The Child With an Acute Rash
Michael B O’Neill, Michelle Mary Mcevoy, Alf J Nicholson, Terence Stephenson, Stephanie Ryan in Diagnosing and Treating Common Problems in Paediatrics, 2017
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.
Solar Urticaria
Henry W. Lim, Herbert Hönigsmann, John L. M. Hawk in Photodermatology, 2007
Urticaria is an extremely common disease that appears in 15% to 20% of the general population at some time in their lives (1). Among them, however, solar urticaria is a relatively rare type of physical urticaria. As Magnus (2) stated, the practicing clinician might expect to have an opportunity to see three or four patients in a professional lifetime. The present authors have seen about 100 patients with solar urticaria so far during the past 30 years. Careful and detailed examinations may reveal more cases than expected. The diagnosis of solar urticaria can be easily made from its characteristic features, although the causative factors, similar to other types of urticaria, are rarely found. Patients themselves usually recognize sunlight as a provocative agent. Wheal reaction can be easily reproduced in most patients with physical urticaria including solar urticaria. In this chapter, solar urticaria will be discussed focussing mainly on the pathomechanism of the disease.
Urticaria and Angioedema
Pudupakkam K Vedanthan, Harold S Nelson, Shripad N Agashe, PA Mahesh, Rohit Katial in Textbook of Allergy for the Clinician, 2021
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.
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].
Efficacy and safety of active vitamin D supplementation in chronic spontaneous urticaria patients
Published in Journal of Dermatological Treatment, 2022
Amal Ahmed Mohamed, Maha S. Hussein, Eman Mohamed Salah, Ahmed Eldemery, Mona Mohamed Darwish, Doaa M. Ghaith, Rasha A. Attala, Radwa El Borolossy
Exclusion criteria: Patients with only physical urticaria, urticarial vasculitis, hereditary or acquired angioedema. Patients with dyslipidemia, diabetes, hypertension, preexisting cardiovascular disease, cerebro-vascular accidents, hypothyroidism, smokers, and other systemic or cutaneous disorders including atopic dermatitis, psoriasis, etc. Patients with hypercalcemia (>11 mg/dL), diabetes, renal insufficiency, hepatic disorders, hyperparathyroidism, sarcoidosis, other granulomatous disorders, malignancy. Pregnant and lactating women and patients who have taken Vitamin D supplementation in past 6 months.
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