1
|
Zysk W, Trzeciak M. Characterization of Chronic Urticaria and Associated Conditions - A Web-Based Survey. Dermatol Pract Concept 2023; 13:dpc.1301a56. [PMID: 36892341 PMCID: PMC9946080 DOI: 10.5826/dpc.1301a56] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2022] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION Chronic urticaria is a common disease, characterized by the development of wheals, angioedema, or both, which can be associated with several comorbidities. Most of the available studies have focused on specific common comorbidities and their association with CU, but have seldom reported the overall burden of comorbidities. OBJECTIVES This study aimed to investigate and analyze self-reported comorbidities in Polish patients with CU. METHODS An anonymous online survey consisting of 20 questions was conducted on members of an Urticaria group on the social media platform Facebook. A total of 102 people took part in this survey. The results were analyzed in Microsoft Excel 2016. RESULTS In the group, 95.1% were females and 4.9% males, with a mean age of 33.8 years. The most common diagnosed type of urticaria was spontaneous (52.9%). Angioedema accompanied urticaria in 68.6% of the respondents, mainly those with delayed pressure urticaria (86.4%). 85.3% of respondents reported comorbidities, most often atopic diseases and allergies (49%), chronic inflammation and infections (36.3%), thyroid (36.3%) and psychiatric disorders (25.5%). Moreover, in 30.4% of patients, at least one autoimmune disease was noted. As compared to the patients without autoimmune urticaria, many more with autoimmune urticaria had a coexisting autoimmune disease (50% vs. 23.7%). Family history of autoimmune diseases was positive in 42.2%, and the familial history of urticaria and atopy was positive in 7.8% and 25.5%, respectively. CONCLUSIONS The knowledge of comorbidities of chronic urticaria may support clinicians to manage and treat patients with this common condition.
Collapse
Affiliation(s)
- Weronika Zysk
- Dermatological Students Scientific Association, Department of Dermatology, Venereology and Allergology, Faculty of Medicine, Medical University of Gdansk, Poland
| | - Magdalena Trzeciak
- Department of Dermatology, Venereology and Allergology, Faculty of Medicine, Medical University of Gdansk, Poland
| |
Collapse
|
2
|
Konstantinou GN, Podder I. Delayed pressure urticaria manifesting as dyspareunia - is it that uncommon? Sex Health 2022; 19:488-489. [PMID: 35915554 DOI: 10.1071/sh22029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 07/07/2022] [Indexed: 01/27/2023]
Abstract
Delayed pressure urticaria (DPU) is a variant of physical urticaria characterised by reproducible whealing on application of sustained pressure to the skin. Clinical manifestations include delayed cutaneous erythema, edema and subcutaneous swelling, typically occurring 4-6h after application of mechanical pressure. Dyspareunia is defined as persistent or recurrent pain in the genital area or within the pelvis that occurs just before, during, or after sexual intercourse. We report an unusual case of DPU manifesting as dyspareunia.
Collapse
Affiliation(s)
- George N Konstantinou
- Department of Allergy and Clinical Immunology, 424 General Military Training Hospital, Thessaloniki, Greece
| | - Indrashis Podder
- Department of Allergy and Clinical Immunology, 424 General Military Training Hospital, Thessaloniki, Greece; and Department of Dermatology, College of Medicine and Sagore Dutta Hospital, Kolkata, West Bengal, India
| |
Collapse
|
3
|
Ibraheim MK, Rogge M. Patch Testing Conundrum: Interpretation in the Setting of Delayed Pressure Urticaria. Contact Dermatitis 2022; 86:553-554. [PMID: 35179775 DOI: 10.1111/cod.14080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/15/2022] [Accepted: 02/16/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Marina Kristy Ibraheim
- McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas
| | - Megan Rogge
- Department of Dermatology, University of Texas Health Science Center at Houston, Houston, Texas
| |
Collapse
|
4
|
Kulthanan K, Ungprasert P, Tuchinda P, Chularojanamontri L, Charoenpipatsin N, Maurer M. Delayed Pressure Urticaria: A Systematic Review of Treatment Options. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 8:2035-2049.e5. [PMID: 32179196 DOI: 10.1016/j.jaip.2020.03.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 02/10/2020] [Accepted: 03/03/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Delayed pressure urticaria (DPU) is characterized by recurrent erythematous and often painful swelling after the skin is exposed to sustained pressure. Treatment is challenging. Antihistamines, the first-line and only approved treatment, are often not effective. OBJECTIVE To systematically review the treatment options for DPU. METHOD A literature search of electronic databases for all relevant articles published till April 29, 2019, was conducted using the search terms "delayed pressure urticaria" and "pressure urticaria." This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations. RESULTS Twenty-one studies (8 randomized controlled trials [RCTs], 10 retrospective cohort studies, and 3 open-label prospective studies) were included. Second-generation H1 antihistamines (sgAHs) were effective in 3 RCTs. The combination of an sgAH and montelukast (2 RCTs) or an sgAH and theophylline (1 non-RCT) was more effective than the sgAH alone. The disease improved with omalizumab (4 non-RCTs), sulphones (3 non-RCTs), oral prednisolone (1 RCT and 2 non-RCTs), intravenous immunoglobulin (1 non-RCT), and gluten-free diet (1 non-RCT). There are no studies on updosing of antihistamines over standard dosage in DPU. CONCLUSIONS Overall, the quality of studies on DPU is low. Because of the lack of other evidence, antihistamines remain the first-line therapy. Updosing of sgAHs could be considered in patients with uncontrolled symptoms on the basis of the extrapolation of evidence from chronic spontaneous urticaria, even though there is no evidence of its efficacy over standard dosage. Addition of montelukast may be considered. Omalizumab or sulphones may be used in treatment-resistant patients. High-quality DPU studies should be conducted.
