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
...Chronic and Physical Urticaria and Angioed...
...aria and Angioedema...
...and angioedema are differentiated fro...
...cute urticaria and angioedema should b...
...te urticaria and angioedema are more fr...
Acute urticaria and angioedema are ofte...
...h skin biopsy is not indicated in most cases of a...
...ommon causes of acute urticaria and a...
...s of Acute Urticaria, Angioedema, or Both...
...reatment
...should be prescribed if the diagnosis of an...
...antihistamines are efficacious for t...
...s oral corticosteroids might be necessary to tr...
...agnosis and Management of Acute Urticaria...
...ronic Urticaria and Angioe...
...ed as urticaria that has been continuo...
...ation of CU varies considerably. Howeve...
...e patients with CU might have both urticaria and...
...ells are the most important cells in p...
...e coagulation cascade, including i...
...on of a patient with CU should involv...
...mmune disorders, including SLE, der...
...to diagnose underlying autoimmune diseases (e....
...ntibodies are frequently identified in patients w...
...carial vasculitis, associated with lo...
...sculitic lesions can sometimes be evanescent, l...
...ence of CU with a number of conditions, including...
...ies, such as lymphoproliferative diseases a...
...ately 30%–50% of patients with CUε produ...
...utility of the autologous serum ski...
...pathogenesis of autoantibody-associated u...
...atients with CU who present with an otherwise unr...
...geted laboratory testing based on history or phy...
...tient evaluation should be focused to deter...
...e medical work-up of a patient with CU should...
...gh history and physical examinatio...
...eening for thyroid disease is of low yield in pat...
...ough commercial assays are now available, the...
...with recurrent angioedema in the absence of coexi...
...can be performed when vasculitis is...
Immediate hypersensitivity skin or serologic t...
...uidelines for Diagnostic Work-up o...
...2. Evaluation of Chronic Urtica...
...Urticaria and AngioedemaIn a subgroup of patient...
...3. Challenge Procedures for Physical U...
...Aquagenic Urticaria Aquagenic urticari...
...rgic Urticaria...
...nts with cholinergic urticaria have hive...
Common provoking factors for cholinergic urt...
...challenges that increase core body temperatu...
...verity of cholinergic urticaria ranges from m...
...Urticaria
...ents with cold urticaria have pruritus and swell...
...iagnosis of cold urticaria can be confirmed...
...tment for cold urticaria is avoidance...
...Pressure Urticaria/Angioedema (DPUA)...
...tients with DPUA have swelling (which can...
...can be confirmed by a challenge with 15 lbs...
...DPUA differs from other types of CU/angioedema a...
...matographia...
...with dermatographia (also known as dermato...
Exercise-Induced Urticaria And Anaphylaxis (EIA...
...ria provoked by exercise can occur in patients wit...
There are 2 groups of patients with EIAn: on...
...ups of patients with food-dependent EIAn ha...
...tant to distinguish EIAn from choline...
...nagement depends on determining whether...
...r Urticaria...
...ents with solar urticaria promptly (ge...
...he diagnosis of solar urticaria can be confir...
...ory Angioedema...
...ients with vibratory angioedema experience p...
...dema can be confirmed by demonstra...
Differential Diagnosis
...ntial Diagnosis...
...ntial Diagnosis (Table 4)...
...is often found in many conditions that result...
Autoinflammatory syndromes are a gro...
...yrin-associated periodic syndromes (a...
Hypocomplementemic or normocomplementemic urticar...
...plementemic urticarial vasculitis syndrome (HUV...
...ng of the area in the medial portion...
...like dermatoses can occur at various stages of...
...men who present with cyclical urtica...
...acks of angioedema with weight gain are character...
...nophilic syndrome (HES) should be conside...
...cell disorders that can present with urticaria-l...
...activation disorders can also present with urti...
...forme can resemble urticaria and m...
...itis B or C can be associated with urticarial...
...s pemphigoid can present initially wi...
...ent swelling of the lips without evidence of...
...rphous light eruption differs from solar...
...call urticaria is a condition in w...
...with Schnitzler syndrome caused by...
Table 4. Common and Less/uncommon Urticaria An...
...uses of Autoantibody-associated Ur...
...6. Other Dermatologic Diseases Present...
...or C can be associated with urticarial v...
...lous pemphigoid can present initially with urticar...
...swelling of the lips without evidence of eczem...
...rphous light eruption differs from solar ur...
...call urticaria is a condition in which urti...
...ith Schnitzler syndrome caused by an Ig...
.... Very Rare Mimickers of Urticaria, Angioedema,...
Treatment
...eatmen...
...re are no definitive studies that d...
...are Approach to the Treatment for CU...
...ologic Therapies...
...s, heat, and tight clothing can exace...
...pseudoallergens in the diet is NOT...
...opical Therapie...
...opical corticosteroids can improve s...
...ntihistamines...
...sts are effective in the majority of patients w...
...ration antihistamines are safe and effective th...
...of second-generation antihistamines might pr...
...ficacy of first-generation antihistamines i...
...eration antihistamines can be considered in...
...2–Antihista...
...amines taken in combination with firs...
...r, this added efficacy might be related to pharma...
...se these agents are well tolerated,...
...receptor antagonists have been shown in several...
...ne receptor antagonists are generally well tole...
...pressants With H1- And H2-Antagonist Ac...
...in: Treatment with hydroxyzine or doxepin can be...
...mic Corticosteroids
...corticosteroids are frequently used in patients...
Alternative Therapies In Patients With C...
...s with CU whose symptoms are not adequ...
...of alternative therapies have been studied for t...
Anti-inflammatory agents, including da...
...nosuppressant Agent...
Several immunosuppressant agents have been u...
...trexate: Experience with methotrexate in pat...
...l case reports and case series. ( C )...
...the limited evidence and potential for more ser...
...ologic Agents...
...contrast to other alternative agents for...
...iologic agents, IV immunoglobulin, and an...
...hotothera...
...erapy might be effective for CIU a...
...limited availability and frequency of...
...scellaneous Alternative Agents...
...have been used in patients with refracto...
...e agents should be reserved for pat...
...osing Alternative Agents For Treatment Of Refr...
...tiple factors are involved in selecting an...
...s For Specific Conditions Associated...
...e that H. pylori eradication leads to improveme...
...Autoantibodies...
...cause limited data support the use...
...s Infection...
...mited data support the use of antivir...
...Progesterone And Estrogen Dermatitis...
...mited data are available for the use of horm...
...proved/Controversial The...
...evidence is weak that pseudoallergen-free...
Given the lack of evidence and burden...
...unproved therapies for CU that are...
...able 8. Pharmacology of H1-antihistaminesHaving tr...
...Laboratory Monitoring of Alternative Agents...