[Medline]. Differential diagnosis of Urticaria and angioedema: Anaphylaxis, Dermatographism, Atopic dermatitis, Urticarial vasculitis, Urticaria pigmentosa, Systemic. Cetirizine versus hydroxyzine and placebo in chronic idiopathic urticaria. J Investig Allergol Clin Immunol. Intravenous immunoglobulin in autoimmune chronic urticaria. J Allergy Clin Immunol Pract. 35:141-57. for: Actelion-Advisory board, grants;Seattle Genetics - Advisory board. [Medline]. [Medline]. J Allergy Clin Immunol. [Full Text]. Allergy Asthma Proc. 2014 May-Jun. [Medline]. Ann Pharmacother. J Allergy Clin Immunol. [Medline]. [Medline]. Acute and chronic urticaria and angioedema. 1993 Jun 3. 2004 May. [Medline]. This website also contains material copyrighted by 3rd parties. ... those in which the skin lesions are almost indistinguishable from those seen in patients with chronic idiopathic urticaria. [Medline]. Pediatr Dermatol. J Dermatol. 78745000 – Urticaria pigmentosa Look For. [Medline]. Ann Pharmacother. [Guideline] Zuberbier T, Asero R, Bindslev-Jensen C, Walter Canonica G, Church MK, Giménez-Arnau AM, et al. 2000 Aug. 143(2):365-72. Common … 2008 Dec. 59(6):909-20; quiz 921-2. Postgrad Med. The EAACI/GA(2) LEN/EDF/WAO Guideline for the definition, classification, diagnosis, and management of urticaria: the 2013 revision and update. Urticaria angioedema. 93 (2):304-305. [Medline]. Umer Najib, MD Clinical Research Fellow, Department of Medicine, Division of Allergy and Inflammation, Beth Israel Deaconess Medical CenterDisclosure: Nothing to disclose. Mallory Shiver, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, Arkansas Foundation for Skin Cancer, Christian Medical and Dental AssociationsDisclosure: Nothing to disclose. Najib U, Sheikh J. 2004 May-Jun. Curr Pharm Des. 24(2):183-213, vi. 123(4):462-7. J Allergy Clin Immunol. Abajian M, … Medscape Education, Clinical Pearls in Managing Hereditary Angioedema, 2002
120:413-8. 2010 Jan. 104(1):1-10; quiz 10-2, 41. [Medline]. Tong LJ, Balakrishnan G, Kochan JP, Kinét JP, Kaplan AP. O'Donnell BF, Barr RM, Black AK, Francis DM, Kermani F, Niimi N, et al. Urticarial vasculitis. Br J Dermatol. Theophylline as "add-on" therapy in patients with delayed pressure urticaria: a prospective self-controlled study. Ann Allergy Asthma Immunol. Improved outcomes in patients with acute allergic syndromes who are treated with combined H1 and H2 antagonists. Ann Allergy Asthma Immunol Jun. Montelukast reduces symptom severity and frequency in patients with angioedema-predominant chronic spontaneous urticaria. [Medline]. 2007. [Medline]. Urticaria and angioedema: an overview. Botto NC, Warshaw EM. It is generally classified as acute or chronic. J Allergy Clin Immunol. for: Actelion-Advisory board, grants;Seattle Genetics - Advisory board. Haas N, Toppe E, Henz BM. Grattan CE, Francis DM, Slater NG, Barlow RJ, Greaves MW. 2018 May 18. After completing the learning activity, participants should be able to distinguish between the typical wheals of urticaria and urticarial lesions suggesting other diagnoses and to assess patients with urticarial lesions in order to exclude or confirm other cutaneous diseases. 1997 Feb. 136(2):197-201. Sype JW, Khan IA. Kalogeromitros D, Kempuraj D, Katsarou-Katsari A, Gregoriou S, Makris M, Boucher W, et al. Bluestein HM, Hoover TA, Banerji AS, Camargo CA Jr, Reshef A, Herscu P. Angiotensin-converting enzyme inhibitor-induced angioedema in a community hospital emergency department. Urticaria is a term referring to a group of diseases which involve the onset of pruritic wheals, angioedema, or both. [Medline]. Ozbagcivan O, Akarsu S, Ilknur T, Fetil E. Urticaria and angioedema as possible reactions of omalizumab. Baek YS, Jeon J, Kim JH, Oh CH. Definition, clinical picture, and differential diagnosis of urticaria. Ann Allergy Asthma Immunol. 2009 Dec. 64(12):1715-21. 9 (3):170-174. [Guideline] Powell RJ, Leech SC, Till S, Huber PA, Nasser SM, Clark AT. Caterpillars and moths: Part I. Dermatologic manifestations of encounters with Lepidoptera. [Medline]. clemastine-343388
