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The Journal of Allergy and Clinical... Aug 2023Chronic urticaria is a common condition presenting with intensely pruritic wheals. Although individual lesions resolve within 24 hours, by definition, chronic urticaria...
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.
Topics: Humans; Angioedema; Urticaria; Chronic Urticaria; Histamine; Diagnostic Errors; Chronic Disease
PubMed: 37380071
DOI: 10.1016/j.jaip.2023.06.033 -
The Pan African Medical Journal 2023
PubMed: 37159631
DOI: 10.11604/pamj.2023.44.76.36864 -
Clinics in Dermatology 2022Dermatographism was first described by William Heberden (1710-1801) more than 250 years ago as a type of urticaria brought on by rubbing or scratching the skin. In 1859,...
Dermatographism was first described by William Heberden (1710-1801) more than 250 years ago as a type of urticaria brought on by rubbing or scratching the skin. In 1859, William Gull (1816-1890) gave it the name factitious urticaria, distinguishing dermatographism from chronic urticaria, in which the skin lesions appear spontaneously. During the 1870s French physicians at the Salpetriere Hospital in Paris became impressed by their ability to write words on the bodies of patients admitted with hysteria and other psychiatric disorders, who also exhibited dermatographism. At first, they described this phenomenon as "autographisme," but by 1890 it became known as "dermographisme," the forerunner of the current term "dermatographism." At the Salpetriere and elsewhere in the world, it became fashionable to photograph patients with dermatographism, to capture the striking urticarial writing on their skin. These photographs were used in atlases and to illustrate dermatology texts and medical journals as well as popular magazines. This contribution presents several vintage photographs of dermatographism from the late 19th century to the early 20th century. Dermatographism has also become featured in popular culture including film, comic books, poetry, and body art, examples of which are provided in this contribution with the assistance of two of our authors, Ariana Page Russell and Jeannine Hall Gailey, who have embraced their dermatographism and have used their artistic and poetic talents to educate and inspire patients about this common skin condition.
Topics: Humans; History, 19th Century; Popular Culture; Urticaria; Skin
PubMed: 35948238
DOI: 10.1016/j.clindermatol.2022.08.006 -
International Journal of Dermatology Feb 2024Dermographism is a common subtype of chronic urticaria. It generally manifests as a linear wheal after scratching or friction, with or without angioedema. The... (Review)
Review
Dermographism is a common subtype of chronic urticaria. It generally manifests as a linear wheal after scratching or friction, with or without angioedema. The pathophysiology is not clear, but currently, we believe that the stimulation of the skin by mechanical stress leads to the activation of mast cells, which provoke the release of histamine and pro-inflammatory mediators, ultimately forming wheal along the stressed area. The gold standard for diagnosis is a medical history and provocation test or dermatographic test. As one of the subtypes of chronic urticaria, the Urticaria Control Test (UCT), Chronic Urticaria Quality of Life questionnaire (CU-Q2oL), and Dermatology Life Quality Index (DLQI) are also effective tools for evaluating disease control in dermographism patients. In addition to avoiding triggers, nonsedating H1 antihistamines are the first-line medications recommended by EAACI and other guidelines; for those who do not respond to standard doses, the recommended dosage can be increased up to 4 times. When necessary, the off-label use of omalizumab can be considered, and some drugs with potential therapeutic effects are still being explored. However, there is still a lack of biomarkers for predicting disease severity, efficacy, and prognosis. Here, we review what we know about dermographism and some points that need exploration in the future.
PubMed: 38419351
DOI: 10.1111/ijd.17102 -
Pediatric Allergy and Immunology :... Apr 2020
Topics: Asthma; Child; Dermatitis, Atopic; Female; Humans; Immunoglobulin E; Male; Pressure; Prevalence; Rhinitis; Skin; Skin Tests; Urticaria
PubMed: 31943377
DOI: 10.1111/pai.13209 -
Journal of Korean Medical Science Jul 2022Omalizumab is a very important drug for the treatment of chronic urticaria. Although omalizumab's therapeutic efficacy has been demonstrated, data on real-world...
BACKGROUND
Omalizumab is a very important drug for the treatment of chronic urticaria. Although omalizumab's therapeutic efficacy has been demonstrated, data on real-world experiences in Korea, especially regarding chronic inducible urticaria (CIndU), are limited. This study attempted to compare the efficacy of omalizumab in Korean chronic spontaneous urticaria (CSU) and CIndU patients.
METHODS
Fifty-two CSU and 29 CIndU patients were included and Urticaria Activity Score 7 (UAS7) at baseline, week 4, and week 12 was assessed retrospectively.
RESULTS
Omalizumab 150 mg significantly decreased UAS7 in both patients with CSU and CIndU with only one dose ( < 0.001). The significant decrease in the UAS7 scores of both groups of patients continued from weeks 4 to 12. Although there was no significant difference in treatment efficacy between the two groups, the symptoms of patients with CSU tended to improve faster; furthermore, the number of antihistamines administered daily reduced more significantly in this patient group ( = 0.047). Additionally, the decrease in the UAS7 score between baseline and week 12 and the response rate were higher in patients with CSU.
CONCLUSION
Omalizumab may be slightly more effective against CSU than against CIndU. Regarding the CIndU subtypes, dermatographic urticaria was associated with the greatest reduction in the UAS7 score, and patients with this condition showed the highest response rate, indicating the best effect of omalizumab. The duration of chronic urticaria was greater in non-responders than in responders ( = 0.025). Conversely, baseline immunoglobulin E levels were significantly higher in responders ( = 0.039).
