Chronic idiopathic urticaria

Not all symptoms after RCM exposure do resemble a hypersensitivity reaction. Toxic reactions related to the toxicity of RCM, imspecific reactions of unknown origin and or factors unrelated to RCM, such as chronic idiopathic urticaria, may occur (fig. 1) [3]. Hypersensitivity reactions to RCM may both present either under the clinical picture of anaphylaxis with the potential to result in fataUties or as delayed occurring... 

Some patients with chronic idiopathic urticaria develop wheals and even angioedema after aspirin or NSAIDs. In others, aspirin causes an obvious increase in the underlying urticaria. The reaction may occur in just 15 min or up to 24 h following aspirin ingestion, but on average it develops within 1-4 h. Most cases resolve within a few hours, but in severe reactions bouts of multiform skin eruptions, covering most of the body, may continue for 10 days after aspirin intake [8,16,17]. 

Patients with chronic idiopathic urticaria, who develop cutaneous reactions in response to aspirin, display certain similarities in eicosanoid profile with AIA. The mechanism of the reactions is often related to COX-1 inhibition [18]. Therefore, aspirin and all drugs that inhibit COX-1 should be avoided in patients who already have had cutaneous reactions to NSAID. Coxibs are usually well tolerated, although occasional adverse reactions have been reported [19, 20]. For treatment of the reactions, antihistamines are usually sufficient, but in more severe cases adrenaline and corticosteroids may be warranted. 

Zembowicz A, Mastalerz L, Setkowicz M, Radzis-zewski W, Szczeklik A Safety of cyclooxygenase-2 inhibitors and increased leukotriene synthesis in chronic idiopathic urticaria with sensitivity to nonsteroidal anti-inflammatory drugs. Arch Dermatol 2003 139 1577-1582. 

Simpson, K., Jarvis, B., Fexofenadine a review of its use in the management of seasonal allergic rhinitis and chronic idiopathic urticaria, Drugs... 

This second-generation histamine HI receptor blocker was put on the world market in the 1980s for the relief of symptoms associated with seasonal allergic rhinitis and chronic idiopathic urticaria [14], Janssen Pharmaceuticals marketed this dmg under the brand name Hismanal. The major benefit of these antihistamines was their... 

Simpson K and Jarvis B (2000) Fexofenadine—a Review of Its Use in the Management of Seasonal Allergic Rhinitis and Chronic Idiopathic Urticaria. Drugs 59 pp 301-321. 

Cetirizine, desloratadine, fexofenadine Cetirizine, desloratadine, and fexofenadine also are indicated for chronic idiopathic urticaria. 

Deslerotadine (Clarinex) [Antihislamine/Selective Receptor Antagonist] Uses Seasonal p ennial aU gic rhinitis chronic idiopathic urticaria Action Active metabohte of Claritin, Hpantihistamine, blocks inflammatory mediators Dose Adul Peds >12 y. 5 mg PO daily 5 mg PO qod... 

Cetirizine is indicated for the symptomatic treatment of perennial allergic rhinitis, seasonal allergic rhinitis, chronic idiopathic urticaria, conjunctivitis and pruritus in adults and children above two years of age. 

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. 

Stress and chronic idiopathic urticaria. These forms have been anecdotally linked to both poor emotional well-being and a reduced health-related quality of life. Evidence... 

In a multicenter, randomized, double-blind, placebo-controlled study in 190 patients, desloratadine was effective in the treatment of moderate to severe chronic idiopathic urticaria, with no adverse electrocardiographic effects (8). 

Fexofenadine is the active metabolite of terfenadine. It has antihistaminic but not dysrhythmogenic properties. It is not metabolized by the liver, but eliminated unchanged in the urine. It is efficacious and well tolerated in seasonal allergic rhinitis (1), with positive effects on nasal blockade (2), and in chronic idiopathic urticaria (1,3). 

Kawashima M, Harada S, Tango T. Review of fexofenadine in the treatment of chronic idiopathic urticaria. Int J Dermatol 2002 41(10) 701-6. 

The effect of eradicating H. pylori in 20 patients with chronic idiopathic urticaria has been assessed in a... 

Meloxicam may be relatively safe when given to patients with NSAID-induced urticaria/angioedema (14,15). Of 148 NSAID-sensitive subjects with an unequivocal history of urticaria with or without angioe-dema, who were challenged with increasing oral doses of meloxicam (1-7 mg/day) in a single-blind placebo-controlled trial, only two had a positive test (urticaria in one and urticaria/angioedema in the other) both had chronic idiopathic urticaria (16). 

Trade names Vozet Xozal Xusal Xyzal (UCB Pharma) Indications Allergic rhinitis, chronic idiopathic urticaria Category Antihistamine Half-life 6-10 Hours... 

Indications Allergic rhinitis and chronic idiopathic urticaria. Category Antihistamine Half-life 5.9 hours... 

It is generally thought that these four canonical mechanisms of IgE-mediated activation of human FceRI + cells are responsible for the pathophysiological involvement of these cells in the majority of patients with allergic disorders [34], However, there is evidence that a significant percentage of allergic diseases (e.g. certain cases of intrinsic asthma and chronic idiopathic urticaria) cannot be explained by the four classical mechanisms of FceRI + cell activation. 

Cetirizine competitively antagonizes histamine at the Hi-receptor site and is indicated in the symptomatic relief of symptoms (e.g., nasal, nonnasal) associated with seasonal and perennial allergic rhinitis treatment of uncomplicated skin manifestations of chronic idiopathic urticaria. Histamine is a potent vasodilator, bronchial smooth-muscle constrictor, and stimnlant of nociceptive itch nerves. In addition to histamine, mnltiple chemical itch mediators can act as pruritogens on C-fibers, including neuropeptides, prostaglandins, serotonin, acetylcholine, and bradykinin. Furthermore, new receptor systems such as vanilloid, opioid, and canna-binoid receptors on cutaneous sensory nerve fibers that may modulate itch offer novel targets for antipruritic therapy. 

Fexofenadine is a peripherally selective histamine receptor antagonist that competitively antagonizes histamine at the Hj-receptor site. It is indicated in the symptomatic relief of symptoms (nasal and nonnasal) associated with seasonal allergic rhinitis and treatment of uncomplicated skin manifestations of chronic idiopathic 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. 

Skin Two patients with chronic idiopathic urticaria had exacerbations when they were... 

Urinary LTEL, measurements indicate that aspirin-sensitive chronic idiopathic urticaria is associated with overproduction of cysteinyl leu-kotrienes. NSAID sensitivity in urticaria is reflected in the overproduction of cysteinyl len-kotrienes inclnding basal production of LTE4. Inhibition of COX-1 and alterations in eicosanoid production, including an increase in PGD2 levels. 

A 30-year-old woman with chronic idiopathic urticaria took a single oral dose of cetirizine 10 mg and about 15 minutes later developed widespread severe pruritus and urticarial eruptions, severe breathlessness, and an inability to speak. She became restless and disoriented and lost consciousness. Her respiration was very shallow and her pulse and blood pressure were unrecordable. 

DuBuske LM. Levocetirizine the latest treatment option for allergic rhinitis and chronic idiopathic urticaria. Allergy Asthma Proc 2007 28(6) 724-34. 

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