Urticaria is a common pruritic skin disorder that is often seen in the office and varies in severity and chronicity. The etiologic cause is frequently not identifiable. Urticaria may be associated with physical factors and triggers, including foods or medications. A significant percentage of patients with chronic urticaria have circulating autoantibodies directed toward immunoglobulin-E or the high-affinity receptor for immunoglobulin-E (FcepsilonRI), or have antithyroid antibodies that might play a role in the activation of the final common pathway in urticaria: mast cell activation and degranulation. Management begins with a careful investigation and elimination of eliciting factors when identified, followed by treatment of underlying disease. Antihistamines are the current mainstay of pharmacotherapy for urticaria, which provide symptomatic relief in most cases. In severe cases, corticosteroids, hydroxychloroquine sulfate (Plaquenil; Sanofi-Synthelabo, New York, NY), and immunosuppressive agents, including cyclosporin, are sometimes used by specialists.
[Show abstract][Hide abstract] ABSTRACT: AD, urticaria, and ACD account for a large percentage of the skin disorders that present at medical offices and emergency departments. With a high degree of morbidity, these diseases can be extremely difficult to manage. Consequently, these diseases continue to be the focus of much of the new research in the field. Recent studies have furthered the understanding of the complex relationship between immune and nonimmune factors in the pathogenesis of these disorders. This research has quickly led to the development of new treatment modalities and protocols for patient care, especially for AD. However, further discovery will be necessary to optimize the management of these often-vexing conditions.
The Medical clinics of North America 11/2009; 93(6):1211-24. DOI:10.1016/j.mcna.2009.08.004 · 2.61 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Urticaria is a disorder characterized by rapid onset of localized swelling of the skin or mucosa, called wheals or urtica. According to frequency and duration, urticaria can be divided into acute and chronic type. Chronic urticaria is any type of urticaria occurring every day or twice per week, lasting longer than 6 weeks. Chronic urticaria is a common disorder and estimated prevalence is 1% of the population. Also, it is not rare in childhood. The pathogenesis of chronic urticaria has not yet been completely understood. Chronic urticaria is a heterogeneous group of disorders, and according to the etiology and cause, several groups of chronic urticaria are distinguished, i.e. autoimmune, pseudoallergic, infection-related, physical urticaria, vasculitis urticaria and idiopathic urticaria. Treatment and management of chronic urticaria can be non-pharmacological and pharmacological, and sometimes it is not possible to control the disease with antihistamines only, which are considered to be the mainstay of treatment. In severe cases of chronic urticaria, especially if autoimmunity has been proven, several authors describe different modules of immunomodulation: cyclosporine, cyclophosphamide, mycophenolate-mofetil, omalizumab, plasmapheresis, systemic corticosteroids, and immunoglobulin therapy. This article primarily addresses the treatment of chronic idiopathic and autoimmune urticaria.
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