Treatment of chronic autoimmune urticaria with omalizumab. Urticaria: Testing for differential diagnosis Diagnosing urticaria will rely on information from a variety of sources, including a physical exam, patient history, and possibly test results. Brief episodes of urticaria can be associated temporally with identifiable causes, and the method of exposure (ie, direct contact, oral or IV routes) is usually known. Patil AD, Bingewar G, Goldust M. Efficacy of methotrexate as add on therapy to H1 antihistamine in difficult to treat chronic urticaria: A systematic review and meta-analysis of randomized clinical trials. Dermatologica. Int Arch Allergy Immunol. [Medline]. Allergy: Principles and Practices. 2008 Sep. 122(3):569-73. Michael A Kaliner, MD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American Association of Immunologists, American College of Allergy, Asthma and Immunology, American Society for Clinical Investigation, American Thoracic Society, Association of American PhysiciansDisclosure: Nothing to disclose. Simons FE. 2014 Jul. 5(1):10. Philadelphia, Pa: Mosby; 2003. Plasmapheresis for severe, unremitting, chronic urticaria. [Medline]. Anaphylaxis. 24(2):141-62, v. [Medline]. 99(2):333-5. [Medline]. 2010;62(4):541–555. Clin Exp Dermatol. 105(4):664-72. Cholinergic urticaria. [Medline]. Eur J Emerg Med. [Medline]. Maurer M, Rosén K, Hsieh HJ, et al. J Dermatolog Treat. Arch Dermatol. 1991 Jul. [Medline]. 2006 Jan. 90(1):187-209. Solar urticaria. [Medline]. 45 (3):547-65. [Medline]. 15 (6):30. Konstantinou GN, Asero R, Maurer M, Sabroe RA, Schmid-Grendelmeier P, Grattan CE. Differential diagnosis of chronic urticaria. Print Close. The definition and diagnostic testing of physical and cholinergic urticarias--EAACI/GA2LEN/EDF/UNEV consensus panel recommendations. Diseases & Conditions, 2010
17 It is important to differentiate urticarial vasculitis from CSU in terms of prognosis, approach to diagnostic evaluation, and therapy. Henry K Wong, MD, PhD is a member of the following medical societies: American Academy of Dermatology, International Society for Cutaneous Lymphomas, Medical Dermatology Society, Society for Investigative DermatologyDisclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Seattle Genetics, Actillion, Celgene, Kyowa-Kirin
Serve(d) as a speaker or a member of a speakers bureau for: Amgen
Received income in an amount equal to or greater than $250 from: Celgene
Received honoraria from Amgen for speaking and teaching; Received grant/ Received grant/research funds from Celgene for none; Received grant/research funds from Abbott Labs for independent contractor; Received grant/research funds from Amgen for none; Received honoraria from Seattle Genetics for consulting. Int J Immunopathol Pharmacol. [Medline]. J Allergy Clin Immunol. Prevalence of sensitivity to food and drug additives in patients with chronic idiopathic urticaria. The clinical appearance of urticaria may also Subscription Required. Coronary artery bypass grafting and aortic valve replacement with cold cardioplegia in a patient with cold-induced urticaria. Efficacy and safety of treatment with omalizumab for chronic spontaneous urticaria: A systematic review for the EAACI Biologicals Guidelines. Dig Dis Sci. 58(3):211-8. The differential diagnosis of urticaria: part I. Cutaneous diseases. Lancet. 2010 Jan. 62(1):1-10; quiz 11-2. [Medline]. Anaphylaxis. [Medline]. [Medline]. Akenroye AT, McEwan C, Saini SS. 10(1):9-21. 2001 Jan-Feb. 18(1):66-7. Beyond antihistamines: treating chronic urticaria. 