Management and diagnostic guidelines for urticaria and angio-oedema

Grattan, Clive; Powell, Sheila; Humphreys, F.

doi:10.1046/j.1365-2133.2001.04175.x

Cited by 119 publications

(67 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Toeweb maceration is a common portal of entry for streptococci in lower leg cellulitis (Fig 2), while tinea pedis is a major factor in patients with recurrent episodes 5,6 . Mycology cultures from macerated toewebs are important (note that athlete's foot fungi do not fluoresce and cannot be detected using Wood's light).…”

Section: Predisposing Factorsmentioning

confidence: 99%

“…Other risk factors include obesity, recent surgery (especially venectomy for coronary artery bypass grafting) and preceding venous eczema or leg ulceration 6 …”

Section: Predisposing Factorsmentioning

confidence: 99%

“…Lymphoedema is especially important as a cause of recurrent episodes 6 and is a situation in which streptococcal cellulitis can be particularly aggressive.…”

Section: Predisposing Factorsmentioning

confidence: 99%

“…evidence for their use is generally weak 6 . It is usually advisable to seek the help of a specialist urticaria clinic at this stage to define the urticarial subgroup.…”

Section: Cme Dermatologymentioning

confidence: 99%

See 3 more Smart Citations

Urticaria, angio-oedema and anaphylaxis

Grattan

2002

Clinical Medicine

View full text Add to dashboard Cite

Urticaria, angio-oedema and anaphylaxis are distinct clinical entities caused by transient plasma leakage from small blood vessels. When the affected vessels are superficial the result is a raised, itchy swelling of the skin known as a weal. Involvement of deeper vessels produces tender subcutaneous and submucosal swellings known as angio-oedema. Generalised plasma exudation leading to shock is a feature of anaphylaxis but also occurs in anaphylactoid reactions and the capillary leak syndrome. DefinitionsUrticaria is an eruption of transient superficial itchy weals, pale or pink in colour which may have a surrounding flare of redness. They may be few in number or numerous and widespread. Their size varies from a few millimetres to many centimetres. The hallmark of urticaria is its rapid fluctuation. Individual lesions come and go within 24 hours, but the eruption of fresh weals means that the whole attack may last much longer.Urticarial lesions (ie areas of superficial swelling) are also seen in skin diseases other than urticaria (eg some drug reactions, bullous pemphigoid). In these conditions, the lesions do not show the rapid fluctuation which characterises urticaria. They will not be considered further in this article.Angio-oedema implies deeper vascular leakage producing swellings predominantly affecting the subcutis. They tend to be large, pale and painful rather than red and itchy, and last longer than weals. Angio-oedema is a cause of distressing oropharyngeal swellings but may occur anywhere on the integument including the genitalia.Anaphylaxis is defined by a life-threatening fall in blood pressure, difficulty with breathing or both. Other features, including widespread redness, itching and urticaria may occur (Table 1). True anaphylaxis is due to an allergic reaction involving allergen-specific immunoglobulin (Ig) E. Anaphylactoid reactions present similarly but do not involve IgE. Classification of urticaria and angio-oedemaIt is helpful to divide urticaria into different clinical categories for the purpose of management. Many acute cases are short-lived or episodic but recurrent urticaria that continues at least twice a week for over six weeks is defined as chronic.The simplest working classification is to separate urticarias into four categories (Table 2): ordinary physical vasculitic urticaria (urticarial vasculitis) contact urticaria.Angio-oedema may be a feature of most patterns of urticaria and, for the most part, can be considered together with urticaria. However, it is worth considering angio-oedema separately when it occurs without weals (Table 3) because it may then be a presentation of C1 esterase inhibitor (C1 inh) deficiency or a drug reaction. Ordinary urticariaOrdinary urticaria is a useful collective term for all recurring urticarias that do not fall into the other three categories, in that they:do CME DermatologyThe common clinical feature of ordinary urticaria is that individual weals last less than 24 hours before disappearing completely without residual colour or texture change ...

show abstract

Section: Predisposing Factorsmentioning

confidence: 99%

“…Other risk factors include obesity, recent surgery (especially venectomy for coronary artery bypass grafting) and preceding venous eczema or leg ulceration 6 …”

Section: Predisposing Factorsmentioning

confidence: 99%

“…Lymphoedema is especially important as a cause of recurrent episodes 6 and is a situation in which streptococcal cellulitis can be particularly aggressive.…”

Section: Predisposing Factorsmentioning

confidence: 99%

“…evidence for their use is generally weak 6 . It is usually advisable to seek the help of a specialist urticaria clinic at this stage to define the urticarial subgroup.…”

