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Acute erythematous rash on the trunk and limbs
Published in Richard Ashton, Barbara Leppard, Differential Diagnosis in Dermatology, 2021
Richard Ashton, Barbara Leppard
Cold, pressure, water and sunlight can all induce an immediate urticarial reaction. Delayed pressure urticaria occurs after a delay of 30 minutes to 12 hours, and occurs at sites of prolonged pressure. Weals or deeper oedema occur, which are itchy and painful, and persist for several days. It can occur on the feet from tight shoes, on soles after climbing a ladder, around the waist, on palms from gripping. Diagnosis requires specific questioning.
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
Pressure-induced urticaria can occur independently or as a comorbid condition with chronic spontaneous urticaria. When it occurs independently, it is characterized by symptoms which occur 4 to 6 hours after the application of pressure to localized areas. Due to the time elapsed between exposure and symptoms, the condition is also termed ‘delayed pressure urticaria’ (Hiragun et al. 2013). Common sources of pressure include tight areas of clothing such as waistbands or straps and standing or sitting for prolonged periods of time. Manifestations of delayed pressure urticaria range from the sensation of edema in normal appearing skin, considered ‘delayed pressure angioedema’, to frank urticaria associated with marked swelling.
Eosinophils and New Antihistamines
Published in Gerald J. Gleich, A. Barry Kay, Eosinophils in Allergy and Inflammation, 2019
This property of cetirizine was demonstrated in other cutaneous models leading to a cutaneous eosinophil accumulation. PAF-induced eosinophil recruitment in the skin was significantly inhibited by cetirizine (10 mg 2×/day) (52), whereas loratadine was inactive (10 mg single intake) (53). Skin challenge with anti-IgE antibodies is characterized by a significant accumulation of eosinophils only in atopic subjects. This phenomenon was significantly inhibited by cetirizine (10 mg 2×/day), while terfenadine (60 mg 2×/day) had a mild, nonsignificant inhibitory effect (54). Anti-IgA antibodies, injected intradermally, as well as anti-IgE antibodies, induced an eosinophil influx only in atopic subjects. However, the anti-IgA-induced cell infiltration was not reduced by cetirizine (10 mg 2×/day) (55). Finally, cetirizine (10 mg 3×/day) reduced pressure-induced wheals and eosinophil recruitment in patients with delayed pressure urticaria. A 65% reduction of eosinophil infiltration was measured using either the Rebuck window technique or the biopsy technique (56,57).
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].
Skin diseases of the vulva: eczematous diseases and contact urticaria
Published in Journal of Obstetrics and Gynaecology, 2018
Freja Lærke Sand, Simon Francis Thomsen
The diagnosis of vulvar contact urticaria caused by either latex or human seminal plasma should be based on history and demonstration of relevant specific IgE antibodies in serum or by skin prick test. An important differential diagnosis of allergic contact urticaria is chronic inducible urticaria, specifically symptomatic dermographism and delayed pressure urticaria with angio-oedema. These inducible urticarias develop reproducibly after repeated physical stimuli such as pressure and rubbing of the skin, and may therefore develop during or immediately after sexual intercourse or vaginal instrumentation.