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International Journal of Dermatology Oct 2014Chronic idiopathic angioedema (CIA) is defined as three or more episodes of angioedema in a period of > 6 months without a clear etiology. In the study, we tried to...
OBJECTIVE
Chronic idiopathic angioedema (CIA) is defined as three or more episodes of angioedema in a period of > 6 months without a clear etiology. In the study, we tried to explore clinical and laboratory characteristics of patients with CIA unaccompanied by urticaria.
METHODS
We retrospectively reviewed clinical and laboratory characteristics of 1238 patients with chronic urticaria and/or angioedema referred to our allergy clinic.
RESULTS
Eight hundred and forty-one (67.9%) subjects had chronic urticaria without angioedema (CU Group), 323 (26.1%) had both urticaria and angioedema (CU + CA group), and 74 (5.9%) had chronic angioedema without urticaria (CA). In 29 (39.2%) cases of CA, no etiologic factor of angioedema was discovered, thus the patients were defined as having chronic idiopathic angioedema (CIA Group). Twenty-two (75.8%) subjects had antihistamine-responsive CIA and seven (24.1%) had antihistamine-unresponsive CIA. There were no statistically significant differences in clinical (except of urticarial eruptions) and laboratory characteristics between CU, CA + CU, and CIA groups. Antihistamine responsive and antihistamine-unresponsive CIA groups had no distinguishable clinical or laboratory features.
CONCLUSIONS
We suppose that CIA, at least its antihistamine-responsive form, represents a rare form of chronic spontaneous urticaria. The reasons why in CIA there are no other clinical signs of mast cell/basophil activation, such as pruritus, urticarial, and dermatographism, are largely unknown and have to be elucidated in future studies.
Topics: Adult; Angioedema; Chronic Disease; Female; Humans; Male; Retrospective Studies; Urticaria
PubMed: 25209993
DOI: 10.1111/ijd.12601 -
Indian Dermatology Online Journal 2015About 25-45% of patients of chronic urticaria (CU) have been stated to have histamine releasing autoantibodies in their blood. The term autoimmune urticaria is...
BACKGROUND
About 25-45% of patients of chronic urticaria (CU) have been stated to have histamine releasing autoantibodies in their blood. The term autoimmune urticaria is increasingly being accepted for this subgroup of patients. Review of the literature suggests high autologous serum skin test (ASST) positivity and presence of antithyroid microsomal antibodies in patients with autoimmune urticaria.
AIMS
To study prevalence of ASST positivity and antithyroid microsomal antibodies in chronic "idiopathic" urticaria and to study the correlation between the two parameters.
METHODS
All patients of chronic idiopathic urticaria satisfying inclusion/exclusion criteria were enrolled in the study after written informed consent. Patients of CU secondary to infections and infestations, physical urticaria including dermatographism, mastocytosis, urticarial vasculitis and those on treatment with immunosuppressive drugs for urticaria were excluded from the study. In all of these patients, complete blood count; ASST, serum T3/T4/thyroid stimulating hormone levels, antithyroid microsomal antibody (AMA) levels were done. Statistical analysis was done by Chi-square test, Fisher exact test and Kappa statistics.
RESULTS
Study included 24 males and 26 females with mean age of 39.54 years. Majority of patients belonged to 20-40 years of age. Females showed more ASST positivity. A total of 12 out of 50 (24%) patients showed positive ASST. A total of four out of 12 (33.33%) had positive ASST and raised AMA levels.
CONCLUSION
Only 25% of patients of chronic idiopathic urticaria had positive ASST. ASST and AMA levels were positively correlated in our study. Further studies are required to authenticate this association.
PubMed: 26225328
DOI: 10.4103/2229-5178.160255 -
Pediatrics Oct 2020A healthy Hispanic boy was born via cesarean delivery after an uncomplicated pregnancy. At 4 weeks old , his parents brought him to the emergency department for...
A healthy Hispanic boy was born via cesarean delivery after an uncomplicated pregnancy. At 4 weeks old , his parents brought him to the emergency department for bruising on both soles of the feet. At 6 weeks old, his parents brought him to primary care for new bruises on his arms and back. After evaluation, primary care referred the patient to the emergency department. The parents denied any recent trauma, fever, cough, decreased urine, or change in appetite. Because of 2 episodes of unexplained bruising, the Department of Children and Families was granted emergency custody of the child. Hematology and ophthalmology did not identify any clear abnormalities. Skeletal surveys were normal. Dermatology was consulted. The examination was normal except for pink blanching patches on the upper back and linearly arranged pink blanching papules on the right lower leg. No crusting, erosions, hyperpigmentation, purpura, petechiae, or ecchymoses were seen. These lesions completely resolved the next day. He tested positive for dermatographism and developed similar lesions on his soles after pushing his feet down onto a soft surface. The intermittent urticarial skin changes were most consistent with physical urticaria. Such lesions could be mistaken for trauma; however, blood vessel damage typically results in progressive coloration changes for >1 day. At the emergency court hearing, given the concurring medical opinions of the dermatologist, pediatrician, and Child Protective Services, the judge returned full custody to the parents. This case reveals the value of dermatologic expertise in assessing skin changes, particularly those associated with physical abuse.
