New approaches in treatment of physical urticarias

Urticaria and angioedema

This article discusses the allergist's or dermatologist's rational pathophysiologic approach to urticaria and angioedema. Every recognized cause is outlined and identified for preventing acute urticaria. Appreciating chronic urticaria as a "twitchy mast cell" syndrome is emphasized. The "art of pharmacologic" gymnastics is presented for the safest and most effective management of patients with urticaria.

Nimodipine versus terfenadine in the treatment of physical stimulus-induced urticaria

Basophil and mastocyte degranulation is calcium-dependent. Calcium-antagonists can inhibit synthesis of and release in vitro some mediators in various types of cells. Both immunologically stimulated and non-immunologically stimulated release of material from basophils isolated from normal and allergic subjects can be antagonized by calcium blockers. The present study was aimed at testing the therapeutic effects and side effects of nimodipine therapy, a new dihydropyridine anti-calcium derivative for physical stimulus-induced urticaria, in comparison with a standard H1-antihistamine therapy. The study was done in 32 outpatients who had physical stimulus-induced urticaria: 20 patients received nimodipine three times a day in a daily dose of 180 mg, 12 patients were treated with terfenadine in a dose of 120 mg. In the majority of patients treated with both nimodipine and terfenadine, satisfactory clinical results were obtained after 3 weeks of therapy. There were, however significant (P less than 0.05) differences in responses. Complete clearance after 3 weeks was noted in 50% patients treated with nimodipine, whereas only 16% of patients on terfenadine were completely clear, and some showed only slight improvement. The treatment was easily manageable, and with few side effects.