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Clinical aspects: urticaria

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Immunology and Drug Therapy of Allergic Skin Diseases

Part of the book series: Progress in Inflammation Research ((PIR))

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Abstract

Urticaria is characterised by itchy and sometimes painful swellings of the skin or mouth due to transient plasma leakage. It has a spectrum of clinical presentations but is invariably short-lived and resolves without permanent damage. Superficial swellings known as wheals may be white initially due to intense edema with a surrounding red neurogenic flare but become pink as they mature. Wheals may vary in size from a few millimeters to many centimeters across. Deeper swellings called angioedema are often large and poorly defined. They may be pale rather than pink and last longer. Wheals and angioedema can occur in the same individual at the same time. A distinction between them may not be obvious as one may merge with the other. At the very severe end of the spectrum urticaria may occasionally lead to anaphylactic shock and is nearly always a feature of anaphylaxis.

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References

  1. Sheldon JM, Matthews KP, Lovell RG (1954) The vexing urticaria problem. Present concepts of aetiology and management. J Allergy 25: 525–560

    Article  PubMed  CAS  Google Scholar 

  2. Humphreys F, Hunter JAA (1998) The characteristics of urticaria in 390 patients. Br J Dermatol 138: 635–638

    Article  PubMed  CAS  Google Scholar 

  3. Greaves MW (1995) Chronic urticaria. N Engl J Med 332: 1767–1772

    Article  PubMed  CAS  Google Scholar 

  4. O’Donnell BF, Lawlor F, Simpson J, Morgan M, Greaves MW (1997) The impact of chronic urticaria on the quality of life. Br J Dermatol 136: 197–201

    Article  PubMed  Google Scholar 

  5. Champion RH, Roberts SOB, Carpenter RG, Roger JH (1969) Urticaria and angio-oedema: a review of 554 patients. Br J Dermatol 81: 588–597

    Article  PubMed  CAS  Google Scholar 

  6. Kobza Black A, Lawlor F, Greaves MW (1996) Concensus meeting on the definition of physical urticarias and urticarial vasculitis. Clin Exp Dermatol 21: 424–426

    Article  Google Scholar 

  7. Kontou-Fili K, Borici-Mazi R, Kapp A, Matjevic LJ, Mitchel FB (1996) Physical urticaria: classification and diagnostic guidelines. Allergy 52: 504–513

    Article  Google Scholar 

  8. Volcheck GW, James TC (1997) Exercise-induced urticaria and anaphylaxis. Mayo Clin Proc 72: 140–147

    Article  PubMed  CAS  Google Scholar 

  9. Kidd JM, Cohen SH, Sosman AJ, Fink JN (1983) Food-dependent exercise-induced ana-phylaxis. J Allergy Clin Immunol 71: 407–411

    Article  PubMed  Google Scholar 

  10. Horio T, Minami K (1977) Solar urticaria: photoallergen in a patient’s serum. Arch Dermatol 113: 157–160

    Article  PubMed  CAS  Google Scholar 

  11. Mijailovic BB, Karadaglic DjM, Ninkovic MP, Mladenovic TM, Zecevic RD, Pavlovic MD (1997) Bullous delayed pressure urticaria; pressure testing may produce a systemic reaction. Br J Dermatol 136: 434–436.

    Article  PubMed  CAS  Google Scholar 

  12. von Krogh G, Maibach HI (1981) The contact urticaria syndrome - an updated review. J Am Acad Dermatol 5: 328–342

    Article  Google Scholar 

  13. O’Laughlin S, Schroeter AL, Jordon RE (1978) Chronic urticaria-like lesions in systemic lupus erythematosus. Arch Dermatol 114: 879–883

    Article  Google Scholar 

  14. Schnitzler L, Schubert B, Boasson M, Gardais J, Tourmen A (1974) Urticaire chronique, lésions osseuses, macroglobuliemie IgM: maladie de Waldenström? Bull Soc Franc Dermatologic Syphilgraphie 81: 363

    Google Scholar 

  15. Gleich G J, Schroeter AL, Marcoux JP, Sachs MI, O’Connell EJ, Kohler PF (1984) Episodic angioedema associated with eosinophilia. N Engl J Med 310: 1621–1626

    Article  PubMed  CAS  Google Scholar 

  16. Clarkson B, Thompson D, Horwith M, Luckey EH (1960) Cyclical edema and shock due to increased capillary permeability. Am J Med 29: 193–216

    Article  PubMed  CAS  Google Scholar 

  17. Sabroe RA, Kobza Black A (1997) Angiotensin-converting enzyme (ACE) inhibitors and angio-oedema. Br J Dermatol 136: 153–158

