Urticaria chronic

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

Document any risk factors for allergic reactions such as chronic urticaria, liver or kidney disease, human immunodeficiency virus, or any other immune deficiencies. 

Urticaria following internal exposure to nickel has been reported [418] the urticaria might be due to mechanisms other than delayed hypersensitivity. Precipitating antibodies against nickel sulphate bound to human albumin was found in some patients with widespread erythema after oral challenge. Moreover, patients with immediate patch test reactions to nickel and chronic urticaria have been reported [419]. 

Unlabeled uses Cromolyn has been used as an alternative therapy in refractory forms of chronic urticaria/angioedema. Oral cromolyn has been used for the treatment of food allergies and mucosal and serosal eosinophilic gastroenteritis. 

Hydroxyzine Hydroxyzine also is indicated for sedation (oral only) analgesia, adjunctive therapy (parenteral only) antiemetic (parenteral only) as adjunctive therapy in allergic conditions with strong emotional overlay, such as asthma, chronic urticaria, and pruritus (parenteral only). 

Hypersensitivity to salicylates or nonsteroidal anti-inflammatory drugs (NSAIDs). Use extreme caution in patients with history of adverse reactions to salicylates. Cross-sensitivity may exist between aspirin and other NSAIDs that inhibit prostaglandin synthesis, and aspirin, and tartrazine. Aspirin cross-sensitivity does not appear to occur with sodium salicylate, salicylamide, or choline salicylate. Aspirin hypersensitivity is more prevalent in those with asthma, nasal polyposis, chronic urticaria. 

Management of pruritus caused by allergic conditions such as chronic urticaria, atopic and contact dermatoses and in histamine-mediated pruritus. 

Anliker MD, Wuthrich B. Chronic urticaria to atorvastatin. Allergy 2002 57(4) 366. 

Salicylates are found in fruits and vegetables. Salicylate-elimination diets have been used successfully in the treatment of asthma and chronic urticaria in aspirin-sensitive individuals (Swain et al 1985 Perry et al 1996). 

Autoimmune urticaria. This seems to be an underlying basis of many cases of chronic idiopathic urticaria. About one third of patients with chronic urticaria spontaneously develop auto-antibodies directed at the receptor FceRI, located on skin mast cells. Chronic stimulation of this receptor leads to chronic hives. Patients often have other autoimmune conditions, such as autoimmune thyroiditis. 

Other colourants in use are sunset yellow (Eiio), another synthetic azo dye, and caramel. Caramel colours are manufactured from sugars and are very widely used. This food colour has caused some concern due to effects in experimental animals, for example the reduction in the number of white blood cells in rats. This may be due to the effects of contaminants at the high doses given which may be enhanced by a reduced intake of vitamin B6 in the diet. Annatto and beta carotene are naturally occurring colourants, but in one study 26 per cent of patients with chronic urticaria were shown to react to annatto. 

The observation of a chronic urticaria in two sisters who excreted abnormal amounts of xanthurenic acid after a 10-g DL-tryptophan load indicated to Knapp et al. (K6) that constitutional genetic factors may be involved in vitamin Bg-deficiency symptoms. This was borne out by a very high xanthurenic acid level during a similar test on another family. 

In subsequent studies (K7), 9 members of 3 different families were loaded with 10 g OL-tryptophan which resulted in a 10-20-fold increase in the 24-hour urinary excretion of kynurenine, 3-hydroxykynurenine, and xanthurenic acid. It appears to be a genetically conditioned disturbance, with dominant inheritance, involving metabolic reactions dependent upon pyridoxine. In most subjects the urinary changes after tryptophan loading could be corrected by vitamin Be therapy. The following diseases were found in this order of frequency in these subjects and their families bronchial asthma, chronic urticaria, anemia, diabetes, arices, and crural ulcers. Knapp s (K7) conclusion is that these disorders may be partially attributable to metabolic disturbances. 

Chronic urticaria usually responds to an H -receptor antihistamine with low sedating properties. 

