RESUMO
RATIONALE: Urticaria is a refractory dermatosis with long duration and a high recurrence rate. More to the point, medication of acute urticaria always demands high doses, which may cause some adverse effects. Acupuncture, with a history for over 2000 years, has been utilized in clinical practice as an alternative treatment strategy for dermatologic diseases. PATIENT CONCERNS: A 26-year-old male nurse on duty suddenly fell sick during the night-shift in the ward. Wheals began spreading all over his body, but he had no urticaria medicine on hand. The unbearable itching made it extremely difficult for him to resume working. DIAGNOSIS: The patient was diagnosed with acute urticaria according to the symptoms. INTERVENTIONS: A 30-minute acupuncture treatment was performed. OUTCOMES: About 5 minutes after needles were inserted into the acupoints, the patient felt significantly relieved of itching sensation; moreover, he could even subjectively control himself from scratching and could calmly wait for gradual disappearance of the wheals. Then 30 minutes later, the wheals almost faded away. LESSONS: The results suggest that acupuncture may be a promising alternative therapy to treat acute urticaria, especially for patients who cannot receive drug treatment.
Assuntos
Terapia por Acupuntura/normas , Urticária/urina , Terapia por Acupuntura/métodos , Adulto , Humanos , Masculino , Resultado do Tratamento , Urticária/psicologiaAssuntos
Vasculite por IgA/diagnóstico , Rim/patologia , Dor Abdominal/sangue , Dor Abdominal/etiologia , Dor Abdominal/urina , Adolescente , Anemia/sangue , Anemia/etiologia , Anemia/urina , Artralgia/sangue , Artralgia/etiologia , Artralgia/urina , Artrite/sangue , Artrite/etiologia , Artrite/urina , Biópsia , Angiografia por Tomografia Computadorizada , Diagnóstico Diferencial , Exantema/sangue , Exantema/etiologia , Exantema/urina , Feminino , Humanos , Hipertensão/sangue , Hipertensão/etiologia , Hipertensão/urina , Vasculite por IgA/sangue , Vasculite por IgA/complicações , Vasculite por IgA/urina , Nefrite/sangue , Nefrite/etiologia , Nefrite/urina , Urticária/sangue , Urticária/etiologia , Urticária/urinaAssuntos
Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/diagnóstico , Anticorpos Anticitoplasma de Neutrófilos/sangue , Vasculite por IgA/diagnóstico , Fatores Imunológicos/administração & dosagem , Rim/patologia , Dor Abdominal/sangue , Dor Abdominal/etiologia , Dor Abdominal/urina , Adolescente , Anemia/sangue , Anemia/etiologia , Anemia/urina , Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/sangue , Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/complicações , Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/tratamento farmacológico , Anticorpos Anticitoplasma de Neutrófilos/imunologia , Artralgia/sangue , Artralgia/etiologia , Artralgia/urina , Artrite/sangue , Artrite/etiologia , Artrite/urina , Biópsia , Angiografia por Tomografia Computadorizada , Diagnóstico Diferencial , Quimioterapia Combinada/métodos , Exantema/sangue , Exantema/etiologia , Exantema/urina , Feminino , Humanos , Hipertensão/sangue , Hipertensão/etiologia , Hipertensão/urina , Vasculite por IgA/sangue , Vasculite por IgA/complicações , Vasculite por IgA/urina , Metilprednisolona/administração & dosagem , Ácido Micofenólico/administração & dosagem , Mieloblastina/imunologia , Nefrite/sangue , Nefrite/etiologia , Nefrite/urina , Pulsoterapia , Rituximab/administração & dosagem , Urticária/sangue , Urticária/etiologia , Urticária/urinaRESUMO
A middle aged female patient presented with generalised palpable purpura associated with intense pruritus along with subconjunctival haemorrhage and orbital inflammation. There was extensive dermographism. Other systemic examinations were within normal limits. Haematological profile was normal except raised D-dimer. Skin biopsy revealed the presence of leucocytoclastic vasculitis. Antinuclear antibody was positive in a titre of 1 : 160, but antidouble-stranded DNA was negative. Urine examination revealed haematuria and proteinuria. Complement C3, C4 and C1q levels were decreased with the presence of anti-C1q antibody. There was a diagnostic dilemma between systemic lupus erythematosus and hypocomplementaemic urticarial vasculitis syndrome. However, as the patient did not fulfil the American College of Rheumatology criteria for systemic lupus erythematosus, but fulfilled all the criteria for hypocomplementaemic urticarial vasculitis syndrome, the case was finally diagnosed as hypocomplementaemic urticarial vasculitis syndrome and treated accordingly with favourable outcome.