    Article  PubMed  CAS  Google Scholar 

  18. Mortureux P, Leaute-Labreze C, Legrain-Lifermann V, Lamireau T, Sarlangue J, Taieb A (1998) Acute urticaria in infancy and early childhood: a prospective study. Arch Dermatol 134: 319–323

    Article  PubMed  Google Scholar 

  19. Niimi N, Francis DM, Kermani F, O’Donnell BF, Hide M, Kobza Black A, Winkelmann RK, Greaves MW, Barr RM (1996) Dermal mast cell activation by autoantibodies against the high affinity IgE receptor in chronic urticaria. J Invest Dermatol 106: 1001–1006

    Article  PubMed  CAS  Google Scholar 

  20. Zweiman B, Valenzano M, Atkins PC, Tanus T, Getsy JA (1996) Characteristics of histamine-releasing activity in the sera of patients with chronic urticaria. J Allergy Clin Immunol 98: 89–98

    Article  PubMed  CAS  Google Scholar 

  21. Fiebiger E, Hammerschmid F, Stingl G, Maurer D (1998) Anti-FcERIa autoantibodies in autoimmune-mediated disorders: identification of structure-function relationship. J Clin Invest 101: 243–251

    Article  PubMed  Google Scholar 

  22. Ferrer M, Kinét J-P, Kaplan AP (1998) Comparative studies of functional and binding assays for IgG anti-FccRIa (a-subunit) in chronic urticaria. J Allergy Clin Immunol 101: 672–6

    Article  PubMed  CAS  Google Scholar 

  23. Hide M, Francis DM, Grattan CEH, Hakimi J, Kochan JP, Greaves MW (1993) Autoantibodies against the high-affinity IgE receptor as a cause of histamine release in chronic urticaria. N Engl J Med 328: 1599–1604

    Article  PubMed  CAS  Google Scholar 

  24. Grattan CEH, Francis DM, Hide M, Greaves MW (1991) Detection of ciculating histamine releasing autoantibodies with functional properties of anti-IgE in chronic urticaria. Clin Exp Allergy 21: 695–704

    Article  PubMed  CAS  Google Scholar 

  25. Grattan CEH, D’Cruz DP, Francis DM (1995) Antiendothelial cell antibodies in chronic urticaria. Clin Exp Rheumatol 13: 272–273

    PubMed  Google Scholar 

  26. O’Donnell BF, O’Neill CM, Francis DM, Niimi N, Barr RM, Barlow RJ, Kobza Black A, Welsh KI, Greaves MW (1999) HLA Class II associations in chronic idiopathic urticaria. Br J Dermatol 140: 853–858

    Article  PubMed  Google Scholar 

  27. Henz BM, Zuberbier T (1998) Causes of urticaria. In: BM Henz, T Zuberbier, J Grabbe, E Monroe (eds): Urticaria: clinical, diagnostic and therapeutic aspects. Springer-Verlag, Berlin

    Chapter  Google Scholar 

  28. Zuberbier T, Iffländer J, Semler C, Henz BM (1996) Acute urticaria: clinical aspects and therapeutic responsiveness. Act Derm Venereol (Stockh) 76: 296–298

    Google Scholar 

  29. Resch CA, Evans RR (1958) Chronic urticaria and dental infection. Cleveland Clinic Quarterly 25: 147–150

    PubMed  CAS  Google Scholar 

  30. James J, Warin R (1971) An assessment of the role of Candida albicans and food yeasts in chronic urticaria. Br J Dermatol 84: 227–237

    Article  PubMed  CAS  Google Scholar 

  31. Tebbe B, Geilen CC, Jorg-Dieter Schulzke, Bojarski C, Radenhausen M, Orfanos CE (1996) Helicobacter pylori infection and chronic urticaria. J Am Acad Dermatol 34: 685–686

    Article  PubMed  CAS  Google Scholar 

  32. Leznoff A, Sussman GL (1989) Syndrome of idiopathic chronic urticaria and angioedema with thyroid autoimmunity: a study in 90 patients. J Allergy Clin Immunol 84: 66–71

    Article  PubMed  CAS  Google Scholar 

  33. Lindelöf B, Sigurgeirsson B, Wahlgren CF, Eklund G (1990) Chronic urticaria and cancer: an epidemiological study of 1155 patients. Br J Dermatol 123: 453–456

    Article  PubMed  Google Scholar 

  34. Phanuphak P, Schocket AL, Arroyave CM, Kohler PF (1980) Skin histamine in chronic urticaria. J Allergy Clin Immunol 65: 371–375

    Article  PubMed  CAS  Google Scholar 

  35. Bédard PM, Brunet C, Pelletier G, Hebert J (1986) Increased compound 48/40 induced local histamine release from lesional skin of patients with chronic urticaria. J Allergy Clin Immunol 78: 1121–1125