100(3):181-8; quiz 188-90, 215. Urticaria may be confused with a variety of other dermatologic diseases that are similar in appearance and are pruritic, including atopic dermatitis (eczema), maculopapular drug eruptions, contact dermatitis, insect bites, erythema multiforme, pityriasis rosea, and others. Valsecchi R, Pigatto P. Chronic urticaria and Helicobacter pylori. [Medline]. Intern Med J. Differentiating Tests An elevated tryptase may help with the diagnosis of urticaria pigmentosa, which is often a feature of systemic mastocytosis, although tryptase … Nettis E, Dambra P, D'Oronzio L, Loria MP, Ferrannini A, Tursi A. [Medline]. Sheikh J. [Medline]. Biologics and biomarkers for asthma, urticaria, and nasal polyposis. Vonakis BM, Saini SS. Javed Sheikh, MD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American College of Allergy, Asthma and ImmunologyDisclosure: Received grant/research funds from Genentech for other. Clin Exp Allergy. Drugs, encoded search term (Acute Urticaria) and Acute Urticaria, A 16-Year-Old Girl With a Rash and Shortness of Breath, Fast Five Quiz: Refresh Your Knowledge on Key Aspects of Acute Urticaria, HRT Tied to Increased Risk of Severe Asthma Exacerbation, The First 30 Minutes: Anaphylaxis After COVID Vaccination, Novel Agent Shows Promise Against Cat Allergy, Masks Don't Affect Oxygen Saturation in People With Asthma, Peanut Sublingual Immunotherapy Feasible and Effective in Toddlers, Hospitalizations for Food Anaphylaxis Triple, but Deaths Down in UK, Less Peanut Allergy in Australia Following Earlier Introduction Into Diet. It is a self-limiting condition From the Department of Biomedical and Surgical Sciences,a Arch Dermatol. An update on acute and chronic urticaria for the primary care provider. Allergy. Chronic urticaria — Urticaria is considered chronic when it is recurrent, with signs and symptoms recurring most days of the week, for six weeks or longer. Urticaria (with or without angioedema) is commonly categorized by its chronicity: Acute urticaria — Urticaria is considered acute when it has been present for less than six weeks. Arch Dermatol. O'Donnell BF, Lawlor F, Simpson J, Morgan M, Greaves MW. [Medline]. briefly and to discuss the differential diagnosis of urticaria. Urticaria is caused by cutaneous mast cell activation and degranulation disease triggered by numerous stimuli. 2006 Oct. 55(4):705-9. [Medline]. Cochrane Database Syst Rev. [Medline]. Chronic urticaria is diagnosed through the taking of a careful history and examination; this diagnosis is based on a history lasting over 6 weeks of daily or episodic weals that last less than 24 hours without the presence of physical trigger factors. 24(1):1-5. J Allergy Clin Immunol. Solar urticaria. J Allergy Clin Immunol. DIFFERENTIAL DIAGNOSIS Other conditions may be confused with urticaria but can be distinguished based on the difference in presentation. Clinical and laboratory examinations in the subgroups of chronic urticaria. Wan KS. 2008 Dec. 20(6):709-16. Simons FE. Assessment of autoimmunity in patients with chronic urticaria. Differential diagnosis with systemic condi-tions is the focus of part II of this series. Dermatologica. 1999 May. 2005 Jul-Sep. 18(3):595-602. 2004 Feb. 92(2):273-5. [Medline]. 1992 May 2. Henoch-Schonlein Purpura (IgA Vasculitis). [Medline]. Ann Allergy Asthma Immunol. [Full Text]. Curr Rheumatol Rep. 2007 Aug. 9(4):312-9. Sánchez-Borges M, Asero R, Ansotegui IJ, Baiardini I, Bernstein JA, Canonica GW, et al. [Medline]. Acta Derm Venereol. [Full Text]. 2012 Nov. 5 (11):125-47. J Dermatolog Treat. 3:CD008596. Microscopic morphology of different types of urticaria. [Medline]. [Full Text]. [Full Text]. [Medline]. 2001 May. Immunol Allergy Clin North Am. 2015 Aug 4. [Medline]. 2020 Aug 3. [Medline]. Bleehen SS, Thomas SE, Greaves MW, Newton J, Kennedy CT, Hindley F, et al. Arch Dermatol. Ruzicka T, Goerz G. Systemic lupus erythematosus and vasculitic urticaria. 56(5):456-7. [Guideline] Fine LM, Bernstein JA. Differential diagnosis of chronic urticaria. StatPearls [Internet]. Dermatology. Current approaches to the diagnosis and treatment of systemic mastocytosis. Ann Allergy Asthma Immunol. 