Collapse
Affiliation(s)
- Kanokvalai Kulthanan
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Patompong Ungprasert
- Clinical Epidemiology Unit, Department of Research and Development, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Papapit Tuchinda
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Leena Chularojanamontri
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Norramon Charoenpipatsin
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Marcus Maurer
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin, Germany.
| |
Collapse
|
5
|
Soliman YS, Lim HW, Kerr HA. Recalcitrant, delayed pressure urticaria treated with long-term intravenous immunoglobulin. JAAD Case Rep 2020; 6:176-177. [PMID: 32099887 PMCID: PMC7029339 DOI: 10.1016/j.jdcr.2019.01.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Yssra S. Soliman
- Department of Internal Medicine, Division of Dermatology, Albert Einstein College of Medicine, Bronx, New York
| | - Henry W. Lim
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | - Holly A. Kerr
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| |
Collapse
|
6
|
Maurer M, Fluhr JW, Khan DA. How to Approach Chronic Inducible Urticaria. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 6:1119-1130. [PMID: 30033913 DOI: 10.1016/j.jaip.2018.03.007] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 03/28/2018] [Accepted: 03/29/2018] [Indexed: 12/22/2022]
Abstract
Chronic inducible urticaria (CIndU) is a group of chronic urticarias characterized by the appearance of recurrent wheals, recurrent angioedema or both, as a response to specific triggers. CIndU includes both physical (symptomatic dermographism, cold and heat urticaria, delayed pressure urticaria, solar urticaria, and vibratory urticaria) and nonphysical urticarias (cholinergic urticaria, contact and aquagenic urticaria). Here, we review the different forms of CIndU with an emphasis on symptomatic dermographism, cold urticaria, cholinergic urticaria, and delayed pressure urticaria. We discuss the clinical features, the diagnostic workup including provocation and threshold testing, and available treatment options.
Collapse
Affiliation(s)
- Marcus Maurer
- Department of Dermatology and Allergy, Charité - Universitätsmedizin, Berlin, Germany.
| | - Joachim W Fluhr
- Department of Dermatology and Allergy, Charité - Universitätsmedizin, Berlin, Germany
| | - David A Khan
- Division of Allergy and Immunology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Tex
| |
Collapse
|
7
|
Antia C, Baquerizo K, Korman A, Bernstein JA, Alikhan A. Urticaria: A comprehensive review. J Am Acad Dermatol 2018; 79:599-614. [DOI: 10.1016/j.jaad.2018.01.020] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
8
|
Pandey S, Sinha RJ, Sharma D, Singh V. Delayed pressure urticaria due to non-invasive blood pressure monitoring in a previously non-atopic man. BMJ Case Rep 2018; 2018:bcr-2018-227267. [PMID: 30219788 DOI: 10.1136/bcr-2018-227267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Siddharth Pandey
- Department of Urology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Rahul Janak Sinha
- Department of Urology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Deepanshu Sharma
- Department of Urology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Vishwajeet Singh
- Department of Urology, King George's Medical University, Lucknow, Uttar Pradesh, India
| |
Collapse
|
9
|
Furtado I, Linda F, Pica S, Monteiro M. [Anesthetic management of late pressure angioedema]. Rev Bras Anestesiol 2017; 67:422-425. [PMID: 28442135 DOI: 10.1016/j.bjan.2017.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 09/12/2016] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Late pressure angioedema is a rare form of angioedema in which light pressure stimulus can lead to edema after 1-12h. This uncommon and unreported entity is especially important in patients who undergo general anesthesia, for whom the usual harmless supine position, intravenous catheter insertion, standard monitoring, airway management and ventilation can lead to life threatening consequences as the trigger is a physical stimulus. CASE REPORT In this report, we describe a successful perioperative anesthetic management of a 30 year old patient, proposed for intra-ocular lens insertion, with a severe form of the disease with peri-oral, tongue and limb edema presentation. CONCLUSION Due to lack of quality evidence, our conduct was based on the pathophysiology mechanisms of the syndrome, histamine and pro-inflammatory cytokines release, with special focus on a careful peri-operative assessment and prophylaxis, minimization of all the possible pressure stimulus, especially in the airway structures, and a strict post-operative monitoring.
Collapse
Affiliation(s)
- Inês Furtado
- Hospital Garcia de Orta, Departamento de Anestesiologia, Almada, Portugal.
| | - Filipe Linda
- Hospital Garcia de Orta, Departamento de Anestesiologia, Almada, Portugal
| | - Sílvia Pica
- Hospital Garcia de Orta, Departamento de Anestesiologia, Almada, Portugal
| | - Marco Monteiro
- Hospital Garcia de Orta, Departamento de Anestesiologia, Almada, Portugal
| |
Collapse
|
10
|
Magerl M, Altrichter S, Borzova E, Giménez-Arnau A, Grattan CEH, Lawlor F, Mathelier-Fusade P, Meshkova RY, Zuberbier T, Metz M, Maurer M. The definition, diagnostic testing, and management of chronic inducible urticarias - The EAACI/GA(2) LEN/EDF/UNEV consensus recommendations 2016 update and revision. Allergy 2016; 71:780-802. [PMID: 26991006 DOI: 10.1111/all.12884] [Citation(s) in RCA: 207] [Impact Index Per Article: 25.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2016] [Indexed: 01/13/2023]
Abstract
These recommendations for the definition, diagnosis and management of chronic inducible urticaria (CIndU) extend, revise and update our previous consensus report on physical urticarias and cholinergic urticaria (Allergy, 2009). The aim of these recommendations is to improve the diagnosis and management of patients with CIndU. Our recommendations acknowledge the latest changes in our understanding of CIndU, and the available therapeutic options, as well as the development of novel diagnostic tools.
