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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
Physical stimuli activate mast cells by unknown mechanisms. Inducible urticaria/angioedema accounts for approximately 20% of chronic urticaria cases. The most common physical urticaria is dermatographism (also called dermographism) in which scratching or stroking of the skin leads to acute wheal production. Dermatographism affects 2–5% of the population (Hiragun et al. 2013). In patients with dermatographism, patterns or words can be ‘written’ on the patient’s skin in wheals (Fig. 24.2). This is rarely a cause of chronic urticaria.
The Child With an Acute Rash
Published in Michael B O’Neill, Michelle Mary Mcevoy, Alf J Nicholson, Terence Stephenson, Stephanie Ryan, Diagnosing and Treating Common Problems in Paediatrics, 2017
Michael B O’Neill, Michelle Mary Mcevoy, Alf J Nicholson, Terence Stephenson, Stephanie Ryan
Urticarial rashes are common in children. Urticaria is caused by degranulation of mast cells with releases of histamine, causing vasodilation and increased capillary permeability. Angioedema may also occur. Anaphylaxis is the sudden onset of urticaria, angioedema, dyspnoea and hypotension and is a medical emergency. Lesions can vary in size from small papules to larger raised plaques that coalesce. Lesions typically appear within minutes and fade over a few hours. They are intensely pruritic. Urticaria can be acute (<6 weeks) or chronic (>6 weeks). There are two main classifications of urticaria: ordinary (which can be acute or chronic) and physical. Most cases of ordinary urticaria are idiopathic. Acute urticaria is more likely to have an identifiable cause than chronic urticaria. Urticaria can occur due to drugs, infections, foods, bites and bee stings. Physical urticaria occurs in localised areas after contact with a stimulus. Dermatographism is the most common form, triggered by firm scratching of the skin. Physical urticaria may also be triggered by pressure, heat, cold, vibrations, sunlight and friction.
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
Urticaria can also be induced by physical phenomena. These are termed the physical or inducible urticarias. Physical urticarias tend to develop minutes after a stimulus is experienced, resolve in about 2 hours, and occur at the site of exposure. Following is a list of common physical urticarias and their triggers: Dermatographism: This is the most common physical urticaria. Patients develop linear wheals in areas where skin experiences shearing forces from scratching or tight clothing. Simple dermatographism, that is dermatographism without pruritus, is estimated to occur in 5% of the population. Symptomatic dermatographism presents with wheals and pruritus, is less common than simple dermatographism, and tends to be more distressing for patients.Cold urticaria: Wheals, burning, and pruritus develop after exposure to cold temperatures followed by rewarming. The reaction can be elicited by placing an ice block on the skin.Delayed pressure urticaria: Urtic arial lesions develop some time (on average 4–6 hours) after pressure on the skin, which can be from belts or other tight clothing. Patients may experience a reaction on the posterior thighs after prolonged sitting or on the soles from prolonged standing. Pain and burning at the site are often more prominent than pruritus. There is an association with chronic spontaneous urticaria. Solar urticaria: Urticarial lesions develop on exposed skin a few minutes following exposure to the sun. Various wavelengths of light may also be responsible. When unrecognized, solar urticaria may cause an acute collapse in sunbathers.Cholinergic urticaria: Multiple small, pruritic, urticarial papules develop after exercise or hot baths, which can stimulate the postganglionic cholinergically innervated sweat glands. This disorder can be very disabling when severe since it can effectively prevent patients from participating in any kind of physical activity.
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.
An update on the cutaneous manifestations of coeliac disease and non-coeliac gluten sensitivity
Published in International Reviews of Immunology, 2018
Urticaria is characterised by angioedema and/or wheals. Chronic urticaria (CU) is a common disabling disorder that affects 15%–25% of the population over their lifetime. It has an average duration of 3–5 years in adults, but always lasts more than six weeks. Physical urticaria and intolerance to food additives account for 20% and nearly 5% of such patients, respectively, with the remaining diagnosed as having chronic idiopathic urticaria (CIU) [61]. The aetiopathogenesis of CU is associated with autoimmune mechanisms. In fact, similar to CD, CU has been shown to have a genetic link with the human leukocyte antigen HLA-DQ8. A large population-based cohort study suggested that CD is associated with urticaria, especially chronic urticaria [62]. In 2017, Kolkhir et al. [63] observed a strong link between CIU and various autoimmune diseases, including CD, vitiligo, Hashimoto’s thyroiditis, pernicious anaemia, Grave’s disease, type 1 diabetes mellitus and rheumatoid arthritis. In these cases of CIU, following a GFD has been confirmed to be effective for controlling skin flares [64].
Use of nonbiologic treatments in antihistamine-refractory chronic urticaria: a review of published evidence
Published in Journal of Dermatological Treatment, 2018
Jesper Grønlund Holm, Ilya Ivyanskiy, Simon Francis Thomsen
Urticaria is characterized by intense itching and formation of wheals lasting for no longer than 24 hours (1). Urticaria can be arbitrarily grouped into an acute and chronic form; existence of symptoms for more than 6 weeks is defined as chronic urticaria. Chronic urticaria is further subdivided into chronic spontaneous urticaria (CSU), where no apparent trigger or causative factor can be identified and chronic inducible urticaria (CINDU), including the physical urticarias, where stimuli such as heat, cold, pressure or ultraviolet light (UV) exposure are the direct and reproducible triggers of symptoms (2). The pathogenesis of CSU remains unclear but up to 40% exhibit histamine-releasing IgG auto-antibodies directed against IgE (immunoglobulin E) or the high-affinity IgE receptor on mast cells and basophils (3).