Urticaria inducible: serie de casos y revisión de la literatura

Las urticarias inducibles constituyen un grupo heterogéneo de trastornos cutáneos caracterizados por la aparición de habones, prurito o angioedema, que en ocasiones se acompañan de síntomas sistémicos causados por estímulos inocuos para la mayoría de la población, como el frío, el calor, la presión, etc., y que comprometen la calidad de vida de los pacientes. La mayor parte de la literatura médica pertinente proviene de reportes y series de casos, ya que su epidemiología se ha estudiado poco. El objetivo de esta revisión es ofrecer una visión actualizada de la información disponible sobre varios tipos de urticaria inducida, mediante la presentación de un caso clínico ilustrativo y la descripción de los mecanismos fisiopatológicos, las manifestaciones clínicas y el tratamiento de cada condición.

Inducible urticaria is a heterogeneous group of skin disorders characterized by the appearance of wheals, pruritus and/or angioedema, sometimes accompanied by systemic symptoms caused by innocuous stimuli (cold, heat, pressure, etc.). This group of disorders compromises people´s quality of life and most of the literature in this regard comes from case reports and case series since its epidemiology has been poorly studied and some cases are very rare. The aim of this review is to show an up-to-date overview of the available literature for various types of inducible urticarias, always beginning with an illustrative case and then describing their pathophysiological mechanisms, clinical manifestations, and treatment.

Chronic urticaria in adults: state-of-the-art in the new millennium

Chronic urticaria has been explored in several investigative aspects in the new millennium, either as to its pathogenesis, its stand as an autoimmune or auto-reactive disease, the correlation with HLA-linked genetic factors, especially with class II or its interrelation with the coagulation and fibrinolysis systems. New second-generation antihistamines, which act as good symptomatic drugs, emerged and were commercialized over the last decade. Old and new drugs that may interfere with the pathophysiology of the disease, such as cyclosporine and omalizumab have been developed and used as treatments. The purpose of this article is to describe the current state of knowledge on aspects of chronic urticaria such as, pathophysiology, diagnosis and the current therapeutic approach proposed in the literature.

Guía Argentina de urticaria y angioedema

Se actualiza el diagnóstico de la urticaria crónica (UC) y los conceptos, definiciones y sugerencias basados en la evidencia para su tratamiento. La urticaria ocurre en al menos 20% de la población en algún momento de la vida. Su etiología difiere en la forma aguda (menos de 6 semanas), y en la crónica. No es posible pronosticar si las formas agudas evolucionarán a UC, ya que todas son agudas al comienzo. La UC ocurre como espontánea (UCE) o inducible (UCI). El diagnóstico es sencillo, pero incluye un minucioso estudio para descartar diagnósticos diferenciales; para UCI son útiles las pruebas de provocación en la caracterización y manejo. Los estudios complementarios se deben limitar y orientar según sospecha clínica. El tratamiento se divide en tres enfoques: evitación, eliminación o tratamiento del estímulo desencadenante o de la causa, y tratamiento farmacológico. Recientemente éste se modificó, con empleo de antihistamínicos de segunda generación como primera línea y aumento de dosis de antihistamínicos H1 no sedantes, hasta 4 veces, como segunda línea. Los antihistamínicos son fundamentales para tratar la UC; sin embargo, un 40% de los pacientes no logra un buen control pese al aumento de dosis y requiere otro medicamento adicional. La evidencia más reciente considera que un grupo de fármacos puede utilizarse como tercera línea en estos casos, para mejorar la calidad de vida y limitar la toxicidad por el uso frecuente o crónico de esteroides sistémicos. Se recomiendan para esta tercera línea solo 3 fármacos: omalizumab, ciclosporina A o antileucotrienos.

This interdisciplinary paper summarizes the news in the diagnosis and treatment of chronic urticaria (CU), and provides concepts, definitions and evidence-based suggestions for its management. Urticaria occurs in at least 20% of the population at some point in their lives. Acute urticaria (less than 6 weeks' duration), differs from CU in its etiology, but the onset of this disease is always acute. CU may occur as spontaneous (SCU) or induced (ICU). The diagnosis is simple, although a careful evaluation is necessary for differential diagnosis. ICU´s diagnosis is mainly clinical, even if provocation tests can be useful. Supplementary studies should be limited and based on the clinical suspicion. Treatment may be divided into three approaches: avoidance, elimination or treatment of the cause, and pharmacological treatment. Recently treatment has been modified with the use of second-generation antihistamines as first-line and increased doses of nonsedating H1 antihistamines, up to 4 times, as second line. Antihistamines are essential to treat CU; however, 40% of patients do not achieve good control despite increased doses and require additional treatment. The most recent evidence indicates a group of drugs to be used as third line in these cases, to improve quality of life and to limit toxicity from frequent or chronic use of systemic steroids. Only 3 drugs are recommended as third line: omalizumab, cyclosporin A or anti-leukotrienes.

Urticaria aguda / Acute urticaria

La urticaria es una reacción de la piel caracterizada clínicamente por la aparición de elevaciones cutáneas eritematosas o blanquecinas, edematosas, pruriginosas y transitorias, que pueden localizarse en cualquier parte de la superficie cutáneao en las mucosas. Su etiología es variada y sus mecanismos etiopatogénicos también suelen ser múltiples. La lesión típica es el habón o roncha, el cuál cambia de lugar en horas, su forma y tamaño son variables, puede persistir minutos, horas o semanas. La mayoría de las urticarias no presenta sintomatología sistémica. Suele clasificarse regularmente en urticaria aguda, cuando lleva menos de 6 semanas de aparición, y en urticaria crónica, cuando lleva más de 6 semanas. El diagnóstico es fundamentalmente clínico. Es una entidad frecuente que por su gran expresividad motivan constantes y reiteradas consultas a los servicios de urgencia. En este artículo se examinarán los mecanismos que llevan a la urticaria y angioedema, y se revisará la patogénesis, los aspectos clínicos, los estudios de laboratorio necesarios y el tratamiento de la urticaria aguda.