Collapse
Affiliation(s)
- M. Magerl
- Department of Dermatology and Allergy; Allergie-Centrum-Charité; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - S. Altrichter
- Department of Dermatology and Allergy; Allergie-Centrum-Charité; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - E. Borzova
- Department of Clinical Allergology; Russian Medical Academy of Postgraduate Education; Moscow Russia
| | - A. Giménez-Arnau
- Department of Dermatology; Hospital del Mar; Institut Mar d′Investigacions Mèdiques IMIM; Universitat Autònoma Barcelona; Barcelona Spain
| | - C. E. H. Grattan
- Cutaneous Allergy; St John's Institute of Dermatology; St Thomas' Hospital; London UK
| | - F. Lawlor
- Cutaneous Allergy; St John's Institute of Dermatology; St Thomas' Hospital; London UK
| | | | - R. Y. Meshkova
- Klinika Medicinskoy Immunologii I Allergologii; Smolensk Russia
| | - T. Zuberbier
- Department of Dermatology and Allergy; Allergie-Centrum-Charité; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - M. Metz
- Department of Dermatology and Allergy; Allergie-Centrum-Charité; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - M. Maurer
- Department of Dermatology and Allergy; Allergie-Centrum-Charité; Charité - Universitätsmedizin Berlin; Berlin Germany
| |
Collapse
|
11
|
Chung WH, Chu CY, Huang YH, Wang WM, Yang CH, Tsai TF. Taiwanese Dermatological Association consensus for the definition, classification, diagnosis, and management of urticaria. J Formos Med Assoc 2015; 115:968-980. [PMID: 26679383 DOI: 10.1016/j.jfma.2015.09.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Revised: 09/17/2015] [Accepted: 09/18/2015] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND/PURPOSE This report describes the 2014 consensus of the Taiwanese Dermatological Association regarding the definition, classification, diagnosis, and management of urticaria. This consensus is distributed to practices throughout Taiwan to provide recommendations for diagnostic and therapeutic approaches for common subtypes of urticaria, in order to improve the quality of life of urticaria patients. The consensus, thus, serves as an important reference for dermatologists throughout Taiwan. METHODS All the consensus contents were voted on by the participating dermatologists, with approval by no less than 75% being required for inclusion. The consensus provides a comprehensive overview of urticaria, including recent advances in identifying its causes and the processes by which it develops. RESULTS All the consensus meeting attendees agreed to a definition of urticaria, which states that it is characterized by the sudden appearance of wheals (also known as hives), angioedema, or both. Most of the experts (16 out of 19, or 84.2%) agreed that chronic urticaria is defined as the sudden occurrence of wheals and/or angioedema for a period of ≥ 6 weeks. In addition, the consensus attendees also approved the Urticaria Activity Score system or the Urticaria Activity Score for 7 days system as the recommended method for assessing disease activity in spontaneous urticaria. CONCLUSION It was also determined that the treatment goal for patients with any form of urticaria should be complete cessation of suffering from all urticaria symptoms. The recommended treatment algorithms for chronic spontaneous urticaria and acute urticaria were finally proposed and approved by 100% (19/19) and 84.2% (16/19) of the consensus attendees, respectively.
Collapse
Affiliation(s)
- Wen-Hung Chung
- Department of Dermatology, Chang Gung University College of Medicine, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Chia-Yu Chu
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yu-Huei Huang
- Department of Dermatology, Chang Gung University College of Medicine, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Wei-Ming Wang
- Department of Dermatology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chih-Hsun Yang
- Department of Dermatology, Chang Gung University College of Medicine, Chang Gung Memorial Hospital, Taipei, Taiwan.
| | - Tsen-Fang Tsai
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
| |
Collapse
|
12
|
Abstract
This paper describes a case of a 13-year-old patient with a systemic hypersensitivity reaction to orthodontic treatment. Her allergy was investigated resulting in a provisional diagnosis of pressure urticaria. The aetiology, diagnosis and clinical management of allergic reactions to dental procedures are discussed.
Collapse
|
13
|
Swerlick RA, Puar N. Delayed pressure urticaria: response to treatment with sulfasalazine in a case series of seventeen patients. Dermatol Ther 2015; 28:318-22. [DOI: 10.1111/dth.12266] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Robert A. Swerlick
- Department of Dermatology; Emory University School of Medicine; Tagore Nagar Civil Lines
| | - Neha Puar
- Dayanand Medical College and Hospital; Tagore Nagar Civil Lines
| |
Collapse
|
14
|
Maurer M, Church M, Gonçalo M, Sussman G, Sánchez-Borges M. Management and treatment of chronic urticaria (CU). J Eur Acad Dermatol Venereol 2015; 29 Suppl 3:16-32. [DOI: 10.1111/jdv.13198] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 04/14/2015] [Indexed: 12/22/2022]
Affiliation(s)
- M. Maurer
- Department of Dermatology and Allergy; Allergie-Centrum-Charité; Charité - Universitatsmedizin Berlin; Berlin Germany
| | - M.K. Church
- Department of Dermatology and Allergy; Allergie-Centrum-Charité; Charité - Universitatsmedizin Berlin; Berlin Germany
| | - M. Gonçalo
- Clinic of Dermatology; University Hospital and Faculty of Medicine; University of Coimbra; Coimbra Portugal
| | - G. Sussman
- Division of Allergy and Clinical Immunology; St. Michael's Hospital and University of Toronto; Toronto ON Canada
| | - M. Sánchez-Borges
- Allergy and Clinical Immunology Department; Centro Médico-Docente La Trinidad; Caracas Venezuela
| |
Collapse
|
15
|
Holahan H, Farah R, Asarch A, Swick B, Liu V. Bullous lesions on the extremities of an incarcerated man. Clin Exp Dermatol 2015; 40:222-4. [DOI: 10.1111/ced.12491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2014] [Indexed: 11/27/2022]
Affiliation(s)
- H. Holahan
- Department of Dermatology; University of Iowa Hospitals and Clinics; Iowa City IA USA
