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
...ronic and Physical Urticaria and Angioedema...
...Urticaria and Angioedema...
...urticaria and angioedema are differentiat...
...e urticaria and angioedema should be differ...
...a and angioedema are more frequently a...
...ute urticaria and angioedema are often but no...
...biopsy is not indicated in most case...
...s of acute urticaria and angioedema, in...
...es of Acute Urticaria, Angioedema, or Both C...
...reatment...
...e should be prescribed if the diagnosis of anap...
In most cases antihistamines are efficacious for...
...e cases oral corticosteroids might be necess...
...gure 1. Diagnosis and Management of A...
...Urticaria and Angioedem...
...U is defined as urticaria that has been continuou...
...f CU varies considerably. However, physical...
...with CU might have both urticaria and ang...
...cells are the most important cells in patients wi...
...ctivation of the coagulation casca...
...n of a patient with CU should involve conside...
...autoimmune disorders, including SLE, dermat...
...diagnose underlying autoimmune diseases (e...
...ntibodies are frequently identified in pa...
...hronic urticarial vasculitis, associated with l...
...vasculitic lesions can sometimes b...
The co-occurrence of CU with a number of cond...
...ancies, such as lymphoproliferative dise...
...oximately 30%–50% of patients with...
...e utility of the autologous serum skin...
...pathogenesis of autoantibody-associa...
...ts with CU who present with an otherwise unr...
...argeted laboratory testing based on history...
...l patient evaluation should be focused to determi...
...medical work-up of a patient with CU should be...
...er a thorough history and physical examination, n...
...for thyroid disease is of low yield i...
...gh commercial assays are now available, the u...
...current angioedema in the absence...
...can be performed when vasculitis is suspec...
...mediate hypersensitivity skin or serol...
...ble 2. Guidelines for Diagnostic Work-up of Pati...
...luation of Chronic Urticaria...
...hysical Urticaria and AngioedemaIn a sub...
...nge Procedures for Physical Urticaria...
...agenic Urticaria Aquagenic urti...
...linergic Urtica...
...th cholinergic urticaria have hives that are "pinp...
...ing factors for cholinergic urticaria incl...
...hallenges that increase core body t...
...severity of cholinergic urticaria ranges...
...Urticaria...
...cold urticaria have pruritus and swelling...
...osis of cold urticaria can be confirmed by applyi...
...e primary treatment for cold urticari...
...yed Pressure Urticaria/Angioed...
...nts with DPUA have swelling (which can be painfu...
...be confirmed by a challenge with 15...
...DPUA differs from other types of CU/angio...
...ermatograp...
...nts with dermatographia (also known as dermatog...
...e-Induced Urticaria And Anaphylaxis (EIAN)...
...icaria provoked by exercise can occur in patie...
...re are 2 groups of patients with EIAn: one group c...
...subgroups of patients with food-dependent EIAn h...
...tant to distinguish EIAn from cholinergi...
...nt depends on determining whether the...
...olar Urtica...
...h solar urticaria promptly (generally within...
...diagnosis of solar urticaria can be...
...bratory Angioe...
...vibratory angioedema experience pruritus and s...
...oedema can be confirmed by demonstr...
Differential Diagnosis
...ifferential Diagn...
...erential Diagnosis (Table 4)...
...ulinemia is often found in many conditions th...
...nflammatory syndromes are a group of condition...
...ssociated periodic syndromes (also referred to as...
...mic or normocomplementemic urticari...
...omplementemic urticarial vasculitis syndro...
...g of the area in the medial portion...
...ria-like dermatoses can occur at vari...
...o present with cyclical urticaria can have auto...
...pisodic attacks of angioedema with weight gain ar...
Hypereosinophilic syndrome (HES) should be consid...
...ast cell disorders that can present with urtic...
...activation disorders can also present wit...
Erythema multiforme can resemble urti...
...can be associated with urticarial vasculiti...
...pemphigoid can present initially...
...sistent swelling of the lips withou...
...olymorphous light eruption differs fr...
...caria is a condition in which urticaria is obse...
...ents with Schnitzler syndrome caused by an IgM...
...able 4. Common and Less/uncommon U...
...able 5. Causes of Autoantibody-associated...
...ble 6. Other Dermatologic Diseases Presenti...
...B or C can be associated with urticarial vasculiti...
...ullous pemphigoid can present initially with u...
...sistent swelling of the lips without ev...
...light eruption differs from solar...
Recall urticaria is a condition in which urticaria...
...th Schnitzler syndrome caused by an IgM monoclon...
...ble 7. Very Rare Mimickers of Urti...
Treatment
...eatmen...
...definitive studies that demonstrate...
Figure 3. Step-care Approach to the...
...onpharmacologic Therapies...
...IDs, heat, and tight clothing can exace...
...udoallergens in the diet is NOT recom...
...opical Therapi...
...ical corticosteroids can improve sympt...
...1–Antihista...
...antagonists are effective in the majo...
...eration antihistamines are safe an...
...second-generation antihistamines...
...fficacy of first-generation antihistamines...
...eneration antihistamines can be considered...
H2–Antihistamines
...-antihistamines taken in combination...
...owever, this added efficacy might be related...
Because these agents are well tolerated, the addit...
...e receptor antagonists have been shown in sever...
...ptor antagonists are generally well t...
...idepressants With H1- And H2-Antagonist...
...epin: Treatment with hydroxyzine or d...
...stemic Corticosteroids
Systemic corticosteroids are frequently u...
...ve Therapies In Patients With CU...
...with CU whose symptoms are not adequately...
...alternative therapies have been studi...
...i-inflammatory agents, including dapsone,...
...osuppressant Agents...
...uppressant agents have been used in p...
...xate: Experience with methotrexate in patie...
...case reports and case series. ( C )564...
...use of the limited evidence and pote...
...gic Agents...
...izumab: In contrast to other alter...
...logic agents, IV immunoglobulin, and anti-...
Phototherapy
Phototherapy might be effective for CIU as w...
...mited availability and frequency of treatme...
...eous Alternative Agents...
...have been used in patients with refractory CU,...
...gents should be reserved for patients with ref...
...tive Agents For Treatment Of Refractory U...
...ltiple factors are involved in selecting an alte...
...rapies For Specific Conditions Associated Wit...
...that H. pylori eradication leads to improvement...
...id Autoantibodies...
...ed data support the use of thyroid hormone th...
Herpes Infection
...limited data support the use of an...
Autoimmune Progesterone And Estroge...
...d data are available for the use o...
Unproved/Controversial Therapie...
...he evidence is weak that pseudoallergen-free di...
...the lack of evidence and burden of...
...her unproved therapies for CU that are NOT recom...
...Pharmacology of H1-antihistaminesHav...
.... Laboratory Monitoring of Alternative A...