Topics: Child Protective Services; Dermatology; Diagnosis, Differential; Humans; Infant; Male; Physical Abuse; Pressure; Referral and Consultation; Urticaria
PubMed: 32994176
DOI: 10.1542/peds.2019-3644 -
Postgraduate Medical Journal Jun 2021
Topics: Adult; COVID-19; Female; Histamine Antagonists; Humans; N95 Respirators; SARS-CoV-2; Urticaria
PubMed: 32913035
DOI: 10.1136/postgradmedj-2020-138688 -
The Journal of Dermatological Treatment 2015Dermatographism occurs when there is an exaggerated response to physical stimulus. There are both simple and symptomatic forms. Symptomatic dermatographsim can be...
Dermatographism occurs when there is an exaggerated response to physical stimulus. There are both simple and symptomatic forms. Symptomatic dermatographsim can be exceedingly difficult to treat. Treatment modalities include H1 and H2 antagonists, leukotriene antagonists, cyclosporine and oral steroids. In a few small case series and studies, phototherapy has been used. We report a further two patients who were treated successfully with TL01 UVB narrowband (NB) phototherapy.
Topics: Aged; Female; Humans; Male; Middle Aged; Phototherapy; Ultraviolet Therapy; Urticaria
PubMed: 25434578
DOI: 10.3109/09546634.2014.991676 -
The Journal of Allergy and Clinical... 2015Identifying clinical characteristics of patients with chronic urticaria (CU) responsive to medication may help guide clinicians select treatment.
BACKGROUND
Identifying clinical characteristics of patients with chronic urticaria (CU) responsive to medication may help guide clinicians select treatment.
OBJECTIVE
The objective of this study was to investigate patient characteristics and medication use associated with urticaria control.
METHODS
A retrospective longitudinal chart review of adult patients with CU was conducted at a multisite allergy practice. Inclusion criteria required at least 4 CU office visits to allow for pre- and posttreatment assessment. Control corresponding to medication(s) used was assessed each visit. Univariate analysis followed by multiple logistic regression was performed.
RESULTS
A total of 221 patients with CU were included; 140 (63%) achieved complete control. The average time to control was 1.4 ± 2.7 years, which required 1-3 classes of medications. Dermatographia odds ratio (OR) = 1.85 (95% CI 1.3-2.7) or other physical urticarias, OR = 1.51 (1-2.4) and neutrophilic infiltrates on skin biopsy were markers of poor control. Thyroid autoantibodies were associated with better control using an H1-antihistamine. Whereas 22% were controlled on a second-generation H1-receptor antagonist plus a leukotriene receptor antagonist (LTRA), an additional 33% were controlled when cyclosporine was added. Use of a first or second H1-antagonist or LTRA was associated with a 3.5-16.9 times higher odds of complete CU control in those with dermatographia. The odds of achieving control for other forms of physical urticaria was greatest when colchicine was added (aOR = 32.6 [12.7-83.2]).
CONCLUSIONS
Patient-specific CU characteristics associated with medication-disease control may be useful for selecting treatment regimens. A subset of CU patients remains poorly controlled that indicates an unmet need for novel therapeutic agents.
Topics: Adult; Anti-Allergic Agents; Biopsy; Chi-Square Distribution; Chronic Disease; Drug Therapy, Combination; Female; Histamine H1 Antagonists; Histamine H2 Antagonists; Humans; Immunologic Tests; Leukotriene Antagonists; Logistic Models; Longitudinal Studies; Male; Medical Records; Middle Aged; Multivariate Analysis; Odds Ratio; Ohio; Predictive Value of Tests; Retrospective Studies; Risk Factors; Time Factors; Treatment Outcome; Urticaria
PubMed: 25680926
DOI: 10.1016/j.jaip.2014.12.007 -
Journal of Cutaneous Medicine and... 2024
Topics: Humans; Histamine Antagonists
PubMed: 38519833
DOI: 10.1177/12034754241238705