| | - R. Farah
- Department of Dermatology; University of Iowa Hospitals and Clinics; Iowa City IA USA
| | - A. Asarch
- Department of Dermatology; University of Iowa Hospitals and Clinics; Iowa City IA USA
| | - B. Swick
- Department of Dermatology; University of Iowa Hospitals and Clinics; Iowa City IA USA
| | - V. Liu
- Department of Dermatology; University of Iowa Hospitals and Clinics; Iowa City IA USA
| |
Collapse
|
16
|
Zuberbier T, Aberer W, Asero R, Bindslev-Jensen C, Brzoza Z, Canonica GW, Church MK, Ensina LF, Giménez-Arnau A, Godse K, Gonçalo M, Grattan C, Hebert J, Hide M, Kaplan A, Kapp A, Abdul Latiff AH, Mathelier-Fusade P, Metz M, Nast A, Saini SS, Sánchez-Borges M, Schmid-Grendelmeier P, Simons FER, Staubach P, Sussman G, Toubi E, Vena GA, Wedi B, Zhu XJ, Maurer M. The EAACI/GA(2) LEN/EDF/WAO Guideline for the definition, classification, diagnosis, and management of urticaria: the 2013 revision and update. Allergy 2014; 69:868-87. [PMID: 24785199 DOI: 10.1111/all.12313] [Citation(s) in RCA: 668] [Impact Index Per Article: 66.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2013] [Indexed: 12/13/2022]
Abstract
This guideline is the result of a systematic literature review using the 'Grading of Recommendations Assessment, Development and Evaluation' (GRADE) methodology and a structured consensus conference held on 28 and 29 November 2012, in Berlin. It is a joint initiative of the Dermatology Section of the European Academy of Allergy and Clinical Immunology (EAACI), the EU-funded network of excellence, the Global Allergy and Asthma European Network (GA(2) LEN), the European Dermatology Forum (EDF), and the World Allergy Organization (WAO) with the participation of delegates of 21 national and international societies. Urticaria is a frequent, mast cell-driven disease, presenting with wheals, angioedema, or both. The life-time prevalence for acute urticaria is approximately 20%. Chronic spontaneous urticaria and other chronic forms of urticaria do not only cause a decrease in quality of life, but also affect performance at work and school and, as such, are members of the group of severe allergic diseases. This guideline covers the definition and classification of urticaria, taking into account the recent progress in identifying its causes, eliciting factors and pathomechanisms. In addition, it outlines evidence-based diagnostic and therapeutic approaches for the different subtypes of urticaria. This guideline was acknowledged and accepted by the European Union of Medical Specialists (UEMS).
Collapse
Affiliation(s)
- T. Zuberbier
- Department of Dermatology and Allergy; Allergy-Centre-Charité; Charité - University Hospital Berlin; Berlin Germany
| | - W. Aberer
- Department of Dermatology; Medical University of Graz; Graz Austria
| | - R. Asero
- Allergy Clinic; Clinica San Carlo; Paderno Dugnano MI Italy
| | - C. Bindslev-Jensen
- Department of Dermatology and Allergy Centre; Odense University Hospital; University of Southern Denmark; Odense Denmark
| | - Z. Brzoza
- Department of Internal Diseases, Allergology and Clinical Immunology in Katowice; Medical University of Silesia; Zabrze Poland
| | - G. W. Canonica
- Respiratory Diseases & Allergy; University of Genoa; IRCCS AOU SanMartino; Genoa Italy
| | - M. K. Church
- Department of Dermatology and Allergy; Allergy-Centre-Charité; Charité - University Hospital Berlin; Berlin Germany
| | - L. F. Ensina
- Department of Clinical Immunology and Allergy; Federal University of Sao Paulo; Sao Paulo Brazil
| | - A. Giménez-Arnau
- Hospital del Mar. Parc de Salut Mar; Universitat Autònoma Barcelona; Barcelona Spain
| | - K. Godse
- Department of Dermatology; Dr. D. Y. Patil Medical College & Hospital; Nerul Navi Mumbai India
| | - M. Gonçalo
- Clinic of Dermatology; Faculty of Medicine and University Hospital; Coimbra Portugal
| | - C. Grattan
- St John's Institute of Dermatology; Guy's and St Thomas' Hospitals NHS Foundation Trust; London UK
| | - J. Hebert
- Center for Applied Research on Allergy Québec; Québec QC Canada
| | - M. Hide
- Department of Dermatology; Institute of Biomedical and Health Sciences; Hiroshima University; Hiroshima Japan
| | - A. Kaplan
- Division of Pulmonary and Critical Care Medicine, Allergy and Clinical Immunology; Department of Medicine; Medical University of South Carolina; Charleston SC USA
| | - A. Kapp
- Department of Dermatology and Allergy; Hannover Medical School; Hannover Germany
| | - A. H. Abdul Latiff
- Department of Paediatrics; Pantai Hospital Kuala Lumpur; Bangsar Kuala Lumpur Malaysia
| | - P. Mathelier-Fusade
- Department of Dermatology and Allergy; University Hospital of Tenon; Paris France
| | - M. Metz
- Department of Dermatology and Allergy; Allergy-Centre-Charité; Charité - University Hospital Berlin; Berlin Germany
| | - A. Nast
- Department of Dermatology and Allergy; Allergy-Centre-Charité; Charité - University Hospital Berlin; Berlin Germany
| | - S. S. Saini
- Johns Hopkins Asthma and Allergy Center; Baltimore MD USA
| | - M. Sánchez-Borges
- Allergy and Clinical Immunology Department Centro Médico-Docente La Trinidad; Caracas Venezuela
| | | | - F. E. R. Simons
- Departments of Pediatrics & Child Health, Immunology; University of Manitoba; Winnipeg MB Canada
| | - P. Staubach
- Department of Dermatology; University Medical Center Mainz; Mainz Germany
| | - G. Sussman
- Division of Allergy and Clinical Immunology; University of Toronto; Toronto ON Canada
| | - E. Toubi
- Bnai-Zion Medical Center; Faculty of Medicine; Technion; Haifa Israel
| | - G. A. Vena
- Unit of Dermatology and Venereology; Department of Biomedical Sciences and Human Oncology; University of Bari; Bari Italy
| | - B. Wedi
- Department of Dermatology and Allergy; Hannover Medical School; Hannover Germany
| | - X. J. Zhu
- Department of Dermatology; Peking University First Hospital; Beijing China
| | - M. Maurer
- Department of Dermatology and Allergy; Allergy-Centre-Charité; Charité - University Hospital Berlin; Berlin Germany
| | | | | | | | | |
Collapse
|
17
|
Abstract
Physical urticaria is a rare but challenging subset of chronic urticaria. Wheals of pressure urticaria are typically delayed in appearance. A pressure test can easily be done to confirm the diagnosis.