Aspirin hypersensitivity is relatively common in adults (about 20%). Estimates of the prevalence of aspirin-induced asthma vary from 3.3 to 44% in different reports (SEDA-5,169), although it is often only demonstrable by challenge tests with spirometry, and only 4% have problems in practice. Patients with existing asthma and nasal polyps or chronic urticaria have a greater frequency of hypersensitivity (76), and women appear to be more susceptible than men, perhaps particularly during the childbearing period of life (77). Acute intolerance to aspirin can develop even in patients who have taken the drug for some years without problems. 

In another study, 34 patients with a history of urticaria and/or angioedema after ingestion of at least two chemically unrelated non-selective NSAIDs, 22 of whom also had chronic urticaria, all underwent a single-blind, placebo-controlled oral tolerance test with rofecoxib (12 and 25 mg 1 hour apart) (144). Rofecoxib caused urticaria and/or angioedema in 6/34 patients (18%), with no difference between patients with or without a history of chronic urticaria. 

A French woman with chronic urticaria (12) and an Indian man with lepromatous leprosy (13) developed fever, wheezing, and breathlessness. Both had peripheral eosinophilia and chest X-rays showed infiltrates. The woman s symptoms began 2 weeks after she started to take dapsone but recurred a few hours after a subsequent rechallenge. The man s symptoms occurred a few hours after each daily dose. Symptoms in both cases resolved within a few days of stopping dapsone. 

Cancian M, Fortina AB, Peserico A. Contact urticaria syndrome from constituents of balsam of Peru and fragrance mix in a patient with chronic urticaria. Contact Dermatitis 1999 41(5) 300. 

Gaig P, Garcia-Ortega P, Emique E, Papo M, Quer JC, Richard C. Efficacy of the eradication of Helicobacter pylori infection in patients with chronic urticaria. A placebo-con-trolled double blind study. Allergol Immunopathol (Madr)... 

Lieberman P, Siegle RL, Kaplan RJ, Hashimoto K. Chronic urticaria and intermittent anaphylaxis. Reactions to iophendylate. JAMA 1976 236(13) 1495-7. 

Mechanisms of non-immediate reactions are unclear but may be immunological and non-immunological. Delayed reactions of the IgE type are known (131). Aminopenicillins seem to be an important cause of non-immediate reactions (132-134). The morbilliform rash that begins 1-10 days after amoxicillin can be caused by a delayed cell-mediated immune reaction (135) as can fixed drug eruptions (136,137), toxic epidermal necrolysis (138-140), bullous erythroderma (141), and contact eczema (142). Investigation of these disorders should include delayed readings of skin tests (135). In patients with chronic urticaria, penicillin allergy was demonstrated by cutaneous tests. 

Boonk WJ, van Ketel WG. Chronische urticaria, penicU- 190. line-aUergie en melkprodukten in de voeding. [Chronic urticaria, penicillin allergy and dairy products in the diet.] 191. Ned Tijdschr Geneeskd 1980 124(42) 1771-3. 

Yeon Jin Kim, Jin Hyouk Choi, Jang Seok Bang, Moo Kyu Suh, Jeong Woo Lee, Tae Hoon Kim. A case of pheniramine maleate-aggravated chronic urticaria. Korean J Dermatol 2000 38 1414-16. 

Warin RP, Smith RJ. Chronic urticaria. Investigations with patch and challenge tests. Contact Dermatitis 1982 8(2) 117-21. 

Warin RP, Smith RJ. Chronic urticaria. Investigations with... 

Kurek M, Grubska-Suchanek E. Challenge tests with food additives and aspirin in the diagnosis of chronic urticaria. J Allergy Clin Immunol 2001 41 463-9. 

Potassium iodide is unlikely to result in acute toxicity. Manifestations of a hypersensitivity reaction may include angioedema, cutaneous and mucosal hemorrhage, urticaria, fever, arthralgia, enlarged lymph nodes, and eosinophilia. In patients with chronic urticaria or systemic lupus erythematosus, hypocomplementemic vasculitis may be precipitated. 

Vaida GA, Goldman MA, Bloch KJ Testing for hepatitis B vims in patients with chronic urticaria and angioedema. J Allergy Clin Immunol 1983 72 193-198. 

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