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...
...caria and Angioedema...
...cute urticaria and angioedema are d...
...rticaria and angioedema should be differe...
...rticaria and angioedema are more freque...
...icaria and angioedema are often but not a...
...iopsy is not indicated in most cases of acute u...
Common causes of acute urticaria and angioedema...
...auses of Acute Urticaria, Angioedema, or Both...
...reatment...
...ould be prescribed if the diagnosis of anaphy...
In most cases antihistamines are efficacious for...
...oral corticosteroids might be necessary t...
...gnosis and Management of Acute Urti...
...Urticaria and Angioedema...
...U is defined as urticaria that has been c...
...he duration of CU varies considera...
...with CU might have both urticaria and angioedema,...
...kin mast cells are the most important cells in...
...ivation of the coagulation cascade, inc...
...uation of a patient with CU should involve consid...
...immune disorders, including SLE, dermatom...
...agnose underlying autoimmune diseases (e.g.,...
Thyroid autoantibodies are frequently ident...
...rticarial vasculitis, associated with low or norma...
...ticarial vasculitic lesions can sometimes be eva...
...co-occurrence of CU with a number of...
Malignancies, such as lymphoproliferative di...
...pproximately 30%–50% of patients with CUÎ...
...lity of the autologous serum skin test (A...
...athogenesis of autoantibody-associat...
...h CU who present with an otherwise unremarkabl...
...atory testing based on history or phy...
...tient evaluation should be focused to determine...
...he medical work-up of a patient with CU s...
...thorough history and physical examination, no...
...or thyroid disease is of low yield in...
...cial assays are now available, the utility of...
...recurrent angioedema in the absence o...
...iopsy can be performed when vasculitis...
...mmediate hypersensitivity skin or serolo...
...delines for Diagnostic Work-up of Patien...
...re 2. Evaluation of Chronic...
...hysical Urticaria and AngioedemaIn a subgroup...
Table 3. Challenge Procedures for Physical...
...quagenic Urticaria Aquagenic urtica...
Cholinergic Urticar...
...holinergic urticaria have hives that are...
...oking factors for cholinergic urticaria inclu...
...ocative challenges that increase core body t...
...ty of cholinergic urticaria ranges from mild pr...
...Urticaria...
...with cold urticaria have pruritus and swelling w...
...s of cold urticaria can be confirm...
...e primary treatment for cold urticar...
...essure Urticaria/Angioedema (DPU...
...atients with DPUA have swelling (which can be pain...
...UA can be confirmed by a challenge w...
...t of DPUA differs from other types of CU/...
...matographia...
...rmatographia (also known as dermatographism,...
...ced Urticaria And Anaphylaxis (EIAN)
...provoked by exercise can occur in...
...re 2 groups of patients with EIAn: one group can...
...ubgroups of patients with food-depen...
...important to distinguish EIAn from cholinerg...
...t depends on determining whether the pat...
...lar Urticaria
...ients with solar urticaria promptly (ge...
...f solar urticaria can be confirmed with phototest...
...atory Angioedem...
...vibratory angioedema experience prur...
...ngioedema can be confirmed by demonstr...
Differential Diagnosis
...fferential Diag...
...erential Diagnosis (Tabl...
...ia is often found in many conditions that resul...
...matory syndromes are a group of conditions that in...
...yrin-associated periodic syndromes (a...
...mplementemic or normocomplementemic urt...
...ementemic urticarial vasculitis syndrome (HUVS)...
...ing of the area in the medial portion...
...caria-like dermatoses can occur at va...
...men who present with cyclical urticaria c...
...ttacks of angioedema with weight g...
...reosinophilic syndrome (HES) should be consider...
...cell disorders that can present with...
...t cell activation disorders can als...
...tiforme can resemble urticaria and might b...
...titis B or C can be associated with...
...emphigoid can present initially wit...
...t swelling of the lips without evidence o...
...us light eruption differs from solar urt...
...ia is a condition in which urticaria is...
...h Schnitzler syndrome caused by an IgM monoclonal...
...le 4. Common and Less/uncommon Urticaria...
...ses of Autoantibody-associated Urticaria, Angio...
...Dermatologic Diseases Presenting with Urticaria...
...titis B or C can be associated with ur...
...igoid can present initially with urticaria-...
...ling of the lips without evidence of eczematous d...
...s light eruption differs from solar urticaria...
...ll urticaria is a condition in whi...
Patients with Schnitzler syndrome caused by an IgM...
...7. Very Rare Mimickers of Urticaria, Angioedema,...
Treatment
...reatme...
...re are no definitive studies that d...
...e 3. Step-care Approach to the Treatment...
...harmacologic Therapies...
..., and tight clothing can exacerbate CU in some...
Avoidance of pseudoallergens in the...
...ical Therapies...
...t topical corticosteroids can improve symptoms fr...
...–Antihistamines
...re effective in the majority of pati...
...ond-generation antihistamines are safe...
...second-generation antihistamines mig...
...of first-generation antihistamines is similar...
...eneration antihistamines can be cons...
...ntihistamines...
...ihistamines taken in combination with first-...
...this added efficacy might be related to pha...
...e agents are well tolerated, the additio...
...eptor antagonists have been shown in...
...ukotriene receptor antagonists are generally w...
...epressants With H1- And H2-Antagonist Ac...
Doxepin: Treatment with hydroxyzine or doxepin can...
...ystemic Corticosteroi...
...ystemic corticosteroids are frequently us...
...tive Therapies In Patients With CU...
...CU whose symptoms are not adequately...
...rnative therapies have been studied...
...ry agents, including dapsone, sulf...
Immunosuppressant Agents...
...mmunosuppressant agents have been used in patient...
...exate: Experience with methotrexate in...
...l case reports and case series. (...
...e limited evidence and potential for more serious...
...ologic Age...
...In contrast to other alternative a...
...al biologic agents, IV immunoglobulin, and anti-...
...ototherapy...
...y might be effective for CIU as well as some...
...of limited availability and freque...
...eous Alternative Agents...
...gents have been used in patients with refract...
...owever, these agents should be res...
...ative Agents For Treatment Of Refractory Ur...
...rs are involved in selecting an alternative agent...
...For Specific Conditions Associated With CU...
...that H. pylori eradication leads to i...
...Autoantibodies...
...se limited data support the use of thy...
...s Infection
...y limited data support the use of antiviral...
...une Progesterone And Estrogen Dermatitis
...imited data are available for the...
...Controversial Therapies...
...weak that pseudoallergen-free diets impr...
...k of evidence and burden of adhering to...
...oved therapies for CU that are NOT recommended i...
...8. Pharmacology of H1-antihistaminesHavi...
...ratory Monitoring of Alternative Agents for P...