The urticaria is a skin reaction characterized clinically by the on set of erythematous skin elevations or whitish, oedematous,pruritic and transient, you can locate anywhere on the surface of the skin or the mucous membranes. Its etiology is varied and its mechanisms etiopathogenic also tend to be multiple. The typical lesion is the wheal or bump, which changes from place with inhours, its size and shape are variable, may persist for minutes, hours or weeks. The majority of the hives does not pose systemic symptoms. Usually qualify regularly in acute urticaria, when it takes less than 6 weeks of appearance, and chronic urticaria, when it takes over 6 weeks. The diagnosis is primarily clinical. Itis a common entity that by their expressivity motivate constants and repeated consultations to emergency services. This article will xamine the mechanisms that lead to angioedema and urticaria, he pathogenesis, clinical aspects, necessary laboratory studies and eatment.

Urticárias físicas: disfunção mastocitária. Condutas preventivas, diagnósticas e terapêuticas / Physical urticarias: mast cell disfunction. Preventive, diagnostic and therapeutical approach

Objetivo: Apresentar e discutir a classificação moderna das urticáriasfísicas baseada nos conceitos imuno e fisiopatológicos atuais. Definir asintomatologia clínica, os fatores precipitantes e agravantes, os métodosdiagnósticos investigativos e elucidativos, e elaborar as diferentesestratégias terapêuticas farmacológicas bem como os métodos dedessensibilização física. Métodos: Fonte consultada: Medline. Númeroe tipo de artigos consultados: 40, incluindo casos-controle, metanálises,relatos de casos e revisões em língua inglesa. As palavras-chave queorientaram a pesquisa dos artigos foram: urticárias físicas, classificação,dessensibilização física. Foi realizada a classificação diagnóstica didáticados diferentes grupos de urticárias físicas. Definição das modalidadeslocalizadas ou difusas, clássicas ou atípicas, adquiridas ou familiares,com ou sem a participação da IgE, dessas dermatoses induzidas forfatores de natureza física. Determinação das predisposições genéticasjá estabelecidas. Resultados: As urticárias físicas são dermatosesdecorrentes de disfunção mastocitária, com diminuição do limiar dedesgranulação citoplasmática dos mediadores de anafilaxia, induzidaspela estimulação de fatores físicos ambientais. Esses fatores precipitantespodem ser mecânicos, térmicos (calor e frio), relacionados a exercícios, àexposição solar e ao contato cutâneo com água. Conclusões: As urticáriasfísicas estão presentes em cerca de 17% dos pacientes portadores deurticárias crônicas, e diferentes formas podem coexistir em um mesmoindivíduo. O tratamento inclui prevenção, a utilização de anti-histamínicosclássicos e dos pouco ou não sedantes, e ocasionalmente corticosteróides,dapsona e outros agentes antiinflamatórios, além do emprego potencialde dessensibilização aos agentes físicos indutores.

Urticaria and the role of antihistamines in pruritus

About 20% of the population experience episodes of urticaria at least once in their lifetime. Type I hypersensitivity reactions may be involved in acute conventional and contact urticaria, but uncommonly in chronic urticaria. The diagnosis of urticaria can often be made only from the history. Patients may not present with skin lesions, so you should ask for history of drug intake and search for an infective focus. Nearly 50% of chronic idiopathic urticaria is associated with histamine-releasing autoantibodies. Episodes of urticaria lasting for more than 24 hours need to be evaluated for vasculitis and systemic disease. Antihistamines are the mainstay of treatment. Caution is to be taken while combining antihistamines with drugs like erythromycin and ketoconazole, for risk of cardiac arrhythmia [torsade de pointes]

Ordinary urticaria: a descriptive study

Clinical and histopathological evaluation of acute and chronic ordinary urticaria. Eighty-two patients having ordinary urticaria, 57 [69.5%] acute and 25 [30.5%] chronic, 24 [29.27%] males and 58 [70.73%] females, had been recorded from the out patient clinic-department of dermatoIog and venerolog-Baghdad Teaching Hospital-Baghdad. Data abstracted from the patients by a questionnaire and clinical assessment. All patients were sent for laboratory investigations including, blood examination, general urine and stool examination. Antinuclear factor was carried out for those patients with chronic urticaria. The mean age of the patients was 24 +/- 4.6 years. Females were more affected than males. Regarding atopy, there was no much difference from control. Night exacerbation was noticed in ordinary urticaria 43 [52.4%]. Emotional tension 32 [39%], food 25 [30.5%], heat 25 [30.5%]. drugs 16 [19.5%] and infections 14 [17%] were the most provoking factors. Gastrointestinal disturbances were the most common associated symptoms and noticed in 23.2% of patients. These symptoms were more in acute urticaria [29.8%] when compared with chronic urticaria [8%]. Parasitic infestations were noticed in chronic urticaria [20.4%], while eosinophilia was more evident in acute urticaria [16.1%]. Positive ANF, leukocytosis, high ESR, anemia and pyuria were observed in some patients. Tuberculin testing was less positive in patients with urticaria. Acute and chronic ordinary urticaria constitute a common type of urticaria affect predominantly females. Good questionnaire and full investigations are essential for the detection of their provoking factors