acute idiopathic urticaria

Cimetidine and chlorpheniramine in the treatment of chronic idiopathic urticaria: a multi-centre randomized double-blind study. [11] Urticarial reactions to penicillin can occur as long as 14 days after a course of treatment has stopped. Dermographism is diagnosed by taking a tongue blade and drawing it over the skin of the arm or back. For some cases of urticaria, especially chronic urticaria, no cause can be found, despite exhaustive efforts. ), Urticaria results from the release of histamine, bradykinin, leukotriene C4, prostaglandin D2, and other vasoactive substances from mast cells and basophils in the dermis. The condition becomes chronic when the lesions persists longer than 6 weeks. Oral contraceptive use or changes in the menstrual cycle have been reported as a possible cause of urticaria: patients commonly report worsening of hives with the menstrual cycle. Kaplan AP, Joseph K, Maykut RJ, Geba GP, Zeldin RK. Arch Dermatol. Avoiding exercise or foods that cause the mentioned symptoms is very important. The common form of cold urticaria demonstrates itself with the rapid onset of hives on the face, neck, or hands after exposure to cold. 117(1):81-8. Cardinale F, Mangini F, Berardi M, Sterpeta Loffredo M, Chinellato I, Dellino A, et al. (See Etiology. Pediatr Dermatol. 1998 Nov. 78(6):440-2. A distinct hive should develop if a person suffers cold urticaria. Allergy: Principles and Practice. [citation needed], This type of hives can occur right away, precisely after a pressure stimulus or as a deferred response to sustained pressure being enforced to the skin. 2001 May. Coronary artery bypass grafting and aortic valve replacement with cold cardioplegia in a patient with cold-induced urticaria. Potential anti-inflammatory agents include dapsone, sulfasalazine, and hydroxychloroquine. Cold urticaria is common and lasts for an average of five to six years. Brief episodes of urticaria can be associated with identifiable causes, and the method of exposure (ie, direct contact, oral or intravenous routes) is usually known. This is termed scombroid food poisoning. 1982 Aug. 72(2):179-85. Medscape Education, Clinical Pearls in Managing Hereditary Angioedema, 2002 EAACI/GA(2)LEN/EDF/WAO guideline: management of urticaria. Urticaria angioedema. ), Acute urticaria may be, in a short time, associated with life-threatening angioedema and/or anaphylactic shock, although it usually presents as rapid-onset shock without urticaria or angioedema. If you log out, you will be required to enter your username and password the next time you visit. Chronic autoimmune urticaria has been found to be associated with autoimmune thyroid disease. Such foods as tree nuts, peanuts, eggs, shellfish, and tomatoes should be considered (the involvement of food additives or preservatives is controversial). 2009 Oct. 64(10):1417-26. [Medline]. The activation of the H1 histamine receptors on endothelial and smooth muscle cells leads to increased capillary permeability. Middleton E, Reed CE, Ellis EF, et al, eds. (See Emergency Care and Complications. Acute urticaria and angioedema: diagnostic and treatment considerations. [22] The incidence of acute urticaria is higher in people with atopy, Dominantly inherited cutaneous and neurocutaneous porphyrias (porphyria cutanea tarda, hereditary coproporphyria, variegate porphyria and erythropoietic protoporphyria) have been associated with solar urticaria. Postgrad Med. Urticaria is characterized by skin findings of spontaneously erupting, pruritic, short‐lived wheals (or hives), which may be caused by a variety of triggers or may be idiopathic, and may be associated with angioedema. J Allergy Clin Immunol. Hives, also known as urticaria, is a kind of skin rash with red, raised, itchy bumps. Cholinergic urticaria. [21] A link between stress and this condition has also been shown. Often the patches of rash move around. Urticaria is caused by immunoglobulin E- and non-immunoglobulin E-mediated release of histamine and other inflammatory mediators from mast cells and basophils. Ketotifen is acknowledged to stabilise mast cells and prevent histamine release, and has been effective in treating this hives disorder. Kaplan AP. The hives should develop within a few minutes. 2008 Dec. 60(6):1401-9. Chronic idiopathic urticaria is another name for long-lasting hives with an unknown cause. Frigas E, Park MA. [citation needed], EU sometimes occurs only when someone exercises within 30 minutes of eating particular foods, such as wheat or shellfish. [12], The skin reaction usually becomes evident soon after the scratching and disappears within 30 minutes. Water urticaria is diagnosed by dabbing tap water and distilled water to the skin and observing the gradual response. 2009 Dec 1. Ann Allergy Asthma Immunol. Pressure urticaria (dermatographia) developed after strokes. Triggering of urticaria by infections has been discussed for many years but the exact role and pathogenesis of mast cell activation by infectious processes is unclear. Gober LM, Sterba PM, Eckman JA, Saini SS. 339(8801):1078-80. 