Idiopathic cold-induced urticarial vasculitis and monoclonal IgG gammopathy

Urticarial Vasculitis

Urticarial vasculitis is a rare autoimmune disorder characterized by persistent edematous papules and plaques on the skin that last longer than 24 hours, often accompanied by systemic symptoms such as joint pain and fever. Unlike common urticaria, this condition involves inflammation of small blood vessels, leading to more severe and long-lasting skin lesions with a tendency to leave a bruiselike appearance. Diagnosis is challenging and may require a skin biopsy. Associated with underlying autoimmune diseases, treatment involves managing symptoms with medications such as antihistamines and corticosteroids, addressing the immune system's dysfunction, and treating any concurrent autoimmune conditions.

The spectrum of acquired and familial cold-induced urticaria/urticaria-like syndromes

Acquired cold urticaria syndromes represent one of the more common forms of physical urticaria. The syndromes are heterogenous, and a diagnostic classification is presented to facilitate collation for future studies. Acquired cold urticaria represents an excellent reproducible in vivo model to investigate the mechanisms of urticaria. The discussion includes clinical manifestations, laboratory features, pathogenesis, and management of these disorders. A description of familial types, particularly familial cold auto-inflammatory syndrome (FCAS) that is manifested by cold-evoked signs and symptoms of chronic inflammation, is included. FCAS historically has been included with acquired cold urticaria, even though the exanthem of FCAS is maculopapular caused by leukocytic infiltration. FCAS has become an important investigative syndrome, as it represents a reproducible in vivo model of chronic inflammation.

Urticarial vasculitis and hypocomplementemic urticarial vasculitis syndrome

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.

Urticarial vasculitis

Chronic or recurrent urticarial lesions are common in both primary care and referral medicine. Diagnosis and treatment are usually a challenge for both the patient and the medical practitioner. Most patients are eventually diagnosed with chronic idiopathic urticaria. IgG autoantibody to IgE receptor or IgE itself causes urticarial lesions in 30% of these patients. Only a minority (approximately 10%) of patients with chronic urticarial lesions have urticarial vasculitis. Although some cases are benign, urticarial vasculitis by itself can cause significant morbidity, and it is often a manifestation of a serious illness. Successful diagnosis and treatment of urticarial vasculitis requires careful assessment over time for underlying diseases like systemic lupus erythematosus, hypocomplementemic urticarial vasculitis syndrome, Sjögren's syndrome, and mixed cryoglobulinemia.