Assuntos
Doenças Autoimunes/diagnóstico , Proteínas do Sistema Complemento/metabolismo , Lúpus Eritematoso Sistêmico/diagnóstico , Pele/patologia , Urticária/diagnóstico , Vasculite Leucocitoclástica Cutânea/diagnóstico , Adulto , Anticorpos Antinucleares/sangue , Doenças Autoimunes/sangue , Doenças Autoimunes/patologia , Doenças Autoimunes/urina , Feminino , Produtos de Degradação da Fibrina e do Fibrinogênio/metabolismo , Hematúria/etiologia , Humanos , Proteinúria/etiologia , Síndrome , Urticária/sangue , Urticária/urina , Vasculite Leucocitoclástica Cutânea/sangue , Vasculite Leucocitoclástica Cutânea/patologia , Vasculite Leucocitoclástica Cutânea/urinaAssuntos
Alérgenos/imunologia , Asma/imunologia , Chinchila/imunologia , Conjuntivite/imunologia , Lipocalinas/imunologia , Rinite/imunologia , Urticária/imunologia , Adulto , Alérgenos/sangue , Alérgenos/urina , Animais , Asma/sangue , Asma/urina , Extratos Celulares , Conjuntivite/sangue , Conjuntivite/urina , Epitélio/imunologia , Epitélio/metabolismo , Feminino , Humanos , Imunoglobulina E/sangue , Lipocalinas/sangue , Lipocalinas/urina , Masculino , Rinite/sangue , Rinite/urina , Fatores Sexuais , Testes Cutâneos , Urticária/sangue , Urticária/urinaRESUMO
BACKGROUND: Little is known about the course of aspirin-induced urticaria. A special regulatory role of cysteinyl leukotrienes and prostaglandin D(2) (PGD(2)) has been postulated. OBJECTIVE: We performed a long-term observation on clinical course, aspirin sensitivity, and urinary eicosanoids in patients with aspirin-induced urticaria. METHODS: For 4 years, we followed up 22 patients with chronic idiopathic urticaria and aspirin hypersensitivity who restrained from the use of aspirin and other COX-1 inhibitors. Aspirin challenges were performed in 2002 (all results were positive) and repeated in 2006. Levels of urinary leukotriene E(4) (LTE(4)) and the main PGD(2) metabolite, 9 alpha 11 beta PGF(2), were measured at the same time points. RESULTS: During the follow-up period, the severity of urticaria has decreased. In 14 of 22 patients, the results of aspirin challenge remained positive. In 2002, these 14 patients responded to aspirin with a significant increase in urinary LTE(4) and 9 alpha 11 beta PGF(2) levels. When studied 4 years later, they showed a similar response of 9 alpha 11 beta PGF(2) (P = .047) and a tendency toward an increase in LTE(4) level (P = .057). There was a correlation between the urinary LTE(4) concentration after aspirin challenge and the intensity of skin eruptions. The dose of aspirin had no effect on the magnitude of response of both LTE(4) and the PGD(2) metabolite. In the remaining 8 patients, negative aspirin challenge results were not associated with changes in the urinary eicosanoids studied. CONCLUSIONS: Aspirin hypersensitivity manifesting as urticaria/angioedema remains present after 4 years in about two thirds of patients. Aspirin-precipitated skin reactions associate with increased excretion of LTE(4) and PGD(2).
Assuntos
Aspirina/efeitos adversos , Inibidores de Ciclo-Oxigenase/efeitos adversos , Dinoprosta/urina , Toxidermias/urina , Leucotrieno E4/urina , Urticária/urina , Adulto , Aspirina/farmacologia , Inibidores de Ciclo-Oxigenase/farmacologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Urticária/induzido quimicamenteRESUMO
BACKGROUND: The recovery of mediator metabolites from urine has the potential to provide a rapid, safe, and easily available index of release of mediators. We aimed to determine urinary metabolites of both histamine and leukotrienes (LTs) in patients affected by chronic urticaria (CU). METHODS: Twenty patients with CU were studied. They were selected on the basis of double-blind placebo-controlled challenge (DBPC) with acetyl salicylic acid (ASA) and food additives. Ten patients (group B) were negative to both challenges. Ten patients (group C) presented urticaria and/or the appearance of angioedema during or 24 h after challenge, with reactions to ASA (five patients) or food additives (five patients). We recruited 15 healthy volunteers as controls (group A). During a second challenge, groups B and C were challenged double-blind with a single dose of ASA, or a specific food additive, or placebo. The healthy group was challenged only with a placebo (talc capsule). Patients in groups B and C were challenged twice: with placebo (as groups B1 and C1) and with ASA (groups B2 and C2) or food additives (C2). Four samples of urine were collected; one during the night before the specific or sham challenge (baseline), and three at 2, 6 and 24 h after the challenge. Urinary methylhistamine (N-MH) and LTE4 were analyzed and normalized for urinary creatinine. RESULTS: For urinary N-MH at baseline, there was a significant difference only between group A and groups B1, B2, C1 and C2 (A vs. B1, P < 0.0001; A vs. B2, P < 0.0001; A vs. C1, P < 0.0001; A vs. C2, P < 0.0001). We detected a significant variation in urinary methylhistamine excretion only in group C2 after 2 h, 6 h and 24 h (P < 0.0001). However, no variations were observed in N-MH excretion rate in the other groups (A, B1, C1) after challenge with placebo, and in B2 after challenge with ASA 20 mg. For urinary LTE4 at baseline no differences were found between the mean values for the different groups. After specific challenge, only C2 patients showed significantly increased excretion rates of urinary LTE4 compared with the other groups challenged with placebo (A, B1, C1), or ASA (B2) (P < 0.0001). No significant correlation was seen between urinary LTE4 and methylhistamine excretion rate in any patients. CONCLUSION: Our results show that urinary excretion of N-MH and LTE4 is different for CU patients without ASA or food hypersensitivity, compared to those with CU with ASA or food additive hypersensitivity after specific challenge.