Collapse
Affiliation(s)
- Angela De Cunto
- Institute for Maternal and Child Health-IRCCS Burlo Garofolo, University of Trieste, Via dell'Istria 67/1, 34100, Trieste, Italy.
| | | | | | | |
Collapse
|
18
|
Odek C, Kendirli T, Cipe F, Katlan B, Doğu F. Pressure-induced angioedema associated with endotracheal tube: successful treatment with epinephrine in two cases. Eur J Pediatr 2012; 171:1573-5. [PMID: 22527569 DOI: 10.1007/s00431-012-1738-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Accepted: 04/03/2012] [Indexed: 11/30/2022]
Abstract
UNLABELLED Pressure-induced urticaria is a non-immunoglobulin E-mediated type of urticaria. Some patients only have angioedema, and the term pressure-induced angioedema (PIA) is more appropriate for them. PIA has not previously been reported in association with endotracheal tube. Here we describe two patients who developed PIA after endotracheal intubation. There were no histories of angioedema, drug and food allergy in both patients. Tests for specific aero-allergens and latex were negative. Serum total immunoglobulin E and C4 levels were in normal ranges. Antihistamines and intravenous steroid therapy were ineffective. Angioedema regressed with intravenous epinephrine infusion and did not relapse after extubation. CONCLUSION We suggest that endotracheal tubes can cause PIA. Epinephrine therapy should be used early at treatment, especially in the patients who are at great risk for life-threatening airway problems.
Collapse
Affiliation(s)
- Cağlar Odek
- Department of Pediatric Critical Care, Ankara University Faculty of Medicine, 06100 Ankara, Turkey.
| | | | | | | | | |
Collapse
|
19
|
Late Dysphagia and dyspnea as complications of esophagogastroduodenoscopy in delayed pressure urticaria: case report. Dysphagia 2011; 27:148-50. [PMID: 21643940 DOI: 10.1007/s00455-011-9348-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2010] [Accepted: 05/20/2011] [Indexed: 10/18/2022]
Abstract
Delayed pressure urticaria (DPU) is characterized by swelling in the area of sustained pressure on the skin. The reported case was a potentially life-threatening complication due to mucosal edema following esophagogastroduodenoscopy (EGD). A 37-year-old man, suffering from severe DPU and chronic spontaneous urticaria, had undergone EGD due to dyspeptic symptoms. A few hours after the EGD procedure, the patient showed both dysphagia and dyspnea. A physical examination indicated massive tongue base and pharynx edema. We suggest that these symptoms were most likely due to the pressure exerted by EGD. No other apparent origins such as angioedema or late-phase allergic reaction to drugs were identified. One should be aware of the increased risk of developing airway and gastrointestinal obstruction during medical procedures associated with compression, such as EGD or endotracheal intubation, in DPU patients.
Collapse
|
20
|
Periorbital Physical Urticaria in an Anophthalmic Patient With Dermatographism. Ophthalmic Plast Reconstr Surg 2011; 27:e20-1. [DOI: 10.1097/iop.0b013e3181df6b0a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
21
|
Kasperska-Zając A, Jasinska T. Analysis of plasma d-dimer concentration in patients with delayed pressure urticaria. J Eur Acad Dermatol Venereol 2010; 25:232-4. [DOI: 10.1111/j.1468-3083.2010.03699.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
22
|
Urticarial lesions: if not urticaria, what else? The differential diagnosis of urticaria: part I. Cutaneous diseases. J Am Acad Dermatol 2010; 62:541-55; quiz 555-6. [PMID: 20227576 DOI: 10.1016/j.jaad.2009.11.686] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2009] [Revised: 11/02/2009] [Accepted: 11/10/2009] [Indexed: 11/22/2022]
Abstract
UNLABELLED Acute urticaria is self-limiting, and a cause can be identified in many patients. Chronic urticaria is a long lasting disease, and patients are commonly examined for an autoimmune origin and for associated diseases. Although the diagnosis of urticaria is straightforward in most patients, it may pose some difficulties at times and it may require a careful differential diagnosis with a number of conditions. Urticarial syndromes comprise both cutaneous and systemic disorders. Part I of this two-part series focuses on the clinical and histologic features that characterize common urticaria and on the cutaneous diseases that may manifest with urticarial lesions and must be considered in the differential diagnosis. LEARNING OBJECTIVES After completing the learning activity, participants should be able to distinguish between the typical wheals of urticaria and urticarial lesions suggesting other diagnoses and to assess patients with urticarial lesions in order to exclude or confirm other cutaneous diseases.
Collapse
|
23
|
Abstract
Chronic urticaria is a common disease characterized by recurrent pruritic wheals with surrounding erythema for >6 weeks. It is associated with a significant health care burden and affects patient quality of life. The etiology of chronic urticaria is often difficult to elucidate; however, known etiologies include autoimmune urticaria, physical urticarias (eg, cold, cholinergic, and delayed pressure urticaria), and idiopathic urticaria. The etiology is unknown in many patients, leading to a diagnosis of chronic idiopathic urticaria. The diagnosis of chronic idiopathic urticaria can be challenging for the primary care physician because of the disease's chronic symptoms. Diagnosis requires a detailed patient history and comprehensive physical examination, with additional testing tailored to the patient's history. Effective treatments include antihistamines, leukotriene receptor antagonists in combination with antihistamines, and oral immunomodulatory drugs, including corticosteroids, cyclosporine, dapsone, hydroxychloroquine, and sulfasalazine. Newer experimental therapies include intravenous immunoglobulin and omalizumab. This article reviews the pathophysiology, diagnosis, and treatment of chronic urticaria.
