Urticárias crônicas induzidas: atualização do tema / Chronic inducible urticaria: topic update

A urticária é uma doença comum, determinada pela ativação de mastócitos que se apresenta por urticas, angioedema, ou ambos. Convencionou-se classificar a urticária, quanto a sua duração, em duas formas: aguda (UA) e crônica (UC). A urticária é definida como crônica quando persiste por 6 semanas ou mais. A urticária crônica compreende urticária crônica espontânea (UCE) e urticárias crônicas induzidas (UCInd), que incluem as urticárias físicas e não físicas. Estudos sugerem que a presença de UCInd associada a UCE está ligada a um pior prognóstico e duração da doença. Essa revisão tem por objetivo atualizar as informações disponíveis sobre a prevalência, quadros clínicos, métodos diagnósticos e tratamentos das UCInd por estímulos físicos ou não.

Urticaria is a common disease determined by the activation of mast cells that presents with urticaria, angioedema, or both. According to its duration, urticaria is classified into two forms: acute (AU) and chronic (CU). Urticaria is defined as CU when it persists for 6 weeks or more. CU consists of chronic spontaneous urticaria (CSU) and chronic inducible urticaria (CIndU), which includes physical and nonphysical urticarias. Studies suggest that the presence of both CIndU and CSU is linked to worse prognosis and longer duration of these diseases. This review aims to update available information on the prevalence, clinical manifestations, diagnostic methods, and treatments of CIndU by physical or nonphysical stimuli.

Cold Urticaria: Clinical Features and Natural Course in a Tropical Country

PURPOSE: To review the clinical features and natural courses of cold urticaria (ColdU) in a tropical country. METHODS: A retrospective chart review was performed of patients who visited Siriraj Urticaria Clinic, Siriraj Hospital, Bangkok, Thailand, and were diagnosed with ColdU between 2007 and 2018. Data on provocation and threshold tests, clinical courses, and laboratory work-up were analyzed and compared with data reported by studies in temperate countries. RESULTS: Of 1,063 chronic urticaria patients, 27 (2.5%) were diagnosed with ColdU, with a mean age of symptom onset of 34.8 years. Half of the patients had a history of atopy, and 1 (3.7%) had a history of anaphylaxis. All patients were positive to 1 of 3 provocation tests: an ice cube test; TempTest 4.0; or a tray filled with ice, salt and water. Thirteen patients underwent the ice cube test, and all had positive results. TempTest was performed on 15 patients, 8 of whom had positive results, with a mean critical temperature threshold (CTT) of 21.0°C. All of the 7 patients who had a negative TempTest result later produced positive results to the immersion of their hand and forearm in a tray filled with ice, salt, and water. All patients were treated with H1-antihistamines, the vast majority (96.3%) being non-sedating H1-antihistamines. Some (14.8%) needed to be administered oral corticosteroids, ciclosporin, or omalizumab. Six patients (22.2%) were in remission. A Kaplan-Meier survival curve demonstrated 5-year and 10-year remission rates of 13.8% and 42.6%, respectively. CONCLUSIONS: The rate of anaphylaxis in patients with ColdU in a tropical country was lower than those reported by other studies conducted intemperate climates. On the other hand, the number of female patients, mean age at symptom onset, atopy rate, rate of concomitant chronic spontaneous urticaria and mean CTT were higher.

Acquired Cold Urticaria: An Under-reported Entity.

Acquired cold urticaria (ACU) is a subtype of physical urticaria which may be primary (idiopathic) or secondary to underlying infections or cryoproteins. In addition to complete history and thorough physical examination, the diagnosis is dependent on a positive cold stimulation time test (CSTT) which is the minimum time of cold contact stimulation required to induce an immediate coalescent wheal. Although idiopathic type is seen in 96% of the cases, it is important to rule out cryoprotein by an intricate yet simple test for cryoprecipitate. The identification of cold exposure as the likely trigger for urticaria is vital because systemic anaphylactic reactions are common in patients with cold urticaria, occurring in roughly 1 in 3 patients. In addition to preventive counseling and avoidance of critical cold exposure, H1-receptor antagonists form the first line of treatment. However resistant cases may require cyclosporine, danazol or omalizumab. No individual case reports of ACU appear in Indian literature. Therefore, the authors attempt to highlight the diagnostic work-up and therapeutic options for this not so uncommon cause of chronic urticaria.

