WordPress.com



American Journal of Clinical Dermatology

Urticaria - A Review

Tasneem Poonawalla; Brent Kelly

Posted: 05/08/2009; Am J Clin Dermatol. 2009;10(1):9-21. © 2009 Adis Data Information BV

Abstract and Introduction

Abstract

Urticaria is often classified as acute, chronic, or physical based on duration of symptoms and the presence or absence of inducing stimuli. Urticarial vasculitis, contact urticaria, and special syndromes are also included under the broad heading of urticaria. Recent advances in our understanding of the pathogenesis of chronic urticaria include the finding of autoantibodies to mast cell receptors in nearly half of patients with chronic idiopathic urticaria. These patients may have more severe disease and require more aggressive therapies. Extensive laboratory evaluation for patients with chronic urticaria is typically unrevealing and there are no compelling data that associate urticaria with chronic infections or malignancy. Pharmacologic therapy consists primarily of the appropriate use of first- and second-generation histamine H1 receptor antihistamines. Additional therapy may include leukotriene receptor antagonists, corticosteroids, and immunomodulatory agents for severe, unremitting disease. Despite our greater understanding of the pathogenesis of urticaria, the condition remains a frustrating entity for many patients, particularly those with chronic urticaria.

Introduction

Urticaria, commonly called 'hives,' has a long and rich history in documented medicine dating back at least to the 10th century B.C. when it was called 'Feng Yin Zheng' in China.[1] Many cultures have described urticaria in some capacity and the disorder has had many names. In the 4th century B.C., Hippocrates noted the similarities between urticaria, contact with stinging nettles, and insect bites and called the condition 'cnidosis' (nettle rash).[2] 'Uredo,' 'essera' (Arabic for elevation), 'urticatio' (derived from the Latin urere; to burn), and 'scarlatina urticaria' have all been used.[2] Use of the term 'morbus porcinus', which means pig's disease, resulted from a translational error of the intended term 'morbus pocellaneus,' which referred to the white color of the central wheal.[3] William Cullen was probably the first to use the term urticaria in 1769.

Nearly as many theories about the pathogenesis of urticaria have been described including, among others, a humoral theory (relating urticaria to body 'humors'), a metereologic theory in 1823 (suggesting that allergy was determined by the constellation of the stars), and a menstrual theory in 1864 (proposing that urticaria was related to endogenous hormones).[1] It was the discovery of the mast cell in 1879 by Paul Ehrlich that led to our current understanding of allergy pathogenesis, including urticaria. However, despite improvements in our understanding of urticaria, the condition remains a frustrating disorder for many patients, particularly those with chronic urticaria. This review attempts to classify urticaria and discuss the evidence-based pathogenesis and treatment options available, with particular emphasis on chronic urticaria.

A MEDLINE search using Ovid was performed to obtain the articles reviewed. Search terms included 'urticaria' and 'hives' and were applied from 1950 to the date of review. Relevant articles, particularly those relating to history, pathogenesis, and treatment, were included in this review. Articles were excluded if they did not add to the known knowledge base of the subject. Additional relevant articles were obtained from citations in the reference sections of identified articles.

Clinical Features and Epidemiology

Urticaria consists of recurrent wheals that are usually pruritic, pink-to-red edematous plaques that often have pale centers. The wheals are transient, and in most types of urticaria last for ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download