2004 Feb. 92(2):273-5. [Medline]. Other medical causes of recurrent urticaria include the following: Cryoglobulinemias (eg, associated with hepatitis C, chronic lymphocytic leukemia), Other immune complex–mediated inflammation, Systemic lupus erythematosus, rheumatoid arthritis, juvenile rheumatoid arthritis, or other rheumatologic diseases (rare causes of urticaria), Hypothyroidism and hyperthyroidism, although euthyroid patients with antithyroid antibodies (ie, vide infra) can be affected What the first 10,000 patients with chronic urticaria have taught me: a personal journey. [2] In half of cases of hives, the cause remains unknown.[2]. People with exercise urticaria (EU) experience hives, itchiness, shortness of breath and low blood pressure five to 30 minutes after beginning exercise. [Medline]. Zuberbier T, Maurer M. Urticaria: current opinions about etiology, diagnosis and therapy. 1987 Apr. Breneman DL. Acute urticaria usually can be controlled using only symptomatic treatment with antihistamines. Grattan CE, O'Donnell BF, Francis DM, Niimi N, Barlow RJ, Seed PT, et al. Randomized double-blind study of cyclosporin in chronic 'idiopathic' urticaria. They come and go within hours. This differentiates EU from cholinergic urticaria. [1] They may also burn or sting. Systemic glucocorticoids can also be used for episodes of severe disease but should not be used for long term due to their long list of side effects. Acu… Urticaria may be caused by other immediate hypersensitivity allergic reactions to an ingested, inhaled, or percutaneously inoculated substance (eg, latex, stinging insects, occupational exposures). Schoepke N, Doumoulakis G, Maurer M. Diagnosis of urticaria. 21(2):102-8. Henry K Wong, MD, PhD Professor and Chairman, Department of Dermatology, University of Arkansas for Medical Sciences College of Medicine Kaplan AP. [Full Text]. [Medline]. Grattan CE. Pressure urticaria may worsen the intensity of the rash; therefore, avoiding tight-fitting clothes may be helpful. N Engl J Med. 28(2):123-7. Current approaches to the diagnosis and treatment of systemic mastocytosis. Clin Exp Dermatol. Lancet. Under normal circumstances, these hives are not the same as those witnessed with most urticariae. 2006 Oct. 55(4):705-9. Urticaria can be classified as acute urticaria or chronic urticaria. 2010 Feb. 125(2 Suppl 2):S161-81. [Guideline] Zuberbier T, Asero R, Bindslev-Jensen C, Walter Canonica G, Church MK, Giménez-Arnau AM, et al. Grattan CE, Francis DM, Slater NG, Barlow RJ, Greaves MW. [Medline]. Int Arch Allergy Immunol. Acute urticaria is nearly always due to some defined exposure to a drug or physical stimulus or an acute infectious illness. [Medline]. 24(2):141-62, v. [Medline]. [54] The discovery of mast cells by Paul Ehrlich in 1879 brought urticaria and similar conditions under a comprehensive idea of allergic conditions. Urticaria (hives) is a common disorder that often presents with angioedema (swelling that occurs beneath the skin). Hives can also be classified by the purported causative agent. People with this disorder do not suffer from dermographism or pressure urticaria. [18], Chronic idiopathic hives has been anecdotally linked to stress since the 1940s. Int Arch Allergy Immunol. Hormonal causes via endocrine tumors or ovarian pathology are rare. Wedi B, Raap U, Wieczorek D, Kapp A. Urticaria and infections. [41], Leukotrienes are released from mast cells along with histamine. Step 2 consists of increasing the dose of the current antihistamine, adding other antihistamines, or adding a leukotriene receptor antagonist such as montelukast. Chronic stimulation of this receptor leads to chronic hives. 121(2 supp 1):S147. 10(4):239-50. These welts can often be itchy and they can vary tremendously in size—some are as small as a pinprick whereas others can grow to cover the entirety of someone’s torso. [37], H2-receptor antagonists are sometimes used in addition to H1-antagonists to treat urticaria, but there is limited evidence for their efficacy. 2007. 172(1):36-40. Curr Pharm Des. [1][2] In half of cases the cause remains unknown. 1987 Jul. Bluestein HM, Hoover TA, Banerji AS, Camargo CA Jr, Reshef A, Herscu P. Angiotensin-converting enzyme inhibitor-induced angioedema in a community hospital emergency department. Sheikh J. [35][36] According to the 2014 American practice parameters, treatment involves a stepwise approach. 1984 Oct. 11(4 Pt 1):643-52. [5], Hives, or urticaria, is a form of skin rash with red, raised, itchy bumps. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMTM3MzYyLW92ZXJ2aWV3. J Allergy Clin Immunol. Acta Derm Venereol. Asero R, Tedeschi A, Lorini M. Leukotriene receptor antagonists in chronic urticaria. If a known triggering factor is present, avoidance is the most effective therapy. Haas N, Toppe E, Henz BM. Acute urticaria is the most common type. Neutrophilic urticaria with systemic inflammation: a case series. ), Although clinically distinctive, urticaria may be confused with a variety of other dermatologic diseases that can be similar in appearance and are pruritic, including atopic dermatitis (eczema), maculopapular drug eruptions, contact dermatitis, insect bites, erythema multiforme, pityriasis rosea, and others.

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