Urticaria and angioedema

Abstract

Urticaria (hives) is a common disorder that often presents with angioedema (swelling that occurs beneath the skin). It is generally classified as acute or chronic. Second-generation, non-sedating, non-impairing histamine type 1 (H1)-receptor antihistamines represent the mainstay of therapy for both acute and chronic urticaria. Angioedema can occur in the absence of urticaria and can be broadly divided into histamine-mediated and non-histamine-mediated angioedema. Histamine-mediated angioedema can be allergic, pseudoallergic or idiopathic. Non-histamine mediated angioedema is largely driven by bradykinin and can be hereditary, acquired or drug-induced, such as with angiotensin-converting enzyme inhibitors. Although bradykinin-mediated angioedema is often self-limited, laryngeal involvement can lead to fatal asphyxiation. The mainstay of management for angioedema is to avoid specific triggers, if possible. For hereditary angioedema, there are specifically licensed treatments that can be used for the management of acute attacks, or for prophylaxis in order to prevent attacks. In this article, the authors will review the causes, diagnosis and management of urticaria (with or without angioedema) and isolated angioedema. The diagnostic and therapeutic approaches to these two conditions are considerably different, and this review is designed to highlight these differences to the reader.

Urticaria and Prodromal Symptoms Including Erythema Marginatum in Danish Patients with Hereditary Angioedema

“…It has long been a clinical dogma, that patients with HAE do not have urticaria, which might cause some clinicians to pre-exclude this important diagnosis when urticarial rash and angioedema occur together or the patient reports urticaria in the disease history (11)(12)(13)(14). Misdiagnosis of EM as urticaria might therefore contribute to diagnostic confusion and significant delay in the diagnosis of HAE, leading to ineffective and potentially harmful treatment regimens with anti-histamines, glucocorticoids and/or adrenaline.…”

Human eosinophils and mast cells: Birds of a feather flock together

“…Urticaria, or hives, occurs in 15%-25% of the population sometime during their lifetime and is characterized by pruritic lesions containing a pale center also known as a wheal with surrounding redness known as a flare. 253 Associated inflammation can be acute, but nearly 30% of urticaria patients experience chronic lesions defined by recurrent episodes for at least 6 weeks. 253 While urticaria can result from physical stimuli (ie, temperature or direct stroking of the skin), non-physical cases are sometimes categorized as autoimmune but most commonly are idiopathic.…”

“…253 Associated inflammation can be acute, but nearly 30% of urticaria patients experience chronic lesions defined by recurrent episodes for at least 6 weeks. 253 While urticaria can result from physical stimuli (ie, temperature or direct stroking of the skin), non-physical cases are sometimes categorized as autoimmune but most commonly are idiopathic. 254 MCs are considered a primary effector cell responsible for initiation of inflammation, in part due to release of histamine and cell-recruiting chemokines.…”

Autologous serum skin test in 250 patients of chronic spontaneous urticaria at tertiary care hospital in Gujarat

“…2 Chronic spontaneous Urticaria is more common in adults, and affects women more frequently than men. 3 Estimated order of frequency of different aetiologies of chronic urticaria include: autoimmune > idiopathic > pseudoallergic > chronic infection. 4 Chronic spontaneous urticaria is classified further as chronic autoimmune urticaria and chronic idiopathic urticaria (CIU).…”

“…4 Chronic spontaneous urticaria is classified further as chronic autoimmune urticaria and chronic idiopathic urticaria (CIU). 3 idiopathic urticaria. 5 Autoimmune Urticaria/angioedema that accounts for about 30-50% of chronic spontaneous urticaria may be associated with other autoimmune conditions such as thyroiditis.…”