Urticaria

Publication Date: February 1, 2014

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

...ute, Chronic and Physical Urticaria and Angi...

...caria and Angioedema...

...cute urticaria and angioedema are d...

...e urticaria and angioedema should be different...

...and angioedema are more frequently a...

...ria and angioedema are often but not al...

...ough skin biopsy is not indicated in m...

...auses of acute urticaria and angioedema, includin...

...auses of Acute Urticaria, Angioedema, or Both...

...tment...

Epinephrine should be prescribed i...

...most cases antihistamines are eff...

...e cases oral corticosteroids might...

.... Diagnosis and Management of Acute Urti...


...ronic Urticaria and Angi...

...ined as urticaria that has been contin...

...f CU varies considerably. However, physica...

...ts with CU might have both urticaria and an...

...s are the most important cells in patien...

...of the coagulation cascade, includ...

...n of a patient with CU should involve considera...

...rous autoimmune disorders, includi...

...erology to diagnose underlying autoi...

...roid autoantibodies are frequently ide...

...al vasculitis, associated with low or normal c...

...ulitic lesions can sometimes be evan...

...he co-occurrence of CU with a number of condi...

..., such as lymphoproliferative diseas...

...30%–50% of patients with CUε produce specific...

...ity of the autologous serum skin test...

...ogenesis of autoantibody-associated urticari...

...atients with CU who present with an otherwise u...

...aboratory testing based on history or ph...

...l patient evaluation should be focused t...

...edical work-up of a patient with CU shoul...

...ter a thorough history and physical ex...

...eening for thyroid disease is of low yield in pati...

...mmercial assays are now available, the ut...

Patients with recurrent angioedema in t...

...biopsy can be performed when vasculitis...

...e hypersensitivity skin or serologic t...

...delines for Diagnostic Work-up of Patien...

.... Evaluation of Chronic Urticaria...


...ysical Urticaria and AngioedemaIn a subgroup of...

...ble 3. Challenge Procedures for Physi...

...ticaria Aquagenic urticaria is a rare c...

Cholinergic Urticari...

...s with cholinergic urticaria have h...

...factors for cholinergic urticaria incl...

...ve challenges that increase core body tempe...

...severity of cholinergic urticaria...

...old Urticaria

...ld urticaria have pruritus and swelling wi...

...iagnosis of cold urticaria can be confirmed by...

...ary treatment for cold urticaria is avoid...

...yed Pressure Urticaria/Angioede...

...nts with DPUA have swelling (which...

...nfirmed by a challenge with 15 lbs of w...

...UA differs from other types of CU/an...

...rmatographia...

...th dermatographia (also known as dermatog...

...Urticaria And Anaphylaxis (EIAN)

...ked by exercise can occur in patients w...

...roups of patients with EIAn: one group can exper...

...patients with food-dependent EIAn have been...

...ant to distinguish EIAn from cholinergic urtica...

...depends on determining whether the p...

Solar Urticaria

...solar urticaria promptly (generally within...

...agnosis of solar urticaria can be confirmed wit...

...ory Angioedema...

...ibratory angioedema experience pruritus and swel...

...edema can be confirmed by demonstra...


Differential Diagnosis

Differential Diagnos...

...al Diagnosis (Table 4)...

...lobulinemia is often found in many...

...flammatory syndromes are a group of...

...n-associated periodic syndromes (als...

...entemic or normocomplementemic urticarial vascu...

...omplementemic urticarial vasculitis syndrome (...

...area in the medial portion of the upper eyes mi...

...dermatoses can occur at various stages of preg...

...nt with cyclical urticaria can have autoi...

...attacks of angioedema with weight...

...ilic syndrome (HES) should be considered when the...

...eous mast cell disorders that can...

...vation disorders can also present with urticari...

...rme can resemble urticaria and might be cause...

...itis B or C can be associated with urticaria...

...pemphigoid can present initially with urticaria-li...

...elling of the lips without evidence of eczematous...

...orphous light eruption differs from so...

...aria is a condition in which urticaria is obser...

...hnitzler syndrome caused by an IgM monoclonal g...


...on and Less/uncommon Urticaria Angi...


Table 5. Causes of Autoantibody-associated Urt...


...le 6. Other Dermatologic Diseases Pr...

...tis B or C can be associated with u...

...mphigoid can present initially with ur...

Persistent swelling of the lips wit...

...s light eruption differs from solar urticaria i...

Recall urticaria is a condition in w...

Patients with Schnitzler syndrome...


...ble 7. Very Rare Mimickers of Urticaria, Ang...


Treatment

...reatmen...

...no definitive studies that demonstrate that pat...


Figure 3. Step-care Approach to th...


...npharmacologic Therapies...

...nd tight clothing can exacerbate CU in some pati...

...nce of pseudoallergens in the diet is...


...ical Therapi...

...topical corticosteroids can improve symptoms...


...€“Antihistamine...

...s are effective in the majority of...

...nd-generation antihistamines are safe and effect...

...s of second-generation antihistamines mi...

...acy of first-generation antihistamines is s...

First-generation antihistamines can be conside...


...–Antihistamin...

...antihistamines taken in combination with first- an...

...wever, this added efficacy might be relat...

...e these agents are well tolerated,...

...ceptor antagonists have been shown in s...

...kotriene receptor antagonists are generally well t...


...With H1- And H2-Antagonist Activity...

...Treatment with hydroxyzine or doxepin can be...


...temic Corticostero...

...corticosteroids are frequently use...


...Therapies In Patients With CU...

...nts with CU whose symptoms are not...

...lternative therapies have been studied for...

...flammatory agents, including dapso...


...pressant Agents...

...l immunosuppressant agents have been used...

...thotrexate: Experience with methotrexate in p...

...ll case reports and case series. ( C )564...

...ecause of the limited evidence and potenti...


...ogic Agents

...umab: In contrast to other alternative agents...

...ral biologic agents, IV immunoglobulin, and anti-...


...ototherapy...

...totherapy might be effective for CIU a...

...ed availability and frequency of treatment, ph...


...ous Alternative Agents...

...have been used in patients with refract...

...agents should be reserved for patient...


...lternative Agents For Treatment Of...

...are involved in selecting an alterna...


...Specific Conditions Associated With CU...

...dence that H. pylori eradication leads...


...d Autoantibodies...

...mited data support the use of thyr...


...s Infection

...a support the use of antiviral therapies...


...ne Progesterone And Estrogen Dermatitis...

...ited data are available for the use of hormon...


Unproved/Controversial Therap...

...is weak that pseudoallergen-free die...

...lack of evidence and burden of adherin...

...d therapies for CU that are NOT reco...


...able 8. Pharmacology of H1-antihistaminesHav...


...Laboratory Monitoring of Alternative Agen...