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Other Reactions from Gloves
Published in Robert N. Phalen, Howard I. Maibach, Protective Gloves for Occupational Use, 2023
T. Bullock, A. Sood, J.S. Taylor
Pressure urticaria and cholinergic urticaria associated with glove use should be diagnosed by the patient's history and cutaneous examination.48 Armstrong et al.6 reported a case of glove-related urticaria of the hands in a hospital worker who did not have type I allergy to latex or type IV hypersensitivity to rubber chemicals. The patient developed a dermographic urticarial response whenever she scratched her hands while wearing the gloves; dermographism could also be elicited at other skin sites. A diagnosis of glove irritation leading to a secondary dermographic response was made. Thomson et al.7 reported three healthcare workers with a history of itching and inflammation of hands related to latex glove use; localized dermographism could be demonstrated in all patients. Patch and prick testing to latex was negative. The dermographism was thought to be precipitated by pressure or shearing forces produced by the recurrent application and removal of tight-fitting surgical gloves.
Urticaria and Angioedema
Published in Pudupakkam K Vedanthan, Harold S Nelson, Shripad N Agashe, PA Mahesh, Rohit Katial, Textbook of Allergy for the Clinician, 2021
Jenny M Stitt, Stephen C Dreskin
Cholinergic urticaria is the most common cause of inducible urticaria accounting for up to 15% of cases. The mechanism is related to cholinergic stimulation of mast cells after exposure to exercise, heat or an increase in basal body temperature. Lesions are somewhat different from typical hives in that they are much smaller, even punctate in size (0.1–1 cm in diameter) although they can coalesce into larger lesions. In addition, they are markedly pruritic and are often surrounded by diffuse erythema. Cholinergic urticaria manifests on the neck and upper thorax initially, and may subsequently involve the entire body. Lesions that coalesce may have the appearance of angioedema.
Recognition, treatment, and prevention of systemic allergic reactions and anaphylaxis *
Published in Richard F. Lockey, Dennis K. Ledford, Allergens and Allergen Immunotherapy, 2020
Emma Westermann-Clark, Stephen F. Kemp, Richard D. deShazo
Cholinergic urticaria, also called “heat urticaria,” is caused by increased core body temperature due to fever, stress, environmental factors, or exercise. Skin lesions frequently appear as 2–4 mm pruritic wheals (“microhives”) surrounded by erythema, which usually begin on the chest and spread over the body. Systemic manifestations, similar to those described for EIA, may also occur but are unusual. Subjects with this syndrome might develop wheals at the site where methacholine is injected or generalized urticaria when the body is warmed, as with a plastic occlusive suit [98].
Perioperative Anaphylaxis from a Perspective of Temperature
Published in Journal of Investigative Surgery, 2022
Jie Luo, Qibin Chen, Su Min, Jian Yu
Temperature-related anaphylaxis most commonly occurs in patients with thermal stimuli (either cold or heat)-induced physical urticaria and cholinergic urticaria, which are more frequent, chronic, and debilitating than generally considered. Although these conditions are relatively rare during the perioperative period, there are more difficulties in diagnosis and treatment, especially for urgent surgical patients and no access to adequate medical history collection. For patients with these diseases or a related history who will undergo elective surgeries, sufficient preparations are required to prevent temperature-related stimuli and for treatment considering their hypersensitive diathesis. Since hypothermia is usually required in cardiac surgeries, special attention should be paid to patients undergoing these surgeries. External temperature-induced urticaria include cold urticaria (CU), heat urticaria (HU), and cholinergic urticaria (CholU), which are triggered by changes in body temperature.
Emerging treatments for chronic urticaria
Published in Expert Opinion on Investigational Drugs, 2022
In CINDU, the chronic urticaria can be reproducibly provoked. Depending on the stimulus, different CINDU subtypes are defined [2]. Provocation factors are cold in cold urticaria, heat in heat urticaria, UV and visible light in solar urticaria, shear forces in symptomatic dermographism, vibrations in vibratory urticaria/angioedema, and pressure in delayed pressure urticaria and enhanced body temperature, and/or sweating by physical or psychological stress in cholinergic urticaria. Avoidance of the specific and definite triggers is often not possible. The underlying causes of CINDU are unknown [2]. The pathomechanism of mast cell activation is supposed to be similar like in CSU. However, so far, in CINDU, sensitization to autoallergens has not been demonstrated conclusively, although there is some evidence that serum factors could be involved in solar urticaria and heat urticaria and sweat antigens in cholinergic urticaria. Similar to CSU, duration of CINDU is often for several years accompanied by a significant impairment of daily activities and quality of life [14].
Ligelizumab for the treatment of chronic spontaneous urticaria
Published in Expert Opinion on Biological Therapy, 2020
Being a next-generation high-affinity anti-IgE monoclonal antibody, Ligelizumab has the potential to effectively and safely treat not only chronic spontaneous urticaria but also other chronic urticaria types as has been previously demonstrated for Omalizumab in investigator-initiated trials, case series, and reports, e.g. symptomatic dermographism [47], cholinergic urticaria [48,49], cold urticaria [50], heat urticaria [51], solar urticaria [52,53], or delayed pressure urticaria [9]. Thus, Ligelizumab has the potential to become the preferred treatment not only for chronic spontaneous urticaria but also for difficult cases of similar conditions such as chronic inducible urticaria. Randomized controlled trials of Ligelizumab for chronic inducible urticaria subtypes such as cold urticaria, delayed pressure urticaria, and cholinergic urticaria are highly encouraged. At the moment there are virtually no approved treatments for these severe and limiting diseases, in which off-label Omalizumab use has shown efficacy but apparently less compared to Omalizumab in chronic spontaneous urticaria [9].