Clinical observations on delayed pressure urticaria.

Repeated pressure tests at regular intervals were carried out on 48 patients with delayed pressure urticaria (DPU). Patients showed a considerable variation in response with periods of positive testing ranging from a few days to months or years. All the DPU patients had had chronic urticaria and/or angio-oedema although sometimes minor and occasional. Pressure tests were also carried out at regular intervals on seven patients with chronic urticaria who had weals at pressure sites but no history of pressure-induced weals (Köbner weals). These weals coincided with positive pressure tests and it seems likely that they all had DPU but only for a short time. Delayed dermographism was studied in eight patients with DPU. There was a good correlation in time and degree between positive pressure tests and delayed dermographism, confirming that delayed dermographism is in fact DPU provoked by a slightly different mode of pressure.

Recurrent angioedema: familial and oestrogen-induced.

We report two sisters who both have had severe attacks of urticaria and angioedema only when taking the contraceptive pill and during the latter half of pregnancy. Although they exhibited many features in common with hereditary angioedema (HAO), the C1 esterase inhibitor levels and other complement components were consistently normal, including levels measured during pregnancy and at the height of the eruption after oestrogen challenge. Aetiological factors in relation to other patterns and causes of urticaria are discussed.

A serological mediator in chronic idiopathic urticaria--a clinical, immunological and histological evaluation.

Seven of twelve autologous sera from patients with chronic idiopathic urticaria re-injected intradermally produced a weal at the site of injection. There was no response in 19 control subjects. Patients showing a positive response had a shorter duration of disease and shorter duration of spontaneous weals, and their urticaria was less likely to be exacerbated by pressure. There was some serological evidence of circulating immune complexes in both positive and negative responders to autologous serum, but only two showed complement abnormalities. When six of the serum-positive patients were re-tested after one year, five still showed a positive response with their original stored serum, but only two, whose disease remained active, were positive when challenged with freshly drawn serum, suggesting that a serum mediator is only present when the urticaria is active. A marked neutrophil infiltrate was seen within and around small dermal blood vessels at the injection site in the majority of urticaria patients but this appearance did not correlate with weal formation. In control subjects the cellular response was mild and mainly mononuclear.

The role of trauma in the spreading weals of hereditary angio-oedema.

Twenty patients with hereditary angio-oedema (HAO) were regularly observed. Trauma often initiates the swellings of HAO which, once formed, may continue to spread. In the prodromal rash too, a narrow band of weals spreads out from a central point, which often corresponds to a site of trauma e.g. a pin prick. The relationship of these observations to the role of trauma in the initiation and spread of weals in other forms of urticaria is discussed.

Chronic urticaria Investigations with patch and challenge tests.

56 patients with chronic urticaria were patch tested with particular reference to the immediate weal response to a range of materials and this was followed by challenge tests to most of the same substances. Positive immediate patch tests were commonly seen with balsam of Peru and cinnamon and this appears to be a reaction in many normal subjects. Positive challenge tests in patients who also had positive immediate patch tests to the same substance occurred in two patients with cinnamon and two patients with cloves. Other substances with a similar action may come to light, in which case the use of immediate patch tests in investigating chronic urticaria is more likely to be of value. 4 patients showed positive immediate patch tests to nickel, one of whom also had a positive 48 hr patch test to nickel. 2 other patients had only positive 48 h patch tests to nickel. However, none of these patients gave a positive challenge test to nickel.

Lichen planus with late onset hypogammaglobulinaemia: a casual relationship?

A case of lichen planus of the mouth and vulva associated with late onset hypogammaglobulinaemia, alopecia areata and vitiligo is described, and the possible significance of a B cell defect in the pathogenesis of lichen planus is discussed.

Factitious urticaria: red dermographism.

A type of reaction of the skin to superficial trauma is described which differs from ordinary dermographism. This is more easily evoked by rubbing and consists of an erythematous band in which diffuse wealing develops which can be palpated and more easily demonstrated by stretching the skin. Ordinary dermographism is excluded since a scratch as usually employed to demonstrate this produces erythema and not a well-defined raised weal. Forty patients who showed this reaction are described and it was also seen in three out of 100 normal subjects tested.

treatment of hereditary angio-oedema by low dose attenuated androgens: disassociation of clinical response from levels of C1 esterase inhibitor and C4.

Nine patients with hereditary angio-oedema (H.A.E.) with a deficiency of C1 esterase inhibitor (C1 INH), have been treated with low dose attenuated androgenic drugs, with complete control of their disease. The C1 esterase inhibitor and C4 levels became normal in only one patient. It is concluded that H.A.E. can be controlled in the absence of correction of the reduced levels of C1 INH and C4. The mode of action of these drugs appears to be more complex than is generally realized.

The effect of H1 and H2 histamine antagonists on symptomatic dermographism.

In ten patients suffering from symptomatic dermographism the combined administration of chlorpheniramine + cimetidine produced a greater reduction in the weal and flare response provoked by a standardized scratch than the administration of chlorpheniramine alone. There was a statistically significant improvement in the overall assessment of the patient's skin condition with the combined administration of chlorpheniramine + cimetidine. Chlorpheniramine given alone produced no significant benefit whilst cimetidine alone produced a marked exacerbation in itching in nearly half the patients who initially entered the study and was sufficient to require withdrawal.