43(6):1226-9. 2005 May. 2008. EAACI taskforce position paper: evidence for autoimmune urticaria and proposal for defining diagnostic criteria. 2015 Feb 18. Thus, the diagnosis relies on a careful history and physical examination, and in … 51 (6):367-74. Please confirm that you would like to log out of Medscape. Such conditions include urticaria pigmentosa, urticarial vasculitis, atopic dermatitis, contact dermatitis, drug eruptions, erythema multiforme, Henoch–Schonlein purpura, scabies, and viral exanthema. Leznoff A, Josse RG, Denburg J, Dolovich J. Smith PF, Corelli RL. Differential diagnosis of anaphylaxis in adults and children Drug eruptions Overview of cutaneous lupus erythematosus New-onset urticaria Urticarial vasculitis Physical (inducible) forms of urticaria Cold urticaria Exercise-induced anaphylaxis: Management and prognosis 2008 Mar. Allergy. 37 (5):631-50. Advances in allergic skin disease, anaphylaxis, and hypersensitivity reactions to foods, drugs, and insects in 2009. 99(4):461-5. Urticarial vasculitis. Sackesen C, Sekerel BE, Orhan F, Kocabas CN, Tuncer A, Adalioglu G. The etiology of different forms of urticaria in childhood. [Medline]. As a general rule, a wheal lasts for up to 1 day, whilst mast cell-mediated angioedema can remain symptomatic for up to 2 days. Viola M, Quaratino D, Gaeta F, Rumi G, Caruso C, Romano A. Cross-reactive reactions to nonsteroidal anti-inflammatory drugs. [Medline]. 2017 May 17. All sections | Differential Diagnosis. Am J Clin Dermatol. 172(1):36-40. Pediatr Dermatol. Drugs. 2018 May-Jun. Prim Care Clin Office Pract. Allergy. [Medline]. Vena GA, Cassano N, Colombo D, Peruzzi E, Pigatto P. Cyclosporine in chronic idiopathic urticaria: a double-blind, randomized, placebo-controlled trial. 2012 Nov 19. Guldbakke KK, Khachemoune A. Etiology, classification, and treatment of urticaria. [Medline]. 1537-58. Kaplan AP. 135208-overview
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[Guideline] Zuberbier T, Asero R, Bindslev-Jensen C, Walter Canonica G, Church MK, Giménez-Arnau AM, et al. 2010 Jan. 104(1):1-10; quiz 10-2, 41. [Medline]. Br J Dermatol. Clin Exp Dermatol. Acute urticaria in children: causes and an aggressive diagnostic approach. 2020 Jun. 2004 May. Werni R, Schwarz T, Gschnait F. Colchicine treatment of urticarial vasculitis. All material on this website is protected by copyright, Copyright © 1994-2021 by WebMD LLC. [Medline]. 123(3):713-7. 123(4):970; author reply 970-1. Ann Allergy Asthma Immunol. [Medline]. Ann Allergy Asthma Immunol. [Medline]. H1-Antihistamines: more relevant than ever in the treatment of allergic disorders. Urticaria and angioedema evoke a completely different differential diagnosis from angioedema without an associated urticarial syndrome. J Allergy Clin Immunol. 162(3):203-5. The lesions in urticaria typically resolves in minutes to hours, migrates continually, and leaves no residual pigmentation after resolving in contrast to UV . [Intolerance to food additives: an update]. Urticaria and angioedema. Outpatient management of acute urticaria: the role of prednisone. Int J Cardiol. 2015 Jun. Kasperska-Zajac A, Jasinska T, Grzanka A, Kowalik-Sztylc A. Markers of systemic inflammation in delayed pressure urticaria. 9:25-33. 1998 Jan. 134(1):41-6. 2020 Aug 7. Allergic skin disease: major highlights and recent advances. Goldfinger S. The inherited autoinflammatory syndrome: a decade of discovery. Update on Omalizumab for Urticaria: What's New in the Literature from Mechanisms to Clinic. [Medline]. Beltrani VS. Urticaria: reassessed. 2018 Mar. Sheila MA, Stephen CD. Dibbern DA Jr. Urticaria: selected highlights and recent advances. 2009 Oct. 64(10):1417-26. 