    Article  PubMed  Google Scholar 

  36. Claveau J, Lavoie A, Brunet C, Bédard P-M, Hébert J (1993) Chronic idiopathic urticaria: possible contribution of histamine releasing factor to pathogenesis. J Allergy Clin Immunol 92: 132–137

    Article  PubMed  CAS  Google Scholar 

  37. Paradis L, Lavoie A, Brunet C, Bédard P-M, Hébert J (1996) Effects of systemic corticosteroids on cutaneous histamine secretion and histamine-releasing factor in patients with chronic idiopathic urticaria. Clin Exp Allergy 26: 815–820

    Article  PubMed  CAS  Google Scholar 

  38. Zuberbier T, Schwarz S, Hartmann K, Pfrommer C, Czarnetzki BM (1996) Histamine releasability of basophils and skin mast cells in chronic urticaria. Allergy 51: 24–28

    PubMed  CAS  Google Scholar 

  39. Juhlin L, Michaelsson G (1969) Cutaneous reactions to kallikrein, bradykinin and histamine in healthy subjects and in patients with urticaria. Acta Derm Venereol 49: 26–36

    PubMed  CAS  Google Scholar 

  40. Smith CH, Atkinson B, Morris RW, Hayes N, Foreman JC, Lee TH (1992) Cutaneous responses to vasoactive intestinal polypeptide in chronic urticaria. Lancet 339: 91–93

    Article  PubMed  CAS  Google Scholar 

  41. Lowman MA, Rees PH, Benyon RC, Church MK (1988) Human mast cell heterogeneity: histamine release from mast cells dispersed from skin, ling, adenoids, tonsils, and colon in response to IgE-dependent and nonimmunologic stimuli. J Allergy Clin Immunol 81: 590–597

    Article  PubMed  CAS  Google Scholar 

  42. Walsh LJ, Tinchiere G, Waldorf HA, Whitaker D, Murphy GF (1991) Human dermal mast cells contain and release tumour necrosis factor-a, which induces endothelial leukocyte adhesion molecule 1. Proc Natl Acad Sci 88: 4220–4224

    Article  PubMed  CAS  Google Scholar 

  43. Bradding P, Feather IH, Howarth PH, Mueller R, Roberts JA, Britten K, Bews JPA, Hunt TC, Okayama Y, Heusser CH et al (1992) Interleukin 4 is localised to and released by human mast cells. J Exp Med 176: 1381–1386

    Article  PubMed  CAS  Google Scholar 

  44. Möller A, Lippert U, Lessman D, Kolde G, Hamann K, Welker P, Schadendorf D, Rosenbach T, Luger T, Czarnetski BM (1993) Human mast cells produce IL-8. J Immunol 151: 3261–3266

    PubMed  Google Scholar 

  45. Grattan CEH, Walpole D, Francis DM, Niimi N, Dootson G, Edler S, Corbett MF, Barr RM (1997) Flow cytometric analysis of basophil numbers in chronic urticaria: basopenia is related to serum histamine releasing activity. Clin Exp Allergy 27: 1417–1424

    Article  PubMed  CAS  Google Scholar 

  46. Charlesworth EN, Hood AF, Soter NA, Kagey-Sobotka A, Norman PS, Lichtenstien LM (1989) Cutaneous late-phase response to allergen. J Crin Invest 83: 1519–1526

    Article  CAS  Google Scholar 

  47. Greaves MW, Plummer VM, McLaughlan P, Stanworth DR (1974) Serum and cell bound IgE in chronic urticaria. Clin Allergy 4: 265–271

    Article  PubMed  CAS  Google Scholar 

  48. Peters MS, Winkelmann RK (1985) Neutrophilic urticaria. Br J Dermatol 113: 25–30

    Article  PubMed  CAS  Google Scholar 

  49. Toppe E, Haas N, Henz BM (1998) Neutrophilic urticaria: clinical features, histological changes and possible mechanisms. Br J Dermatol 138: 248–253

    Article  PubMed  CAS  Google Scholar 

  50. Sabroe RA, Grattan CEH, Francis DM, Barr RM, Kobza Black A, Greaves MW (1999) The autologous serum skin test: a screening test for autoantibodies in chronic idiopathic urticaria. Br J Dermatol 140: 446–452

    Article  PubMed  CAS  Google Scholar 

  51. Zavadak D, Tharp MD (1995) Chronic urticaria as a manifestation of the late phase reaction In: EN Charlesworth (ed): Immunology and allergy clinics of North America. Urticaria, WB Saunders, Philadelphia, 745–760