Collapse
Affiliation(s)
- Luz Fonacier
- Winthrop University Hospital, Mineola, NY 11501, USA.
| | | | | |
Collapse
|
24
|
Dortas Jr SD, Valle SOR, Pires AHS, Guimarães PV, Jorge AS. Urticária de pressão tardia com manifestações sistêmicas: relato de caso. An Bras Dermatol 2009; 84:671-4. [PMID: 20191182 DOI: 10.1590/s0365-05962009000600016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2008] [Accepted: 07/01/2009] [Indexed: 11/21/2022] Open
Abstract
A Urticária de Pressão Tardia é considerada uma doença rara, cujo quadro clínico é diferente da urticária clássica e pode envolver manifestações sistêmicas. Sendo assim,o diagnóstico é pouco frequente, até mesmo pelos especialistas. Neste artigo, apresentamos uma paciente, com história típica de lesões desencadeadas por pressão e que, por apresentar febre e leucocitose, foi internada para investigação de quadro infeccioso.
Collapse
|
25
|
Magerl M, Borzova E, Giménez-Arnau A, Grattan CEH, Lawlor F, Mathelier-Fusade P, Metz M, Młynek A, Maurer M. The definition and diagnostic testing of physical and cholinergic urticarias--EAACI/GA2LEN/EDF/UNEV consensus panel recommendations. Allergy 2009; 64:1715-21. [PMID: 19793059 DOI: 10.1111/j.1398-9995.2009.02177.x] [Citation(s) in RCA: 98] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The recommendations for the definition and diagnosis presented in this position paper are the result of a panel consensus meeting held in December 2008 in Berlin. This consensus meeting was a joint initiative of EAACI (European Academy of Allergology and Clinical Immunology) Dermatology Section, the EU-funded network of excellence, GA(2)LEN (Global Allergy and Asthma European Network), the EDF (European Dermatology Forum) and UNEV (urticaria network e.V.). The aim of these recommendations is to improve the diagnosis and management of patients with physical urticaria or cholinergic urticaria and to promote research and a better understanding of these diseases. Our recommendations used the paper produced by a 1996 expert meeting (1) and they acknowledge the latest changes in our understanding of physical urticarias and cholinergic urticaria as well as the recent development of novel diagnostic tools. In addition, this consensus paper highlights areas of need for further research.
Collapse
Affiliation(s)
- M Magerl
- Department of Dermatology and Allergy, Allergie-Centrum-Charité, Charité- Universitätsmedizin, Berlin, Germany
| | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Cassano N, Mastrandrea V, Vestita M, Vena GA. An overview of delayed pressure urticaria with special emphasis on pathogenesis and treatment. Dermatol Ther 2009; 22 Suppl 1:S22-6. [PMID: 19891688 DOI: 10.1111/j.1529-8019.2009.01268.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Nicoletta Cassano
- 2nd Dermatology Clinic, Department of Internal Medicine, Immunology and Infectious Diseases, University of Bari, Bari, Italy
| | | | | | | |
Collapse
|
27
|
Gregoriou S, Rigopoulos D, Katsambas A, Katsarou A, Papaioannou D, Gkouvi A, Kontochristopoulos G, Danopoulou I, Stavrianeas N, Kalogeromitros D. Etiologic aspects and prognostic factors of patients with chronic urticaria: nonrandomized, prospective, descriptive study. J Cutan Med Surg 2009; 13:198-203. [PMID: 19706227 DOI: 10.2310/7750.2008.08035] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Studies investigating etiologic factors in chronic urticaria are based on small populations of a few hundred patients. In addition, data on prognostic factors of the disorder are scarce. OBJECTIVE To investigate the etiologic and prognostic factors of chronic urticaria on a large population referred to tertiary specialized hospital departments. METHODS The study investigated 2,523 patients with chronic urticaria and a negative autologous serum skin test using anamnesis, and the literature suggested laboratory tests for etiologic factors of the disorder. The patients were prescribed cetirizine 10 mg daily plus treatment of any underlying disorders illuminated by the laboratory investigation. The rescue medicine was loratadine 10 mg. The patients were evaluated every 3 months. Comparative statistical methods were used to evaluate the prognostic factors having an impact on the duration of the disorder until resolution of symptoms. RESULTS Etiologic factors of chronic urticaria-angioedema were identified in 38.7% of the patients. Physical urticarias had a prevalence of 17.1% in the population under study. Other common etiologic factors identified included infection (7.7%) and autoimmune thyropathy (7.3%). Multiple regression analysis showed that female gender, long duration of the disorder at the initial examination, the presence of angioedema, and physical urticarias are associated with worse prognosis of the disorder, whereas increased self-reported stress and psychiatric disease had no impact on the course of the disorder. CONCLUSION A detailed medical history and selective laboratory tests can illuminate etiologic factors in less than 40% of patients with chronic urticaria. Prognostic factors identified to impact the natural history of the disorder could be helpful when designing studies assessing the efficacy of therapeutic agents for chronic urticaria.
