Allergy-induced urticaria of the colon.

This article reports 2 adult patients who had developed an acute allergic reaction to food ingredients or medications, respectively. Both patients presented with concurrent urticaria of the skin and colon. The latter finding appeared as numerous raised plaques of the colonic mucosa on radiographic and computed tomography (CT) of the abdomen. The urticarial lesions affecting the skin and large bowel resembled each other and resolved after treatment with antihistamines. Pertinent clinical data and previously published cases of this unusual entity are briefly reviewed.

Dynamic optical coherence tomography of histamine induced wheals.

BACKGROUND: Dynamic optical coherence tomography (D-OCT) is a noninvasive imaging technique providing images of the skin and detecting movement in the tissue ie, measuring blood flow. The "attenuation coefficient" describes light absorption and scattering abilities of the tissue, while the dynamic signal provides a quantitative measure of the blood flow. AIM: The study objective is to describe the dynamic changes of the skin and skin vessels during histamine release using D-OCT. METHODS: Healthy volunteers had local histamine injections in the skin and D-OCT-scans performed at 2-minute intervals to detect changes in blood flow, attenuation and clinical symptoms. RESULTS: 9/10 participants showed clinical wheals. An increase in blood flow was shown at all depths (P < .001 at 2 minutes). The highest relative increase was seen at 300 µm. The signal at 500 µm decreased to insignificant values and remained low after 4 minutes. A decrease in visualization depth of up to 32.7% as well as a significant increase in the attenuation coefficient was shown (P < .001 at 12 minutes for both tests). CONCLUSION: Dynamic optical coherence tomography is able to reliably identify changes in blood flow of histamine induced wheals. Dermal oedema reduces visualization depth and increases the attenuation coefficient.

The Dysfunction of the Cerebellum and Its Cerebellum-Reward-Sensorimotor Loops in Chronic Spontaneous Urticaria.

Chronic spontaneous urticaria (CSU) is a common itchy skin disease. Despite its prevalence, the neuropathology of CSU is uncertain. In this study, we explored resting state functional connectivity (rs-FC) changes in CSU, as well as how the symptom changes following intervention can modulate rs-FC. Forty patients and 40 healthy controls (HCs) were recruited. Following an intervention, 32 patients participated in a second scan approximately 6 weeks after the first scan. Compared with healthy controls, CSU subjects exhibited higher regional homogeneity (ReHo) values in the cerebellum, which were positively associated with urticaria activity scores over 7 days (UAS7) at baseline. After an intervention accompanied with clinical improvement, we found that ReHo values decreased at the cerebellum and increased at the bilateral primary somatosensory cortex (SI)/primary motor cortex (MI)/supplementary motor area (SMA). Using the cerebellum as a seed, CSU subjects exhibited increased rs-FC with reward regions when compared with HCs and exhibited decreased rs-FC at the right orbitofrontal cortex and right sensorimotor region following the intervention. The improvement rate values were positively associated with reduced rs-FC values in the two regions. Using the cluster of SI/MI/SMA as a seed, CSU patients exhibited decreased rs-FC with the left putamen, caudate, accumbens, and thalamus following the intervention. These results demonstrate the altered cerebellar activity and cerebellum-reward-sensorimotor loops in CSU.

Is silent sinusitis a cause of chronic urticaria in children?

The etiologies of chronic urticaria (CU) comprise a wide variety of disorders including chronic infections. The association of sinusitis and CU is controversial due to the lack of a control group. The objective of this study was to investigate the role of silent sinusitis as a cause of CU in children. A sinus X-ray (SXR) was performed in 107 children with CU. SXR abnormalities were found in 52.3% of the patients. Nine patients (8.4%) had symptoms of sinusitis and were treated with amoxicillin/clavulanate. Five of these patients (55.6%) had CU remission. Forty-seven patients (43.9%) who had an abnormal SXR without sinusitis symptoms were randomized into treated (23 patients) and control (24 patients) groups. Eighteen patients (78.3%) in the treated group and 15 patients (62.5%) in the control group had CU remission (p = 0.24). These data did not support a causal relationship of sinusitis and CU in children.

Basilar hyperlucency in a patient with emphysema due to hypocomplementemic urticarial vasculitis syndrome.

Disproportionate emphysematous involvement of the lung bases, compared with the apices, sometimes called basilar hyperlucency, is an unusual radiographic pattern that has been reported primarily in patients with alpha-1 antitrypsin deficiency, but also in individuals with emphysema caused by intravenous injection of methylphenidate. We present a patient with emphysema associated with hypocomplementemic urticarial vasculitis syndrome and whose chest radiograph demonstrated basilar hyperlucency. To the extent that basilar hyperlucency has not been well recognized as a feature of hypocomplementemic urticarial vasculitis syndrome, this report extends the spectrum of causes of this unusual radiographic pattern of emphysema.

Normocomplementemic urticarial vasculitis inaugurating destructive polyarthritis.

Urticarial vasculitis is an entity characterized by recurrent bouts of urticaria and histological evidence of leukocytoclastic vasculitis. An underlying systemic disease is often present. Joint manifestations occur mainly in cases with hypocomplementemia. We report a case of destructive polyarthritis preceded by urticarial vasculitis without hypocomplementemia.

Echographic evaluation with image analysis of histamine-induced wheals.

10 healthy, non-atopic women, aged 20-30, underwent histamine prick tests, performed in duplicate on the volar surface of the forearm with progressively increasing histamine concentration, from elbow to wrist on the left arm and from wrist to elbow on the right. Histamine wheal assessments were performed with the following methods at 5, 10, 15 and 20 min from challenge: planimetry for wheal area determination, A-scanning for skin thickness evaluation and echographic image analysis for assessing skin edema corresponding to the hypoechogenic area in the dermis. Wheal extension, skin thickness and edema of the dermis increase in time according to the histamine concentration. However, in response to the same concentration, regional variations consisting in greater wheal extension and dermis hypoechogenic areas were observed on proximal than on distal sites. Conversely, statistically significant differences were found between tests carried out on the right arm compared to those on the left regarding skin thickness. These variations have to be considered when interpreting data derived from pharmacological studies on the inhibition of histamine-induced reactions.

Submucosal colonic edema--urticaria of the colon.

Radiographically, colonic urticaria presents a non-specific pattern of submucosal edema. Previously unreported diverticulitis with colonic distention resulting in the flat, polygonal, mosaic pattern typical of this entity is described.

Laboratory tests in chronic urticaria.

One hundred twenty-five patients with chronic urticaria were evaluated with 11 commonly recommended laboratory and radiologic procedures. Abnormal studies were obtained in 26 (20.8%) of these patients, but the majority of these abnormalities were evident from the initial history and physical examination. These results indicate that, with the possible exception of sinus roentgenograms, these laboratory studies are not likely to be helpful in the evaluation of chronic urticaria unless there are suggestive findings in the history and physical examination. The yield and equivalent charge of diagnosis for each procedure used was also analyzed.

Urticaria of the colon.

The clinical manifestations of colonic urticaria vary, depending on the presence of associated abnormalities. A case of an association between colonic urticaria and cecal volvulus is described.