Section: Cme Dermatologymentioning

confidence: 99%

See 2 more Smart Citations

Urticaria, angio-oedema and anaphylaxis

Grattan

2002

Clinical Medicine

View full text Add to dashboard Cite

show abstract

“…Ho we ver, in the disc la i mer of the gu i de li nes for ur ti ca ri a, which was pre pa red for der ma to lo gists on be half of the Bri tish As so ci a ti on of Der ma to lo gists, it was sta ted that de vi a ti on from the gu i de li nes sho uld not be de e med neg li gence. 8 Grat tan et al al so sta ted that it may be ne ces sary even de si rab le to de part from gu i de li nes in the in te rests of spe ci fic pa ti ents and spe ci al cir cums tan ces. 2 The fa i lu re in re qu es ting the ne ces sary di agnos tic pro ce du res was not af fec ted by age or gen der of the pa ti ents, or by the du ra ti on and se ve rity of the di se a se.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of a Guideline for Etiological Diagnosis of Chronic Urticaria

Günaştı¹,

Aksungur²,

Yücel³

et al. 2010

Turkiye Klinikleri J Med Sci

View full text Add to dashboard Cite

A AB BS S T TR RA AC CT T B Ba ac ck k g gr ro o u un nd d: : Ex hi bi ting po ten ti al ca u ses of chro nic ur ti ca ri a in ro u ti ne da ily prac ti ce is a comp lex pro ce du re. A gu i de li ne, de ve lo ped by the re se arc hers, in ves ti ga ting the eti o logy of chro nic ur ti ca ri a was eva lu a ted in this study. In this gu i de li ne eryt hrocy te se di men ta ti on ra te, comp le te blo od co unt, uri ne analy sis and di rect mic ros co pic exa mi na ti on of sto ol for pa ra si tes we re rou ti ne and ot her di ag nos tic pro ce du res we re re qu es ted ac cor ding to cli ni cal fin dings of po ten ti al ca u ses. O Ob b j je ec c t ti i v ve e: : The pur po se of the study was to de ter mi ne the ra te of imp le men ta ti on of the gui de li ne con si de ring a da ily prac ti ce. M Ma a t te e r ri i a al l a an nd d M Me et t h ho od ds s: : Fol lo wing di ag no sis of chro nic ur ti cari a, pa ti ents we re in ter ro ga ted with a stan dard qu es ti on na i re form, and we re exa mi ned in or der to de ter mi ne the cli ni cal fin dings of pos sib le ca u ses of the di se a se. The re cords of 903 pa ti ents in total we re ret ros pec ti vely eva lu a ted. Du ring the eva lu a ti on pro cess, the ne ces sary and un ne ces sary di ag nos tic pro ce du res re gar ding the gu i de li ne we re de ter mi ned by using com pu te ri zed al go rithms. During eva lu a ti on so me pa ra me ters such as age and gen der of pa ti ents, du ra ti on and se ve rity of the di se a se, and num bers and types of di ag nos tic pro ce du res af fec ting the gra de of the re qu est and comp le ti on we re al so ta ken in to ac co unt. R Re e s su ul lt ts s: : The to tal num ber of ne ces sary pro ce du res was 4070, less than one third of which we re re qu es ted by the physi ci ans. Ho we ver, the pa ti ents comp le ted mo re than thre e fo urths of the re qu es ted pro ce du res. Mo re o ver, the physi ci ans re qu es ted so me unne ces sary pro ce du res in al most one third of the pa ti ents. C Co on nc c l lu u s si i o on n: : Ac cor ding to cli ni cal fin dings, lo wer thres hold for ne ces sity of in ves ti ga ti on le ads to mo re fa i lu re in imp le men ta ti on of a gu i de line. Gu i de li nes de ve lo ped for the eti o lo gi cal di ag no sis of chro nic ur ti ca ri a sho uld be eva lu a ted retros pec ti vely on da ta from da ily prac ti ces to eva lu a te the uti lity of a gu i de li ne. K Ke ey y W Wo or rd ds s: : Ur ti ca ri a; ret ros pec ti ve stu di es; gu i de li ne; eti o logy Ö ÖZ ZE ET T G Gi i r ri iş ş: : Gün lük uy gu la ma da kro nik ür ti ke rin ola sı ne den le ri ni or ta ya çı kar mak kar ma şık bir iş lem dir. Bu ça lış ma da kro nik ür ti ke rin ne de ni ni araş tır mak için araş tır ma cı lar ta ra fın dan ge liş tiril miş olan bir reh ber de ğer len di ril di. Bu reh ber de erit ro sit se di man tas yon hı zı, tam kan sa yı mı, tam id rar tet ki ki ve ga i ta da pa ra zit in ce le me si ru tin ola rak, di ğer ta nı sal iş lem ler ise kli nik bul gu la ra gö re is ten di. A Am m...

show abstract