Collapse
Affiliation(s)
- Stamatis Gregoriou
- Department of Dermatology, Andreas Sygros Hospital, University of Athens, 16121, Athens, Greece.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Zuberbier T, Asero R, Bindslev‐Jensen C, Walter Canonica G, Church MK, Giménez‐Arnau A, Grattan CEH, Kapp A, Merk HF, Rogala B, Saini S, Sánchez‐Borges M, Schmid‐Grendelmeier P, Schünemann H, Staubach P, Vena GA, Wedi B, Maurer M. EAACI/GA(2)LEN/EDF/WAO guideline: definition, classification and diagnosis of urticaria. Allergy 2009; 64:1417-1426. [PMID: 19772512 DOI: 10.1111/j.1398-9995.2009.02179.x] [Citation(s) in RCA: 443] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
This guideline, together with its sister guideline on the management of urticaria [Zuberbier T, Asero R, Bindslev-Jensen C, Canonica GW, Church MK, Giménez-Arnau AM et al. EAACI/GA(2)LEN/EDF/WAO Guideline: Management of urticaria. Allergy, 2009; 64:1427-1443] is the result of a consensus reached during a panel discussion at the 3rd International Consensus Meeting on Urticaria, Urticaria 2008, a joint initiative of the Dermatology Section of the European Academy of Allergology and Clinical Immunology (EAACI), the EU-funded network of excellence, the Global Allergy and Asthma European Network (GA(2)LEN), the European Dermatology Forum (EDF) and the World Allergy Organization (WAO). Urticaria is a frequent disease. The life-time prevalence for any subtype of urticaria is approximately 20%. Chronic spontaneous urticaria and other chronic forms of urticaria do not only cause a decrease in quality of life, but also affect performance at work and school and, as such, are members of the group of severe allergic diseases. This guideline covers the definition and classification of urticaria, taking into account the recent progress in identifying its causes, eliciting factors, and pathomechanisms. In addition, it outlines evidence-based diagnostic approaches for different subtypes of urticaria. The correct management of urticaria, which is of paramount importance for patients, is very complex and is consequently covered in a separate guideline developed during the same consensus meeting. This guideline was acknowledged and accepted by the European Union of Medical Specialists (UEMS).
Collapse
Affiliation(s)
- T. Zuberbier
- Department of Dermatology and Allergy, Charité– Universitätsmedizin Berlin, Germany
| | - R. Asero
- Ambulatorio di Allergologia, Clinica San Carlo, Paderno Dugnano (MI), Italy
| | - C. Bindslev‐Jensen
- Allergy Centre, Department of Dermatology, Odense University Hospital, Denmark
| | - G. Walter Canonica
- Allergy and Respiratory Diseases, DIMI – University of Genoa, Genoa, Italy
| | - M. K. Church
- Department of Dermatology and Allergy, Charité– Universitätsmedizin Berlin, Germany
| | - A. Giménez‐Arnau
- Department of Dermatology, Hospital del Mar, IMAS, Universitat Autònoma of Barcelona, Spain
| | - C. E. H. Grattan
- Dermatology Centre, Norfolk & Norwich University Hospital, Norwich, UK
| | - A. Kapp
- Department of Dermatology and Allergology, Hannover Medical University, Germany
| | - H. F. Merk
- Department of Dermatology, University Hospital RWTH Aachen, Germany
| | - B. Rogala
- Clinical Department of Internal Diseases, Allergology and Clinical Immunology, Medical University of Silesia, Poland
| | - S. Saini
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - M. Sánchez‐Borges
- Allergy and Immunology Department, Centro Medico‐Docente La Trinidad, Caracas, Venezuela
| | | | - H. Schünemann
- Department of Clinical Epidemiology & Biostatistics, Hamilton, Canada
| | - P. Staubach
- Department of Dermatology, Johannes Gutenberg‐University, Mainz, Germany
| | - G. A. Vena
- Unit of Dermatology, University of Bari, Bari, Italy
| | - B. Wedi
- Department of Dermatology and Allergology, Hannover Medical University, Germany
| | - M. Maurer
- Department of Dermatology and Allergy, Charité– Universitätsmedizin Berlin, Germany
| | | | | | | | | |
Collapse
|
29
|
Jauhar S, Staines K, McQueen M, Watson IB, Wray D, Felix DH. Dermographism and delayed pressure urticaria. ACTA ACUST UNITED AC 2007; 103:774-9. [PMID: 17331756 DOI: 10.1016/j.tripleo.2006.11.052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2006] [Revised: 11/27/2006] [Accepted: 11/29/2006] [Indexed: 11/22/2022]
Abstract
There are few papers in the literature that describe pressure urticaria in the maxillofacial region. We present 2 cases and discuss the significance and principles of management. One case describes the diagnosis of pressure urticaria and the second describes the dental management of a patient with severe pressure urticaria.
Collapse
Affiliation(s)
- Sachin Jauhar
- Glasgow Dental Hospital and School, Glasgow, Scotland.
| | | | | | | | | | | |
Collapse
|
30
|
Abstract
There are many conditions that may present with swelling that mimics angioedema. When swelling persists for greater than a few days or is unresponsive to treatment for urticaria/angioedema, other etiologies should be considered. In most instances, a thorough history and physical examination will define other etiologies. However, for more persistent conditions, further laboratory evaluation and a biopsy may be required to define the diagnosis. Rarely is a more aggressive approach required to make the diagnosis. Clinicians should remember that if the swelling does not act like angioedema, it more than likely is not angioedema.
Collapse
Affiliation(s)
- David Weldon
- Texas A&M University Health Sciences Center, College Station, TX 77840, USA.
| |
Collapse
|
31
|
Kalogeromitros D, Kempuraj D, Katsarou-Katsari A, Gregoriou S, Makris M, Boucher W, Theoharides TC. Theophylline as "add-on" therapy in patients with delayed pressure urticaria: a prospective self-controlled study. Int J Immunopathol Pharmacol 2005; 18:595-602. [PMID: 16164841 DOI: 10.1177/039463200501800320] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Delayed pressure urticaria (DPU) is a skin condition that involves the gradual development of wheals and edema at sites of physical pressure. Its pathogenesis is not clear and histamine-1 receptor (H-1R) antagonists provide only partial relief. In this prospective, clinical study, we investigated the effect of theophylline, which has a long history of benefit in allergic asthma, added to cetirizine in patients with DPU. Twenty three patients received during period 1 cetirizine (10 mg po QD) and theophylline (200 mg po BID) for 6 months, followed by period 2 of 1 month washout with only rescue medication as needed, and then by period 3 with cetirizine (10 mg QD plus placebo (BID) for 5 more months. The addition of theophylline resulted in statistically significant improvement over cetirizine alone by 2 months and continued for the duration of treatment. Treatment of cultured human mast cells with theophylline (10 microM) did not inhibit allergic histamine release, but the in vivo beneficial effect of theophylline may require significant pretreatment period to manifest itself, or may involve inhibition of other mast cell dependent mediators. A double-blind study, accompanied by serum histamine and tryptase levels, should be in order.
