1
|
Bernstein JA, Ziaie N, Criado R, Criado PR, Rea S, Davis M. Chronic Urticaria and Angioedema: Masqueraders and Misdiagnoses. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:2251-2263. [PMID: 37380071 DOI: 10.1016/j.jaip.2023.06.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 06/19/2023] [Accepted: 06/22/2023] [Indexed: 06/30/2023]
Abstract
Chronic urticaria is a common condition presenting with intensely pruritic wheals. Although individual lesions resolve within 24 hours, by definition, chronic urticaria lasts for a duration of at least 6 weeks. Both spontaneous and inducible forms exist. In the spontaneous variant, chronic urticaria occurs in the absence of clearly identifiable triggers. In chronic inducible urticaria, specific triggers may include dermatographism, cholinergic (heat), cold, exercise, delayed pressure, and solar. Extensive laboratory evaluation for chronic spontaneous urticaria is not required unless indicated by clinical history or physical examination. Angioedema describes sudden onset of localized edema involving the deep layers of the skin and submucosal tissues. It can be seen in isolation or in conjunction with chronic urticaria. Angioedema typically resolves slower than wheals, taking up to 72 hours or longer. Histamine- and bradykinin-mediated forms exist. Both chronic urticaria and angioedema have many mimics, and a broad range of differential diagnoses should be considered. Importantly, an incorrect diagnosis may have significant implications for the additional investigation, treatment, and prognosis of the affected patient. The aim of this article is to discuss the characteristics of chronic urticaria and angioedema, and an approach to the investigation and diagnosis of their mimics.
Collapse
Affiliation(s)
- Jonathan A Bernstein
- Department of Internal Medicine, Division of Allergy and Immunology, University of Cincinnati, Cincinnati, Ohio
| | - Navid Ziaie
- Department of Internal Medicine, Division of Allergy and Immunology, University of Cincinnati, Cincinnati, Ohio
| | - Roberta Criado
- Department of Dermatology, Faculdade de Medicina do ABC, Santo André, São Paulo, Brazil; Alergoskin Allergy and Dermatology, Santo André, São Paulo, Brazil
| | - Paulo Ricardo Criado
- Department of Dermatology, Faculdade de Medicina do ABC, Santo André, São Paulo, Brazil; Alergoskin Allergy and Dermatology, Santo André, São Paulo, Brazil
| | - Stephanie Rea
- Department of Dermatology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Mark Davis
- Department of Dermatology, Mayo Clinic, Rochester, Minn.
| |
Collapse
|
2
|
|
3
|
Peroni A, Colato C, Zanoni G, Girolomoni G. Urticarial lesions: if not urticaria, what else? The differential diagnosis of urticaria: part II. Systemic diseases. J Am Acad Dermatol 2010; 62:557-70; quiz 571-2. [PMID: 20227577 DOI: 10.1016/j.jaad.2009.11.687] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2009] [Revised: 11/02/2009] [Accepted: 11/10/2009] [Indexed: 12/15/2022]
Abstract
UNLABELLED There are a number of systemic disorders that can manifest with urticarial skin lesions, including urticarial vasculitis, connective tissue diseases, hematologic diseases, and autoinflammatory syndromes. All of these conditions may enter into the differential diagnosis of ordinary urticaria. In contrast to urticaria, urticarial syndromes may manifest with skin lesions other than wheals, such as papules, necrosis, vesicles, and hemorrhages. Lesions may have a bilateral and symmetrical distribution; individual lesions have a long duration, and their resolution frequently leaves marks, such as hyperpigmentation or bruising. Moreover, systemic symptoms, such as fever, asthenia, and arthralgia, may be present. The most important differential diagnosis in this group is urticarial vasculitis, which is a small-vessel vasculitis with predominant cutaneous involvement. Systemic involvement in urticarial vasculitis affects multiple organs (mainly joints, the lungs, and the kidneys) and is more frequent and more severe in patients with hypocomplementemia. Clinicopathologic correlation is essential to establishing a correct diagnosis. LEARNING OBJECTIVES After completing the learning activity, participants should be able to distinguish urticarial lesions suggesting diagnoses other than common urticaria; assess patients with urticarial lesions, and suspect systemic diseases presenting with urticarial skin lesions.
Collapse
Affiliation(s)
- Anna Peroni
- Department of Biomedical and Surgical Sciences, Section of Dermatology and Venereology, University of Verona, Verona, Italy
| | | | | | | |
Collapse
|
4
|
Affiliation(s)
- Nicholas A. Soter
- Ronald O. Perelman Department of Dermatology, New York University School of
Medicine, New York, New York
| |
Collapse
|
5
|
Lin RY. Urticarial vasculitis. Br J Dermatol 2008. [DOI: 10.1111/j.1365-2133.1996.tb07409.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
6
|
Davis MDP, Brewer JD. Urticarial vasculitis and hypocomplementemic urticarial vasculitis syndrome. Immunol Allergy Clin North Am 2004; 24:183-213, vi. [PMID: 15120147 DOI: 10.1016/j.iac.2004.01.007] [Citation(s) in RCA: 108] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Urticarial vasculitis is a clinicopathologic entity in which episodes of urticaria are accompanied by histopathologic features of cutaneous vasculitis. The histopathologic definition of vasculitis varies from report to report. In this article, vasculitis is defined as histopathologic features of blood vessel damage: There should be evidence of leukocytoclasis and vessel wall destruction, which may or may not be accompanied by fibrinoid deposits. Red blood cell extravasation and perivascular inflammatory cell infiltrate also may be present. The extent to which each of these elements must be present has been debated.