A Case of Combined Cholinergic and Cold Urticaria

No abstract available.

Urticárias físicas: revisão / Physical urticaria: review

Objetivo: Revisar a literatura sobre urticária física (UF) incluindo a nova classificação, diagnóstico e opções terapêuticas. Fontes de dados: artigos originais, revisões e consensos indexados nos bancos de dados MEDLINE e LILACS de 2002 a 2007 e livros. Palavras de busca: urticária física, urticária ao frio, dermografismo, urticária ao calor, angioedema vibratório, urticária solar, urticária de pressão, urticária colinérgica, urticária aquagênica e anafilaxia induzida por exercício. Resultados: Nas últimas décadas um aumento na compreensão dos mecanismos envolvidos na urticária tem realçado a heterogeneidade de seus diferentes subtipos. De acôrdo com o novo guia da Academia Européia de Alergologia e Imunologia Clínica os subtipos de urticária podem ser agrupados em: urticárias espontâneas, urticárias físicas e outras urticárias. As urticárias físicas (UF) são responsáveis por cerca de 20 per cent a 30 per cent de todos os casos de urticária crônica. A UF envolve patogênese, curso clínico e terapêutico complexos. A parte mais importante da avaliação diagnóstica consiste na obtenção de extensa e detalhada história clínica e exame físico. Testes de provocação são empregados para confirmar o diagnóstico. A UF quando se manifesta isoladamente, tende a responder bem a anti-histamínicos H1, a exceção da urticária de pressão tardia. Comentários: As UFs constituem um subgrupo singular de urticária em que os pacientes desenvolvem lesões secundárias a estímulos físicos. Desencadeantes comuns incluem: exercício, frio, calor, pressão, luz solar e vibração. Sintomas sistêmicos podem ocorrer durante episódios graves. As UFs têm um profundo impacto sobre qualidade de vida e performance, assim, um conhecimento básico dessas doenças raras é importante para todos os que cuidam da saúde.

Objective: To review the literature on physical urticaria including the new classification, diagnosis and therapeutic options. Sources of data: books, original articles, reviews and consensus indexed on MEDLINE and LILACS databases from 2002 to 2007. Kew words researched: physical urticaria, cold urticaria, dermatographism, heat urticaria vibratory angioedema, solar urticaria, pressure urticaria, cholinergic urticaria, aquagenic urticaria and exercise-induced anaphylaxis Results: In the last few decades an increasing understanding of the mechanisms involved in urticaria has highlighted the heterogeneity of its different subtypes. According to the new European Academy of Allergology and Clinical Immunology guidelines, urticaria subtypes can be grouped into spontaneous urticaria, physical urticaria, and other urticaria disorders. Physical urticarias (PU) are responsible for approximately 20 per cent to 30 per cent of all cases of chronic urticaria. PU involves complex pathogenesis, clinical course and therapy. The most important part of the diagnostic evaluation is a comprehensive and detailed history and physical examination. Physical challenge tests are used to confirm the diagnosis. PU, when manifesting isolated, tends to respond well to H 1 antihistamines, with the exception of delayed pressure urticaria. Comments: PU are a unique subgroup of chronic urticaria in which patients develop lesions secondary to physical stimuli. Common triggers include: exercise, cold, heat, pressure, sunlight, and vibration. Systemic symptoms have occurred during severe episodes. PU has a profound impact on quality of Iife and performance. 50, a basic knowledge of these unusual disorders is important for all healthcare providers. .

