Delayed pressure urticaria

Immunologic Dapsone has been used in the treatment of urticarial vasculitis, chronic idiopathic urticaria and angioedema, and delayed pressure urticaria, and in patients with poor responses to conventional therapy. Serious allergic reactions to dapsone have been described in under 5% of patients during long-term treatment and are known collectively as the dapsone hypersensitivity syndrome. 

A 35-year-old woman developed the dapsone hypersensitivity syndrome after taking dapsone for 13 days for delayed pressure urticaria [11 ]. She had an erythematous papular rash on the face, trunk, and limbs, multiple bilateral cervical and retroauricular tender lymph nodes, a hyperemic pharynx, and oral ulcers. There was an eosinophilia. Dapsone was withdrawn and she was given oral prednisone over 6 weeks with hydroxyzine and ranitidine. She recovered over 3 months. 

Do Valle SO, Franca AT, Fires GV, Guimaraes P, Dias GA, Levy SA. Dapsone hypersensitivity syndrome during delayed pressure urticaria treatment. Ann Allergy Asthma Immunol 2010 104(2) 181-2. 

Physical urticarias are not known to be induced by specific occupations, but they may become manifest in this setting. This holds particularly for professions requiring heavy mechanical work. Increased physical and sportive activities may also explain the higher frequency of manifest cholinergic and delayed pressure urticaria in men (Table 1). Severely affected persons... 

Static pressure Delayed pressure urticaria 0.5-10 h 8-48 Locally applied weights... 

In cholinergic and cold urticaria, whealing can occur in association with angioedema, or angioedema may be the only manifestation, as is always the case in vibratory angioedema. In delayed pressure urticaria, wheals always reach into the deeper dermis and thus resemble angioedema. 

While the majority of wheals in physical urticaria develop rapidly and are of short duration, reactions can also appear with a delay of 2 h or even 4-8 h after stimulation. The most frequent representative of this group is delayed pressure urticaria, with lesions persisting for up to 3 days. 

Dermographic urticaria and urticarial dermographism as well as delayed urticarial dermographism must be differentiated from delayed pressure urticaria, which is elicited by resting rather than sheering forces. 

Barlow RJ, Warburton F, Watson K, Black AK, Greaves MW (1993) Diagnosis and incidence of delayed pressure urticaria in patients with chronic urticaria. J Am Acad Dermatol 29 954-958... 

Czarnetzki BM, Meentken J, Rosenbach T, Pokropp A (1984b) Clinical, pharmacological and immunologicd aspects of delayed pressure urticaria. Br J Dermatol 111 315-323... 

Czarnetzki BM, Cap H-P, Forck G (1987) Late cutaneous reactions to common allergens in patients with delayed pressure urticaria. Br J Dermatol 117 695-701... 

Dover JS, Black AK, Ward AM, Greaves MW (1988) Delayed pressure urticaria. Clinical features, laboratory investigations, and response to therapy of 44 patients. J Am Acad Dermatol 18 1289-1298... 

Engler R, Squire E, Benson P (1995) Chronic sulfasalazine therapy in the treatment of delayed pressure urticaria and angioede-ma. Ann Allergy 74 155-159... 

Estes S, Young C (1981) Delayed pressure urticaria an investigation of some parameters of lesion induction. J Am Acad Dermatol 5 25-31... 

Kontou-Fili K, Maniatakou G, Demaka P, Gonianakis M, Palaiogolos G, Aroni K (1991) Therapeutic effects of cetirizine 2HCI in delayed pressure urticaria clinicopathologic findings. J Am Acad Dermatol 24 1090-1093 Laufer P, Laufer R (1983) Solar urticaria in cystic fibrosis. Cutis 31 665-666... 

Warin RP (1987) A simple out-patient test for delayed pressure urticaria (letter). Br J Dermatol 116 742-743 Willis I, Epstein JH (1974) Solar vs heat-induced urticaria. Arch Dermatol 110 389-392... 

Various other types of urticaria have been observed in 25-94% of patients with pressure urticaria. More than 50% have an associated delayed dermographic urticaria (Dover et al. 1988). There is also a slightly increased frequency of atopic diseases in the patient or family history. The increased incidence of positive prick tests is however mostly due to false-positive reactions caused by associated urticarial dermographism (Czarnetzki et al. 1987). An increased incidence of aspirin intolerance is found by some investigators (Dover et al. 1988). 

Serum factors that act as photoallergens after UV irradiation may be involved in the pathogenesis (Holzle and Hadshiew 1996). An association with other diseases has been reported for cystic fibrosis, dermo-graphic, heat, delayed pressure and cold urticaria (Laufer and Laufer 1983 Kojima et al. 1986 Horio and Fujigaki 1988 Holzle and Hadshiew 1996). 

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