Evaluating Chronic Urticaria Patients for Allergies, Infections, or Autoimmune Disorders

Abstract

Urticaria is a common disorder affecting one-fifth of the world's population. The pathophysiology is characterized by an increased propensity for mast cell degranulation with the release of potent mediators into the dermal and subdermal tissues with resulting vasoactive, chemotactic, and inflammatory effects. The final clinical manifestation of the typical urticarial lesion is the effect of several diverse effects and causes. The general classification is acute, chronic, and physical urticaria. In general, allergenic triggers can be identified in between 60-80% of acute urticarias. Physical urticarias are characterized by the onset after the specific inciting stimulus, which can reproduce the characteristic lesion which is usually of shorter duration (with the exception of delayed pressure urticaria). Chronic idiopathic urticaria is associated with thyroid autoimmunity and, more recently, anti-mast cell receptor antibodies. An extensive work-up is usually not indicated or helpful in identifying a cause. Food or other allergens are rare causes of this type of presentation. The evaluation and work-up is dependent on clues identified by history. The treatment is removal of specific and non-specific triggers and the use of symptomatic medications generally attenuating the mediator effects.

Chronic urticaria

“…Also, urticaria has been associated with a number of autoimmune diseases. [11] A few of them are systemic lupus erythematosus, cryoglobulinemia, neoplasms, juvenile rheumatoid arthritis and autoimmune thyroid disease, including Graves disease. [9] Urticaria is a feature of Muckle-Wells syndrome (amyloidosis, nerve deafness and urticaria) and Schnitzler syndrome (fever, joint/bone pain, monoclonal gammopathy and urticaria).…”

“…Aspirin may exacerbate CU in 6.7-67% of patients. [20] Other drugs implicated are alcohol, narcotics (codeine, morphine) and oral contraceptives. [21]…”

The high prevalence of Encephalitozoon intestinalis in patients receiving chemotherapy and children with growth retardation and the validity of real-time PCR in its diagnosis

“…The etiology is unknown in approximately 70% of chronic urticaria cases. Sensitivity to nutrients takes first place among the causes identified (21,22). Studies on the role of parasites in the etiology of urticaria have shown that the most responsible protozoa are G. intestinalis and B. hominis (23,24).…”

The Presence of H. Pylori in Cases of Chronic Idiopathic Urticaria

“…Patients with autoimmune urticaria may benefit from methotrexate or cyclosporine. [13][14][15] A possible association between H. pylori infection and chronic urticaria has been proposed [16][17][18][19][20][21][22], and several mechanisms have been implicated. One proposed mechanism is that an increase in gastric vascular permeability during infection results in greater exposure of the host to alimentary allergens [23].In support of this suggestion duodenal ulcer patients have a higher incidence of allergic manifestations than controls.…”