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Urticaria/Hives
Published in Charles Theisler, Adjuvant Medical Care, 2023
Urticaria, also known as hives, are swollen, pale red elevated bumps, patches, or welts on the skin that appear suddenly because of allergies. The pink-to-red raised patches can show up anywhere on the body, including the face, lips, tongue, throat, and ears. These raised areas, or wheals, usually itch but they may also burn or sting. They range in size from a pencil eraser to the size of a dinner plate and may join together to form larger areas known as plaques.
Allergic and Immunologic Reactions
Published in Ayşe Serap Karadağ, Lawrence Charles Parish, Jordan V. Wang, Roxburgh's Common Skin Diseases, 2022
Saira N. Agarwala, Aspen R. Trautz, Sylvia Hsu
Overview: In some patients, the etiology of urticaria is never determined. The release of histamine causes pruritus, while the release of other vasodilatory mediators causes localized swelling. When the process occurs deeper in the dermis and subcutaneous tissue, it is termed angioedema.
Acute erythematous rash on the trunk and limbs
Published in Richard Ashton, Barbara Leppard, Differential Diagnosis in Dermatology, 2021
Richard Ashton, Barbara Leppard
Acute urticaria may be caused by: A type 1 allergic response, which occurs within a few minutes of contact with an allergen either on the skin (e.g. nettle rash, latex allergy see p. 299) or ingested (e.g. strawberries or penicillin). The rash disappears spontaneously within an hour. Contact with the same allergen again will result in a further episode.Direct release of histamine from mast cells by aspirin, codeine or opiates. IgE is not involved. This is the commonest cause of infrequent acute episodes of urticaria, occurring when a patient takes aspirin for a cold or headache.Drugs which can cause serum sickness (an immune complex reaction). Urticaria, arthralgia, fever and lymphadenopathy are the hall marks of this. It may be caused by the following drugs:PenicillinPhenothiazinesThiazide diureticsNitrofurantoinThiouracil
Does synthetic pharmacotherapy still have a place in treating chronic spontaneous urticaria?
Published in Expert Opinion on Pharmacotherapy, 2022
Rebecca M. Thiede, Mohammad Fazel, Karen M. MacDonald, Ivo Abraham
Chronic urticaria is an inflammatory disease driven by mast cells and characterized by spontaneous wheals (with individual lesions self-resolving in <24 hours) and/or angioedema for at least 6 weeks occurring in relation to known or unknown causes. Also known as hives, urticaria can be inducible or spontaneous. Inducible urticaria is characterized by the development of wheals, angioedema, or both in response to a specific external physical trigger and will not occur without this trigger: cold, heat, sunlight, pressure, exercise, contact with offending solid or liquid substances, including foods, plant and animal matters, water, chemicals, among others. In contrast, symptoms of spontaneous urticaria (also referred to as idiopathic urticaria) occur without known or identifiable external physical triggers [1]. Resolution of chronic urticaria, inducible or spontaneous, may take several months or years. Treatment is necessary to limit flares, reduce pruritus, and improve quality of life. Chronic urticaria affects both the objective functioning and subjective well-being of patients [2–4]. The 2014 approval of the monoclonal antibody omalizumab as an add-on therapy, as well as biological therapies currently being evaluated, raises the question of the role, if any, of synthetic agents.
Pediatric chronic spontaneous urticaria: a brief clinician’s guide
Published in Expert Review of Clinical Immunology, 2022
Martina Votto, Giovanna Achilli, Maria De Filippo, Amelia Licari, Alessia Marseglia, Alice Moiraghi, Antonio Di Sabatino, Gian Luigi Marseglia
Urticaria is defined as a condition characterized by the development of wheals (hives) with or without angioedema. Hives are transient and usually last less than 24 hours. Itch is the most common associated symptom of urticaria. Urticarial lesions typically show the following features: 1) wheals appear as edematous, erythematous papules or plaques with a pale center and surrounding erythema; 2) they can be localized or generalized; 3) they have variable size and shape (round, oval, annular, arcuate, serpiginous) and resolve without skin changes. Angioedema is characterized by a sudden, pronounced edema of the lower dermis and subcutis or mucous membranes associated with tingling, burning, tightness, sometimes pain, and a slower resolution (up to 72 hours) [1]. Although the underlying mechanisms can be very distinct, the pathophysiology of urticaria and angioedema are similar and result in increased vascular permeability.
Emerging treatments for chronic urticaria
Published in Expert Opinion on Investigational Drugs, 2022
For patients and clinicians, the pipeline for the treatment of chronic urticaria is very promising. While omalizumab biosimilars are investigated in clinical trials, the expected approval of ligelizumab will soon expand the so far very effective and safe anti-IgE approach observed with omalizumab. For other anti-IgE mAbs like UB-221, the development is considerably behind. Data are too limited so far to clearly define the role of anti-cytokine and anti-cytokine receptor biologics such as dupilumab, tezepelumab, mepolizumab, benralizumab and CDX-0159, of which only dupilumab is actually investigated in phase 3. Regarding small molecules, three selective oral BTK inhibitors are considered in CU, remibrutinib, rilzabrutinib, and fenebrutinib, of which the development of remibrutinib is most advanced, namely in phase 3. As the pipeline interventions address different targets, the results of the studies will give new insights into the pathomechanism of CSU and of CINDU and might identify additional endotypes. It is welcome that for the first time, CINDU subtypes are addressed in RCTs. Hopefully, in the next future, we will have additional approved and also more targeted approaches to adequately treat chronic urticaria.