Topics: Anti-Allergic Agents; Chronic Disease; Chronic Urticaria; Humans; Omalizumab; Retrospective Studies; Treatment Outcome; Urticaria
PubMed: 35818702
DOI: 10.3346/jkms.2022.37.e211 -
Cureus Jul 2022The urgent requirement for a preventative vaccination became more pressing due to the severe repercussions that the SARS-CoV-2 (COVID-19) virus had on society and the...
The urgent requirement for a preventative vaccination became more pressing due to the severe repercussions that the SARS-CoV-2 (COVID-19) virus had on society and the economy. The deployment of the COVID-19 vaccination program had to be expedited. As with all vaccinations, adverse events have been recorded with the COVID-19 vaccine. Some patients may experience cutaneous reactions such as rashes, itching, hives, and swelling after receiving the COVID-19 vaccine, but it is unclear how common these events are or how frequently they recur. This article discusses an unusual case of a young man who got chronic severe dermatographism after receiving a booster shot of the Moderna vaccine (Moderna, Inc., Cambridge, Massachusetts).
PubMed: 35936173
DOI: 10.7759/cureus.26566 -
Journal of Immunology Research 2022Chronic urticaria (CU) is comprised of diverse phenotypes, and thus, a shift towards a precision medical approach is warranted in its management.
BACKGROUND
Chronic urticaria (CU) is comprised of diverse phenotypes, and thus, a shift towards a precision medical approach is warranted in its management.
METHODS
This study enrolled 78 patients with CU. Serum erythrocyte sedimentation rate, hemoglobin, hematocrit, eosinophil count, IgE, antinuclear antibody (ANA), and serum diamine oxidase (DAO) levels of the patients were measured and were compared according to the patient's response to second-generation antihistamines (sgAH), corticosteroids, leukotriene receptor antagonist (LTRA), H blockers, and low-histamine diet.
RESULTS
Age- and sex-adjusted logistic regression analysis showed that patients with duration of CU > 3 years (adjusted odd ratio [aOR] = 4.39) and a DAO level < 10 U/mL (aOR = 3.90) were significantly associated with a good sgAH response. Age > 50 years (aOR = 0.02), duration of chronic urticaria > 3 years (aOR =0.06), and an ANA titer ≥ 1 : 80 (aOR = 0.03) were significantly and inversely associated with corticosteroid response. A low-histamine diet response was significantly associated with LTRA response (aOR = 67.29). In addition, a DAO level < 5.4 U/mL (aOR = 71.95) was significantly associated with H blocker response. Furthermore, concomitant angioedema (aOR = 10.56), multiple food triggers (aOR = 11.69), and a DAO level < 5.4 U/mL (aOR = 3.78) were significantly associated with a low-histamine diet response. Conversely, dermatographic urticaria and a hematocrit level < 36% were significantly and inversely associated with low-histamine diet response.
CONCLUSIONS
Several promising biomarkers were identified in this study to predict the efficacy of chronic urticaria treatment. DAO could be a novel biomarker for predicting the efficacy not only of dietary intervention but also for antagonists of H and H receptors.
Topics: Chronic Disease; Chronic Urticaria; Diet; Histamine; Humans; Urticaria
PubMed: 35242884
DOI: 10.1155/2022/5243825 -
The Journal of Allergy and Clinical... 2014Physical urticaria is a subtype of chronic urticaria induced by a physical stimulus.
BACKGROUND
Physical urticaria is a subtype of chronic urticaria induced by a physical stimulus.
OBJECTIVE
To evaluate the consistency between a history of physical urticaria and results of challenge testing.
METHODS
Seventy-six subjects, ages 3 to 77 years old, were referred with the diagnosis of a physical urticaria and were evaluated by using challenge testing directed toward the presenting diagnosis, yet included other stimuli based on history. The majority of subjects were tested to 3 or more stimuli, thus 294 provocation tests were performed. Fifty-seven subjects were surveyed for the status of their physical urticaria at least 1 year after initial evaluation.
RESULTS
Of the 76 subjects with a positive history of a physical urticaria, 38% (n = 29) were challenge negative to the presenting diagnosis. Eight subjects within the challenge negative group reacted positively to additional testing, thus 28% (n = 21) remained negative to all challenge testing, which allowed discontinuation of medications and avoidance behavior. A negative challenge result was less likely with subjects who presented with cold-induced urticaria (25%), delayed pressure urticaria (25%), and dermatographism (29%), yet more common with cholinergic (65%) and solar urticaria (67%). A 1-year follow-up survey of 57 subjects was consistent with initial results. Nineteen of this subgroup were rechallenged for the presenting diagnosis, and the outcome was unchanged in 17 subjects and, in 2 subjects the urticaria had resolved.
CONCLUSIONS
The diagnosis by history of a physical urticaria should be verified by testing whenever possible and particularly if the condition is judged as severe and thus requires both significant life-style changes and pharmacologic intervention.
Topics: Adolescent; Adult; Aged; Child; Child, Preschool; Chronic Disease; Cold Temperature; Exercise Test; Female; Humans; Male; Middle Aged; Photic Stimulation; Physical Stimulation; Predictive Value of Tests; Pressure; Prognosis; Risk Factors; Risk Reduction Behavior; Severity of Illness Index; Time Factors; Ultraviolet Rays; Urticaria; Young Adult
PubMed: 25439372
DOI: 10.1016/j.jaip.2014.07.008