Collapse
Affiliation(s)
- Mark D P Davis
- Department of Dermatology, Mayo Clinic, 200 First Street SW, Rochester, MN 55095, USA.
| | | |
Collapse
|
7
|
Abstract
Urticaria and urticarial vasculitis may be triggered by allergens, infection, autoimmunity and other immunological conditions. Careful evaluation, skin biopsy and specific laboratory tests can assist in diagnosis. The appropriate use of antihistamines, glucocorticoids, and other immunomodulators are discussed.
Collapse
Affiliation(s)
- Bhuvana Guha
- Department of Medicine, East Tennessee State University, Johnson City, Tenn. 37614-0622, USA
| | | | | |
Collapse
|
8
|
Abstract
Viral hepatitis is a common disease with significant morbidity and mortality that is found throughout the world. It is a known cause of acute and chronic liver disease. Because the disease can be asymptomatic in its acute stages, the diagnosis is often missed. This article reviews the extrahepatic manifestations of the disease, in particular the visible cutaneous lesions, which offer clues to the diagnosis of viral hepatitis. Familiarity with the most common skin lesions associated with each type of hepatitis virus will be useful in identifying previously undiagnosed individuals. This article serves as a review of the most widely published associations between skin diseases and specific subtypes of viral hepatitis.
Collapse
Affiliation(s)
- Allyson M Jones
- Department of Internal Medicine, St. Joseph's Hospital, Houston, TX, USA
| | | | | |
Collapse
|
9
|
Ramos-Casals M, García-Carrasco M, Font Franco J, Ingelmo Morín M. Manifestaciones clínicas e inmunológicas asociadas a la infección crónica por el virus de la hepatitis C. Rev Clin Esp 2002. [DOI: 10.1016/s0014-2565(02)71033-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
10
|
Ramos-Casals M, Font J, Ingelmo M. [Prevalence and clinical significance of hepatitis C virus infection in systemic autoimmune diseases]. Med Clin (Barc) 2001; 116:701-9. [PMID: 11412684 DOI: 10.1016/s0025-7753(01)71958-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- M Ramos-Casals
- Unidad de Enfermedades Autoinmunes Sistémicas, Hospital Clínic, Barcelona, Spain
| | | | | |
Collapse
|
11
|
Affiliation(s)
- A K Black
- St. John's Institute of Dermatology, King's Medical School, St. Thomas Hospital, London, UK
| |
Collapse
|
12
|
Worm M, Muche M, Schulze P, Sterry W, Kolde G. Hypocomplementaemic urticarial vasculitis: successful treatment with cyclophosphamide-dexamethasone pulse therapy. Br J Dermatol 1998; 139:704-7. [PMID: 9892919 DOI: 10.1046/j.1365-2133.1998.02473.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Systemic hypocomplementaemic urticarial vasculitis unresponsive to several immunosuppressive and immunomodulatory drugs was seen in two women aged 43 and 45 years. Cyclophosphamide-dexamethasone pulse therapy was started in both patients and resulted in significant clinical improvement. The pulse treatment was well tolerated in both patients and no major adverse effects occurred. These cases indicate that cyclophosphamide-dexamethasone pulse therapy is efficient in the treatment of hypocomplementaemic urticarial vasculitis.
Collapse
Affiliation(s)
- M Worm
- Department of Dermatology, Charité Clinic, Humboldt University, Schumannstr. 20-21, D-10117 Berlin, Germany.
| | | | | | | | | |
Collapse
|
13
|
Buskila D, Shnaider A, Neumann L, Lorber M, Zilberman D, Hilzenrat N, Kuperman OJ, Sikuler E. Musculoskeletal manifestations and autoantibody profile in 90 hepatitis C virus infected Israeli patients. Semin Arthritis Rheum 1998; 28:107-13. [PMID: 9806371 DOI: 10.1016/s0049-0172(98)80043-7] [Citation(s) in RCA: 91] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Recent interest has been expressed in rheumatic manifestations in hepatitis C virus (HCV)-infected populations. The aim of this study was to determine the prevalence and characteristics of the musculoskeletal manifestations and serological markers of autoimmunity in HCV-infected patients in Israel. METHODS Ninety anti-HCV-positive patients were consecutively interviewed and examined. The prevalence of autoantibodies and their association with rheumatologic symptoms were also determined. RESULTS Rheumatic manifestations were found in 28 subjects (31%), and included arthralgias (9%), arthritis (4%), cryoglobulinemia (11%), sicca symptoms (8%), cutaneous vasculitis (2%), polymyositis (1%), and antiphospholipid syndrome (1%). Rheumatic complications were not associated with liver disease severity, or subjects' gender. In addition, myalgia was reported by 22 patients (24%), and fibromyalgia was diagnosed in 14 (16%). Sixty-nine percent of the patients had at least one autoantibody detected in their serum, the most prevalent being rheumatoid factor (RF), 44%; antinuclear antibody (ANA), 38%; and IgM and IgG anticardiolipin antibodies (ac1), 28% and 22%, respectively. The frequency of autoantibodies was not associated with liver disease severity or rheumatic disorders. CONCLUSIONS Musculoskeletal manifestations and autoimmune markers are common in HCV infection. An investigation of risk factors for HCV infection is pertinent in a patient presenting new rheumatic manifestations and should be included in the history of present illness. Future studies of these disorders may uncover the full spectrum of these associations and provide new insights into their operating mechanisms.
Collapse
Affiliation(s)
- D Buskila
- Department of Medicine B, Soroka Medical Center, Beer Sheeva, Israel
| | | | | | | | | | | | | | | |
Collapse
|
14
|
|
15
|
Abstract
Urticaria and angioedema are common processes that are experienced by 15% to 25% of the population at least once during a lifetime. This article presents an overview of urticaria and angioedema with emphasis on these processes as they relate to rheumatic disease. Discussion includes classification of urticaria and angioedema and recommended evaluation and treatment of patients presenting with such problems.
Collapse
|