Assuntos
Aspirina/efeitos adversos , Inibidores de Ciclo-Oxigenase/efeitos adversos , Aditivos Alimentares/efeitos adversos , Leucotrieno E4/urina , Metilistaminas/urina , Urticária/urina , Administração Oral , Adulto , Aspirina/administração & dosagem , Biomarcadores/urina , Broncoconstritores/administração & dosagem , Broncoconstritores/efeitos adversos , Doença Crônica , Ensaios Clínicos Controlados como Assunto , Inibidores de Ciclo-Oxigenase/administração & dosagem , Relação Dose-Resposta a Droga , Método Duplo-Cego , Hipersensibilidade a Drogas/etiologia , Hipersensibilidade a Drogas/urina , Feminino , Aditivos Alimentares/administração & dosagem , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Benzoato de Sódio/administração & dosagem , Benzoato de Sódio/efeitos adversos , Glutamato de Sódio/administração & dosagem , Glutamato de Sódio/efeitos adversos , Sulfitos/administração & dosagem , Sulfitos/efeitos adversos , Tartrazina/administração & dosagem , Tartrazina/efeitos adversos , Fatores de TempoRESUMO
A case of triphenyltin acetate (TPTA) poisoning is described. The patient, who had been exposed mainly to cutaneous absorption, showed acute stages of an urticarial eruption, signs of hepatic injury, slight glucose intolerance, and electroencephalographic abnormalities. Concomitant with the highest concentrations of tin in plasma and the peak of tin excretion in urine, neutrophils did not show the normal increase in actin polymerisation after stimulation with a chemotactic peptide (100 nM fMLP). The peak of urinary excretion of tin occurred between the fifth and the sixth day after poisoning; subsequently, the rate of excretion became slow, suggesting biphasic kinetics with the possibility of a cumulative trend.
Assuntos
Dermatite Ocupacional/induzido quimicamente , Fungicidas Industriais/intoxicação , Compostos Orgânicos de Estanho/intoxicação , Urticária/induzido quimicamente , Adulto , Dermatite Ocupacional/patologia , Dermatite Ocupacional/urina , Eletroencefalografia/efeitos dos fármacos , Humanos , Fígado/efeitos dos fármacos , Masculino , Neutrófilos/efeitos dos fármacos , Pele/patologia , Absorção Cutânea , Estanho/urina , Urticária/patologia , Urticária/urinaRESUMO
Seventeen chronic urticaria patients with a history suggestive of acetylsalicylic acid (ASA, Aspirin)-intolerance were challenged with ASA; only 2 patients showed marked clinical reactions. These clinical reactions were accompanied by a significant increase in the urinary excretion of the most important histamine metabolite, N tau-methylhistamine, in comparison with 15 non-responders (p less than or equal to 0.05) and placebo test. These results suggest an involvement of histamine in the pathogenesis of ASA-intolerance in chronic urticaria patients.
Assuntos
Aspirina/efeitos adversos , Liberação de Histamina/efeitos dos fármacos , Metilistaminas/urina , Urticária/urina , Adulto , Idoso , Doença Crônica , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeAssuntos
Compostos Azo/efeitos adversos , Aditivos Alimentares/efeitos adversos , Liberação de Histamina/efeitos dos fármacos , Urticária/induzido quimicamente , Adolescente , Adulto , Testes de Provocação Brônquica , Dinoprostona , Relação Dose-Resposta a Droga , Feminino , Humanos , Masculino , Prostaglandinas E/urina , Tromboxano B2/urina , Urticária/sangue , Urticária/urinaRESUMO
A double-blind trial comparing a new antihistaminic agent (oxatomide) with clemastine was carried out in 30 patients with chronic urticaria. The study included over-all clinical assessment by patient and clinician as well as determination of excretion of 1,4-methylimidazoleacetic acid determined by a reversed-phase ion-pair high-performance liquid chromatographic method. It was found that the effect of oxatomide was equal to that of clemastine.