    Google Scholar 

  52. Zuberbier T, Chantraine-Hess S, Harmann K, Czarnetski BM (1995) Pseudoallergenfree diet in the treatment of chronic urticaria. A prospective study. Acta Derm Venereol (Stockh) 75: 484–487

    CAS  Google Scholar 

  53. Rumbyrt JS, Katz JL, Schocket AL (1995) Resolution of chronic urticaria in patients with thyroid autoimmunity. J Allergy Clin Immunol 96: 901–905

    Article  PubMed  CAS  Google Scholar 

  54. di Campli C, Gasbarrini A, Nucera E, Francheschi F, Ojetti V, Torre ES, Schiavino D, Pola P, Patriarca G, Gasbarrini G (1998) Beneficial effects of Helicobacter pylori eradication on idiopathic chronic urticaria. Digestive Dis Sci 43: 1226–1229

    Article  Google Scholar 

  55. Robertson I, Greaves MW (1978) Responses of human skin blood vessels to synthetic histamine analogues. Br J Clin Pharmacol 5: 319–322

    Article  CAS  Google Scholar 

  56. Bleehen SS, Thomas SE, Greaves MW, Newton J, Kennedy CTC, Hindley F, Marks R, Hazell M, Rowell NR, Fairiss GM et al (1987) Cimetidine and chlorpheniramine in the treatment of chronic idiopathic urticaria: a multi-centre randomised double-blind study. Br J Dermatol 117: 81–88

    Article  PubMed  CAS  Google Scholar 

  57. Paul E, Bodeker RH (1986) Treatment of chronic urticaria with terfenadine and ranitidine: a randomised double-blind study in 45 patients. Eur J Clin Pharmacol 31: 277–280

    Article  PubMed  CAS  Google Scholar 

  58. Bressler RB, Sowell K, Huston DP (1989) Therapy of chronic idiopathic urticaria with nifedipine: demonstration of beneficial effect in a double-blinded, placebo controlled, crossover trial. J Allergy Clin Immunol 83: 756–763

    Article  PubMed  CAS  Google Scholar 

  59. Liu H-N, Pan L-M, Hwang S-C, Chi T-L (1990) Nifedipine for the treatment of chronic urticaria: a double-blind cross-over study. J Dermatol Treatment 1: 187–189

    Article  CAS  Google Scholar 

  60. National Prescribing Centre (1998) Safety of calcium-channel blockers. MeReC Bulletin 9: 13–16

    Google Scholar 

  61. Engler RJM, Squire E, Benson P (1995) Chronic sulfasalazine therapy in the treatment of delayed pressure urticaria and angioedema. Ann Allergy Asthma Immunol 74: 155–159

    PubMed  CAS  Google Scholar 

  62. Jaffer AM (1991) Sulfasalazine in the treatment of corticosteroid-dependent chronic idiopathic urticaria. J Allergy Clin Immunol 88: 964–965

    Article  PubMed  CAS  Google Scholar 

  63. Grattan CEH, Francis DM, Slater NGP, Barlow RJ, Greaves MW (1992) Plasmapheresis for severe, unremitting, chronic urticaria. Lancet 339: 1078–1080

    Article  PubMed  CAS  Google Scholar 

  64. O’Donnell BF, Barr RM, Kobza Black A, Francis DM, Kermani F, Niimi N, Barlow RJ, Winkelmann RK, Greaves MW (1998) Intravenous immunoglobulin in autoimmune chronic urticaria. Br J Dermatol 138: 101–106

    Article  PubMed  Google Scholar 

  65. Toubi E, Blant A, Kessel A, Golan TD (1997) Low-dose cyclosporin A in the treatment of severe chronic idiopathic urticaria. Allergy 52: 312–316

    Article  PubMed  CAS  Google Scholar 

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  1. Dermatology Centre, West Norwich Hospital, Norwich, NR2 3TU, UK

    Clive E. Grattan

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  1. Department of Dermatology, University Hospital Utrecht, Heidelberglaan 100, Utrecht, CX, NL-3584, Netherlands

    C. A. F. M. Bruijnzeel-Koomen  & E. Knol  & 

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Grattan, C.E. (2000). Clinical aspects: urticaria. In: Bruijnzeel-Koomen, C.A.F.M., Knol, E. (eds) Immunology and Drug Therapy of Allergic Skin Diseases. Progress in Inflammation Research. Birkhäuser, Basel. https://doi.org/10.1007/978-3-0348-8464-8_10

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  • DOI: https://doi.org/10.1007/978-3-0348-8464-8_10

  • Publisher Name: Birkhäuser, Basel

  • Print ISBN: 978-3-0348-9579-8

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