Successful treatment of chronic urticaria

Abstract

exercise. Only oral challenge with a wheatmeal roll followed by an additional exercise test on the bicycle ergometer produced immediate-type reactions. After 20 min, itching of the skin on the neck and back occurred, followed by generalized urticaria with swelling of the upper lip. The patient received intravenous injections of 4 mg of dimetindene maleate and 250 mg of methyl-prednisolone. This relieved the symptoms within minutes. In the literature, 163 cases of fooddependent, exercise-induced anaphylaxis are described; they have been reviewed by Steurich & Feyerabend (3). Although various foods (tomato, peanut, soybean, and seafood) have been associated with food-dependent, exercise-induced anaphylaxis, the most frequently reported cause of these reactions seems to be wheat (3). The activities required to precipitate symptoms were running, ball games, tennis, and walking. Our patient was atopic and suffered from face dermatitis and perennial rhinitis with allergy to house-dust mites. The positive skin test and the detection of speci®c IgE antibodies made it possible to demonstrate an immediate-type allergy to wheat¯our and gluten (gliadin). Recently, Palosuo et al. demonstrated by ELISA that the major allergen of wheat is gliadin (4). Only oral challenge with a wheatmeal roll followed by exercise produced immediate-type reactions such as generalized urticaria and swelling of the upper lip, and thus led to the diagnosis of food-dependent, exercise-induced anaphylaxis to wheat¯our (gliadin).

Is there a role for antileukotrienes in urticaria?

“…14,15,23,[28][29][30] However, in many studies, challenge with ASA 15,19,[22][23][24][25]28,29,31,32 and ⁄ or ASST 13,19,22,[24][25][26][27]31,32 have not been reported or performed. Finally, many patients were affected by physical urticaria.…”

“…Anecdotal studies suggested therapeutic effects for antileukotrienes in the treatment of urticaria exacerbations induced by ASA 13 and other nonsteroidal antiinflammatory drugs (NSAIDs) in patients with CU, 14 chronic autoimmune urticaria, 15 acquired cold urticaria, 16,17 delayed-pressure urticaria (DPU), 18 and intractable CU. 19 A single negative study reported a pranlukast-evoked urticaria in patients affected by ASAinduced urticaria; 20 however, this molecule is not marketed in Europe.…”

Randomized placebo-controlled trial comparing desloratadine and montelukast in monotherapy and desloratadine plus montelukast in combined therapy for chronic idiopathic urticaria

“…[9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] The effects of LT-RAs in patients with CIU have been evaluated mostly in a heterogeneous population of patients. The majority of the studies reported in the literature are anecdotal reports, and only a few are placebo-controlled studies.…”

Leukotriene receptor antagonists in monotherapy or in combination with antihistamines in the treatment of chronic urticaria: a systematic review

“…Anecdotal studies suggested therapeutic effects for antileukotrienes in the treatment of urticaria exacerbations induced by ASA24 and other nonsteroidal anti-inflammatory drugs (NSAIDs) in patients with CIU,25 chronic autoimmune urticaria,26 acquired cold urticaria,27,28 delayed-pressure urticaria (DPU),29 and intractable CIU 30. A single negative study reported a pranlukast-evoked urticaria in patients affected by ASA-induced urticaria 31.…”