Urticaria
Key Points
Key Points
- Acute urticaria and angioedema are differentiated from chronic urticaria (CU) based on the duration of illness. Urticaria and angioedema with duration of <6 weeks is termed acute urticaria.
- If urticaria of <6 weeks' duration has features suggesting it might progress to a chronic illness, such patients should be periodically re-evaluated until a diagnosis is clarified.
- Acute urticaria and angioedema should be differentiated from anaphylaxis.
- Urticaria/angioedema associated with signs and symptoms in organs other than the skin, such as the pulmonary tract (wheezing and cough), gastrointestinal system (vomiting and diarrhea), nervous system (dizziness and loss of consciousness), or cardiac system (changes in blood pressure or heart rate), can occur in patients with anaphylaxis.
- Epinephrine should be prescribed if the diagnosis of anaphylaxis has not been excluded.
Acute, Chronic and Physical Urticaria and Angioedema
..., Chronic and Physical Urticaria and Angioedema...
...rticaria and Angioedema...
...ticaria and angioedema are differentiated from chr...
...icaria and angioedema should be differentia...
...e urticaria and angioedema are more frequently...
...caria and angioedema are often but not alw...
...lthough skin biopsy is not indicated in most ca...
...ses of acute urticaria and angioedema...
...es of Acute Urticaria, Angioedema,...
...tment...
...ephrine should be prescribed if the di...
...cases antihistamines are efficacious for therap...
...severe cases oral corticosteroids mig...
...re 1. Diagnosis and Management of Acute Urti...
...hronic Urticaria and A...
...is defined as urticaria that has been continuo...
...tion of CU varies considerably. However, phys...
...ome patients with CU might have both urticaria an...
...mast cells are the most important...
...of the coagulation cascade, includi...
...a patient with CU should involve consi...
...mmune disorders, including SLE, de...
...to diagnose underlying autoimmune diseas...
...tibodies are frequently identified in patients...
...urticarial vasculitis, associated with lo...
...ial vasculitic lesions can sometimes be evanesce...
...o-occurrence of CU with a number of conditions,...
...alignancies, such as lymphoproliferativ...
...mately 30%–50% of patients with CUε produce...
...the autologous serum skin test (ASST) a...
...athogenesis of autoantibody-associated...
...ents with CU who present with an otherwise u...
...aboratory testing based on history or physical...
...nitial patient evaluation should be...
...medical work-up of a patient with CU...
...r a thorough history and physical examinati...
...ng for thyroid disease is of low yield in patient...
...rcial assays are now available, the utility...
...current angioedema in the absence of coexisting ur...
...be performed when vasculitis is sus...
...hypersensitivity skin or serologic t...
...uidelines for Diagnostic Work-up of Patients with...
...valuation of Chronic Urticaria...
Physical Urticaria and AngioedemaIn a subgroup...
...ge Procedures for Physical Urticaria...
...ic Urticaria Aquagenic urticaria is...
...holinergic Urt...
...ents with cholinergic urticaria have hives that...
...n provoking factors for cholinergic urticaria inc...
...ative challenges that increase core bo...
The severity of cholinergic urticaria ranges from...
...ld Urticaria...
...with cold urticaria have pruritus and sw...
...diagnosis of cold urticaria can be confirme...
...treatment for cold urticaria is avoidance of cold...
...d Pressure Urticaria/Angioedema (DPUA)
...with DPUA have swelling (which can be p...
...nfirmed by a challenge with 15 lbs of weight...
...of DPUA differs from other types of CU/angioedema...
...ermatographia...
...dermatographia (also known as derm...
...nduced Urticaria And Anaphylaxis (EIAN)...
...ed by exercise can occur in patients with 2 condi...
...oups of patients with EIAn: one group ca...
Two subgroups of patients with food...
...rtant to distinguish EIAn from cholinergi...
...ends on determining whether the patient h...
...r Urticaria...
...h solar urticaria promptly (generally within 1–3...
...osis of solar urticaria can be confirm...