A Case of Cold Urticaria Induced by Ice Cream in a 5-Year-Old Boy with Family History / 소아알레르기및호흡기학회지

Cold urticaria is characterized by the development of urticaria and/or angioedema after cold exposure. It is an uncommon form of physical urticaria and thought to be rare in children. There is a higher rate of family history of atopy and cold urticaria. We report a case of cold urticaria in a 5-years-old boy who showed perioral swelling, wheal and flare associated with ice cream. He had a relevant family history on his grandmother's side with cold urticaria, and on his father's side with dermographism, respectively. In this patient, cold urticaria was confirmed by ice cube test and a brief review followed.

A Case of Cold Urticaria and Cholinergic Urticaria in the Same Patient / 대한피부과학회지

Cold urticaria and cholinergic urticaria are considered to be distinct disorders in which mediator release and hives can be induced by different stimuli. Cold urticaria can be induced by cold stimuli, and cholinergic urticaria, characterized by micropapular wheals, by exercise, emotional stimuli, or other stresses that increase the body temperature. While neither cold urticaria nor cholinergic urticaira is rare, it is unusual to see both disorders occurring in the same patient. Also, our case presents atypical urtication to cold exposure, similar to classic cholinergic urticarial lesions, called "cold-induced cholinergic urticaria". We present a 20-year-old man with 4-year history who experienced generalized micropapular wheals induced by cold exposure as well as exercise and hot environment.

A Case of Localized Cold Urticaria / 대한피부과학회지

Cold urticaria is a group of distinct clinical entities with different clinical manifestations that share the common feature of an urticarial response to cold exposure. In the localized cold urticaria, it is confined to portions of the body that have contact with the cold. In this article, we report an unusual patient with cold urticaria in which cold exposure causes hives in localized region of the face and the ice-cube test was positive only in that area.

A case of cold urticaria showing metachromasia in skin biopsy / 천식및알레르기

The patient was a 24-year-old male who complained of urticaria upon exposure to cold air and after showering in cold water. Allergic skin tests were positive for cockroach. To determine whether he had cold urticaria, we performed an ice cube test. The patient complained of pruritus, erythema, and wheals appeared at 10min. Skin biopsy specimens collected 10 minutes after ice-cube test showed perivascular mononuclear cell infiltration and edema in hematoxylin and eosin stains, and metachromatic cell and degranulation in toluidine blue stain.

Familial cold urticaria / 대한피부과학회지

A case of familial cold urticaria is reported in a 29-year-old male who showed generalized erythematous macules and papules, finally an urticarial eruption shortly after cold exposure, particularly in cold windy weather with damp. Coincidentally, systemic symptoms such as headache, fever and chills, arthralgia, and conjunctival injection were acompanied. Autosomal dominant inheritance was found on examination of his pedigree in which 11 of 18 rnembers showed similar clinical manifestations. Routme laboratory findings were within normal limits except mild leukocytosis and elevated erythrocyte sedimentation rate. Biopsy specimen from a cold-evoked lesion revealed mild ederna and mild perivascular infiltrations composed of neutrophils, eosinophils and lymphocytes in the derms, Treatments included several widely-used antihistaminics, but turned out to be unsatisfactory.

A case of hypocomplementemic urticarial vasculitis syndrome with cold urticaria / 대한피부과학회지

A 38-year-old man presented with a 2-year history of recurreit irticaria, abdominal pain and arthralgia of his finger joints. These symptoms were not con rolled in spite of taking medication and had a tendence to be aggravated in the winter. Laboratory findings revealed hvpocomlementemia, hypergammaglobulinemia and a positive rect on with an ice cube test. Skin biopsy specimen taken from the urticarial lesion of the left upper arm showed leukocytoclastic vasculitis with perivascular neutrophilic infiltrition, nuclear dusts, and extravasation of red blood cells. We thus made the diagnosis of hypocomplementemic urtirarial vasculitis syndrome with cold urticaria. The patient was treatcd ith systemic corticosteroids and antihistamines.