, includin...
...tion of a patient with CU should invol...
...us autoimmune disorders, including SLE, dermat...
...agnose underlying autoimmune diseases (e.g., co...
...ntibodies are frequently identified in...
...onic urticarial vasculitis, associated with lo...
Urticarial vasculitic lesions can s...
...ce of CU with a number of conditions, including H....
...cies, such as lymphoproliferative d...
...30%–50% of patients with CUε produce speci...
...of the autologous serum skin test (ASST) and autol...
...enesis of autoantibody-associated ur...
...ents with CU who present with an otherwise u...
...tory testing based on history or physical examinat...
...nitial patient evaluation should be focused...
...dical work-up of a patient with CU should be do...
...gh history and physical examination, no f...
...or thyroid disease is of low yield in patient...
...ial assays are now available, the utility of test...
...ients with recurrent angioedema in the abs...
...n be performed when vasculitis is su...
...e hypersensitivity skin or serologic...
Table 2. Guidelines for Diagnostic Wor...
.... Evaluation of Chronic Urticaria...
...cal Urticaria and AngioedemaIn a subgroup o...
...enge Procedures for Physical Urtic...
...agenic Urticaria Aquagenic urtica...
...ients with cholinergic urticaria have...
Common provoking factors for cholinergic urtica...
...challenges that increase core body t...
...ty of cholinergic urticaria ranges from mil...
...Cold Urticaria...
...ts with cold urticaria have pruritu...
...of cold urticaria can be confirmed by applying a...
...treatment for cold urticaria is avoidance o...
...Delayed P...
...th DPUA have swelling (which can be painfu...
...A can be confirmed by a challenge with 15 l...
...f DPUA differs from other types of CU/angi...
...Dermatograph...
...ts with dermatographia (also known a...
...Exercise-Induced...
...aria provoked by exercise can occur in patients wi...
...ups of patients with EIAn: one group can...
...bgroups of patients with food-dependent...
...to distinguish EIAn from cholinergic...
...ement depends on determining whether the patien...
...Solar Urt...
...nts with solar urticaria promptly (genera...
...e diagnosis of solar urticaria can b...
...Vib...
...ts with vibratory angioedema experience...
...ory angioedema can be confirmed by demonstra...
Differential Diagnosis
...Differential Diagnosis...
...D...
...nemia is often found in many conditions that...
...y syndromes are a group of conditions that inv...
...n-associated periodic syndromes (also refe...
...ntemic or normocomplementemic urticarial vasculiti...
...pocomplementemic urticarial vasculitis syndr...
...ng of the area in the medial portion of th...
...e dermatoses can occur at various stage...
...omen who present with cyclical urticaria can hav...
...s of angioedema with weight gain are chara...
...ilic syndrome (HES) should be considered...
...mast cell disorders that can present wi...
...ll activation disorders can also present with urt...
...orme can resemble urticaria and might be cause...
...tis B or C can be associated with urt...
...higoid can present initially with urticaria-like p...
...elling of the lips without evidence of eczemato...
...us light eruption differs from solar...
...ll urticaria is a condition in which urticari...
...h Schnitzler syndrome caused by an IgM mon...
...n and Less/uncommon Urticaria Angioed...
...Causes of Autoantibody-associated Urtic...
...able 6. Other Dermatologic Diseases...
...B or C can be associated with urticarial vasculiti...
Bullous pemphigoid can present initially...
...lling of the lips without evidence of eczematous...
...rphous light eruption differs from solar u...
...aria is a condition in which urticaria is observed...
...Schnitzler syndrome caused by an IgM mon...
...able 7. Very Rare Mimickers of Urticaria, Angioe...
Treatment
...Treatmen...
...re are no definitive studies that demonstr...
...Step-care Approach to the Treatment for CU...
...Nonpha...
...IDs, heat, and tight clothing can exacerbate CU i...
...dance of pseudoallergens in the diet is NOT rec...
...Topica...
...l corticosteroids can improve symptoms...
...H1–Ant...
...ts are effective in the majority of patien...
...ond-generation antihistamines are safe...
...of second-generation antihistamine...
...f first-generation antihistamines is simil...
...st-generation antihistamines can b...
...H2–Antihistamines...
...es taken in combination with first- and...
...added efficacy might be related to...
...gents are well tolerated, the addit...
...ne receptor antagonists have been shown in...
...ptor antagonists are generally well tolerated...
...Antidepressants With...
...oxepin: Treatment with hydroxyzine or doxepin c...
...Systemic Corticostero...
...icosteroids are frequently used in patients w...
...Alternative...
...ients with CU whose symptoms are not adequately...
...of alternative therapies have been studied fo...
...flammatory agents, including dapsone,...
...Immunosuppressant Agen...
...ral immunosuppressant agents have been u...
...otrexate: Experience with methotrexate in...
...e reports and case series. ( C )564...
...the limited evidence and potential for m...
...Biolog...
...mab: In contrast to other alternative agent...
...c agents, IV immunoglobulin, and ant...
...Phototherap...
...ight be effective for CIU as well a...
...of limited availability and frequency of treatme...
...Misce...
...s have been used in patients with r...
...se agents should be reserved for pa...
...Choosing Alternative Agen...
...rs are involved in selecting an alternative...
...that H. pylori eradication leads to improvement...
...Thyroid Auto...
...data support the use of thyroid hormone t...
...Herpes I...
Very limited data support the use of antiviral t...
...data are available for the use of hormonal...
...ontroversial Therapies...
...evidence is weak that pseudoallergen-free...
...iven the lack of evidence and burden of a...
...proved therapies for CU that are NOT...
Table 8. Pharmacology of H1-antihistamines...
...boratory Monitoring of Alternative Agents...