...tory Angioedema...
...nts with vibratory angioedema experience pruritu...
...ratory angioedema can be confirmed by demonstrat...
Differential Diagnosis
...ential Diagnosis...
...ntial Diagnosis (Table 4)...
...obulinemia is often found in many conditions...
...toinflammatory syndromes are a group of cond...
...ated periodic syndromes (also referred...
...ntemic or normocomplementemic urticarial...
...ntemic urticarial vasculitis syndrome (HUVS) i...
...elling of the area in the medial port...
...a-like dermatoses can occur at various s...
...nt with cyclical urticaria can have...
...odic attacks of angioedema with weight gain...
...hilic syndrome (HES) should be considered when...
...us mast cell disorders that can present with urt...
...ivation disorders can also present w...
...orme can resemble urticaria and might be caused b...
...or C can be associated with urticari...
...pemphigoid can present initially...
...tent swelling of the lips without evidenc...
...ht eruption differs from solar urticaria...
...aria is a condition in which urticaria is...
...ients with Schnitzler syndrome caused by...
...e 4. Common and Less/uncommon Urticaria Angio...
...auses of Autoantibody-associated Urticaria,...
...able 6. Other Dermatologic Diseases P...
...r C can be associated with urticarial vasculi...
...higoid can present initially with urticaria-like...
...tent swelling of the lips without evidence of ec...
...olymorphous light eruption differs from...
...urticaria is a condition in which u...
...nts with Schnitzler syndrome caused by an...
...ble 7. Very Rare Mimickers of Urticaria, Angioede...
Treatment
...reatment...
...definitive studies that demonstrate that p...
.... Step-care Approach to the Treatmen...
...macologic Therapies
...t, and tight clothing can exacerbate...
...oidance of pseudoallergens in the diet is NOT...
...pical Therapies...
...orticosteroids can improve symptoms fr...
...1–Antihistamine...
H-antagonists are effective in the maj...
...tion antihistamines are safe and effec...
...r doses of second-generation antihistamines might...
...ficacy of first-generation antihistamines...
...rst-generation antihistamines can be considered i...
...ntihistamines...
...tihistamines taken in combination with first-...
...dded efficacy might be related to pharmacolo...
...ents are well tolerated, the addition of H-antag...
...riene receptor antagonists have been shown in se...
...eceptor antagonists are generally well tolerat...
...ants With H1- And H2-Antagonist Activity...
...reatment with hydroxyzine or doxepin can be consi...
...temic Corticosteroids
...mic corticosteroids are frequently used in p...
...lternative Therapies In Patients Wi...
...ents with CU whose symptoms are not...
...r of alternative therapies have been studied for...
...lammatory agents, including dapsone, sulfasalazin...
...pressant Agents...
...unosuppressant agents have been used in patie...
Methotrexate: Experience with methotrexat...
...case reports and case series. ( C )564...
...limited evidence and potential for more serious a...
...iologic Agents...
...zumab: In contrast to other alternative agents fo...
...ral biologic agents, IV immunoglobulin, a...
...totherapy...
...apy might be effective for CIU as well as some ph...
...ecause of limited availability and frequency...
...aneous Alternative Agents...
...er agents have been used in patients wi...
...gents should be reserved for patien...
...Alternative Agents For Treatment Of Refractory Ur...
...le factors are involved in selecting an alternativ...
...s For Specific Conditions Associat...
...ence that H. pylori eradication lead...
...hyroid Autoantib...
...ause limited data support the use of thyroid hormo...
Herpes Infec...
...a support the use of antiviral therapies in p...
...mmune Progesterone And Estrogen De...
...ta are available for the use of hormonal...
...d/Controversial Therapies
...evidence is weak that pseudoallergen-free diets i...
...he lack of evidence and burden of adhering to the...
...d therapies for CU that are NOT recommend...
...e 8. Pharmacology of H1-antihistaminesHaving troub...
...e 9. Laboratory Monitoring of Alternative Age...