Collapse
Affiliation(s)
- D Kalogeromitros
- Division of Allergy and Clinical Immunology, Attikon Hospital, University of Athens School of Medicine, Athens, Greece
| | | | | | | | | | | | | |
Collapse
|
32
|
Vena GA, Cassano N, D'Argento V, Milani M. Clobetasol propionate 0·05% in a novel foam formulation is safe and effective in the short-term treatment of patients with delayed pressure urticaria: a randomized, double-blind, placebo-controlled trial. Br J Dermatol 2005; 154:353-6. [PMID: 16433809 DOI: 10.1111/j.1365-2133.2005.06986.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Delayed pressure urticaria (DPU) is characterized by the appearance of typical painful skin lesions (weals) after pressure stimulus. Oral corticosteroids are effective treatments but long-term therapy is problematic. A new topical formulation of clobetasol propionate 0.05% in thermophobic foam (CF) (Olux) has recently become available. The foam is easy to apply, with low skin residues. OBJECTIVES To evaluate in a double-blind placebo-controlled trial the efficacy, tolerability and safety of CF in the topical treatment of DPU. METHODS Twenty-six subjects with a positive history of DPU (13 men, mean age 44 years) were enrolled in a 4-week trial. CF or the corresponding placebo were applied twice daily. Drug application was performed in the most affected areas and in a target area where a standardized pressure challenge test was performed at baseline and at week 4. Efficacy was evaluated by scoring skin lesions regarding erythema, oedema and itching (0, no sign; 4, severe signs) and by calculating the area of the pressure challenge-induced lesion. Safety was evaluated by measuring plasma levels of adrenocorticotropic hormone (ACTH) and cortisol. RESULTS CF significantly (P = 0.0001) reduced lesion area by 84% in comparison with baseline values and by 97% in comparison with the placebo group values. Lesion area in the CF group was reduced from 144 cm(2) to 21 cm(2) at the end of the study. No significant differences in lesion area and clinical lesion scores were observed in the placebo group (lesion area 201 cm(2) at baseline; 216 cm(2) after 4 weeks). A significant clinical improvement was observed in all treated skin areas in the CF group. Mean +/- SD erythema score was reduced by CF from 1.8 +/- 0.6 at baseline to 0.6 +/- 0.5 at the end of the treatment (P = 0.001). Similar modifications were observed also for oedema (from 1.6 +/- 0.6 to 0.2 +/- 0.5) and itching score. Nonsignificant modifications of plasma levels of ACTH, cortisol and glucose were observed in both study groups, in comparison with baseline values. No adverse events were recorded during the trial in either treatment group. CONCLUSIONS CF is effective, safe, convenient and well tolerated in the short-term treatment of DPU.
Collapse
Affiliation(s)
- G A Vena
- MIDIM Department, 2nd Dermatology Clinic, University of Bari, Bari, Italy
| | | | | | | |
Collapse
|
33
|
Kerstan A, Rose C, Simon D, Simon HU, Bröcker EB, Trautmann A, Leverkus M. Bullous delayed pressure urticaria: pathogenic role for eosinophilic granulocytes? Br J Dermatol 2005; 153:435-9. [PMID: 16086763 DOI: 10.1111/j.1365-2133.2005.06677.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Bullous delayed pressure urticaria (DPU) is a rare variant of DPU. Treatment of DPU is difficult and the underlying pathogenic mechanism of DPU remains elusive. We report a 72-year-old man with DPU and associated chronic urticaria as well as delayed urticarial dermographism. Pressure challenge gave rise to a deep weal covered by multiple vesicles and bullae after 24 h. Histological examination of a skin biopsy specimen obtained 24 h after pressure challenge demonstrated intraepidermal bullae filled with eosinophils accompanied by a dense, predominantly eosinophilic infiltrate in the dermis. Whereas the numbers and morphology of mast cells were unaltered, the extracellular deposition of eosinophil cationic protein revealed evidence for eosinophil activation. Concomitantly, both CD4+ and CD8+ T lymphocytes were present in the infiltrate and expressed interleukin 5. As bullous DPU may represent the maximal variant of DPU, the investigation of the cellular infiltrate and the chemokines/cytokines released may reveal potential pathogenic mechanisms. A possible effector role of eosinophilic granulocytes, T-cell subsets and mast cells is discussed.
Collapse
Affiliation(s)
- A Kerstan
- Department of Dermatology Venerology and Allerology, University of Würzburg, Germany
| | | | | | | | | | | | | |
Collapse
|
34
|
Abstract
Persistent or frequent episodes of urticaria are difficult to evaluate and treat. The best test to identify most patients with a specific underlying cause (eg, physical trigger, allergen, systemic disease) likely is the taking of a careful and detailed history and performance of a physical examination by a specialist who is knowledgeable in urticarial disease. Further study of the pathogenesis and treatment of urticaria is crucial. Given the limited efficacy of presently approved antihistamine treatments and the significant side effects of steroids and cyclosporine, there is a pressing need to evaluate other anecdotally supported urticaria treatments in randomized, controlled trials.
Collapse
Affiliation(s)
- Donald A Dibbern
- Division of Allergy and Clinical Immunology, Oregon Health and Sciences University, 3181 SW Sam Jackson Park Drive, OP34, Portland, OR 97239-3098, USA
| | | |
Collapse
|