2009 Mar. Cooke A, Bulkhi A, Casale TB. Davis MD, Brewer JD. Urticaria associated with acute group A beta-hemolytic streptococci infection. Diagnosis and treatment of urticaria and angioedema: a worldwide perspective. Lang DM. 2009 Dec 1. Zuberbier T, et al. Rose RF, Bhushan M, King CM, Rhodes LE. Clinical and laboratory examinations in the subgroups of chronic urticaria. Dirk M Elston, MD is a member of the following medical societies: American Academy of DermatologyDisclosure: Nothing to disclose. A clinical and histologic study. 20(4):194-7. Tong LJ, Balakrishnan G, Kochan JP, Kinét JP, Kaplan AP. Likely cause is postviral syndrome. 2020 Jul 26. e14077. 117(1):81-8. 1(2):80-2. Brodell LA, Beck LA. 3rd ed. 2014 Mar-Apr. A Comparison of the United States and International Perspective on Chronic Urticaria Guidelines. Gober LM, Sterba PM, Eckman JA, Saini SS. [Medline]. 2008 Mar. Indian Dermatol Online J. 28(2):123-7. Local urticaria on a patient with latex allergy who was touched with a latex glove. Postgrad Med. Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug ReferenceDisclosure: Received salary from Medscape for employment. Wheals may, however, be combined with other symptoms such as blisters. 2008 Sep. 122(3):569-73. The definition and diagnostic testing of physical and cholinergic urticarias--EAACI/GA2LEN/EDF/UNEV consensus panel recommendations. Slater JW, Zechnich AD, Haxby DG. 1994 Jun. Javed Sheikh, MD Assistant Professor of Medicine, Harvard Medical School; Clinical Director, Division of Allergy and Inflammation, Clinical Director, Center for Eosinophilic Disorders, Beth Israel Deaconess Medical Center Acute urticaria in a toddler affecting the face. 100(3):181-8; quiz 188-90, 215. . Cutis. Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug ReferenceDisclosure: Received salary from Medscape for employment. Simonart T, Askenasi R, Lheureux P. Particularities of urticaria seen in the emergency department. 2013 Apr. Omalizumab is efficacious for management of recalcitrant, antihistamine-resistant chronic urticaria. 1987 Jul. Wong RC, Fairley JA, Ellis CN. For more information, see the CKS topic on Eczema - atopic. Rapid oral challenge-desensitization for patients with aspirin-related urticaria-angioedema. What the first 10,000 patients with chronic urticaria have taught me: a personal journey. Curr Pharm Des. 144(3):217-25. Clin Exp Dermatol. Randomized double-blind study of cyclosporin in chronic 'idiopathic' urticaria. Acute urticaria and angioedema: diagnostic and treatment considerations. [Medline]. 2015 Mar. [Medline]. [Medline]. 2008 Nov. 38(11):852-7. Middleton E, Reed CE, Ellis EF, et al, eds. In 47 patients (31.8%), early bullous pemphigoid or dermatitis herpetiformis was included in the differential diagnosis. [Medline]. Grattan CE, O'Donnell BF, Francis DM, Niimi N, Barlow RJ, Seed PT, et al. Autoantibodies against the high-affinity IgE receptor as a cause of histamine release in chronic urticaria. [Medline]. J Allergy Clin Immunol. Urticaria, also known as welts, hives, or wheals, is characterised by the appearance of intensely pruritic erythematous plaques. 1997 Apr. The diagnosis and management of acute and chronic urticaria: 2014 update. Hossler EW. 2009. Kaplan AP, Joseph K, Maykut RJ, Geba GP, Zeldin RK. Comparison of montelukast and fexofenadine for chronic idiopathic urticaria. 21(2):102-8. [Medline]. 2007. Dermatol Ther (Heidelb). Varadarajulu S. Urticaria and angioedema. Frigas E, Park MA. Hide M, Francis DM, Grattan CE, Hakimi J, Kochan JP, Greaves MW. [Medline]. 15(4):173-7. 2009 Jun. [Medline]. Prolonged QT interval with markedly abnormal ventricular repolarization in diphenhydramine overdose. [Medline]. Schoepke N, Doumoulakis G, Maurer M. Diagnosis of urticaria. 2007 Jan. 79(1):41-9. 99(4):461-5. Ann Emerg Med. Nichols KM, Cook-Bolden FE. Urticaria Guidelines: Consensus and Controversies in the European and American Guidelines. 328(22):1599-604. Lin RY, Curry A, Pesola GR, Knight RJ, Lee HS, Bakalchuk L, et al. 2010 Feb. 125(2 Suppl 2):S161-81.
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