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Query: UMLS:C0042109 (urticaria)
 6,569 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Asthma is orchestrated by cytokine products of activated T cells. Glucocorticoids are thought to ameliorate asthma at least partly through T cell inhibition. Consequently, other T cell immunomodulatory agents have been assessed for asthma therapy. Since these agents may have serious unwanted effects, attention has been focused on patients with severe asthma refractory to maximal topical, and additional systemic glucocorticoid therapy. Although gold salts show a modest but significant glucocorticoid-sparing effect in severe asthma, lung function is not improved and not all patients respond. The minimum duration of a valid trial of therapy is probably 6 months. Unwanted effects include dermatitis, hepatic dysfunction, proteinuria and interstitial pneumonitis. Meta-analysis of trials of methotrexate in oral glucocorticoid-dependent asthma have confirmed that concomitant weekly methotrexate for a minimum of 3 to 6 months enables significant (approximately 20%) overall reduction in oral glucocorticoid requirements, although only approximately 60% of patients show a significant response. There is little effect on lung function. Blood count and liver function must be monitored. Opportunistic infection is rare but potentially fatal. Cyclosporine, administered for at least 3 months, is effective in only a proportion of patients with oral glucocorticoid-dependent asthma, where it may improve disease severity and/or enable oral glucocorticoid dosage reductions. Regular monitoring of renal function, blood pressure and blood concentrations of cyclosporine is required. The evidence that intravenous immunoglobulin (Ig) is of any benefit in patients with glucocorticoid-dependent asthma is at present equivocal. The therapy is expensive and associated with a high incidence of unwanted effects (fever, aseptic meningitis, urticaria). The macrolides tacrolimus (FK506) and sirolimus (rapamycin) have end effects similar to those of cyclosporine. Brequinar sodium, mycophenolate mofetil and leflunomide are inhibitors of de novo synthesis of pyrimidines and purines, to which T cells are particularly sensitive. Such drugs may in theory be beneficial for therapy of patients with oral glucocorticoid-dependent asthma. Humanized anti-CD4, anti-IgE and anti-interleukin (IL)-5 monoclonal antibodies, and other cytokine inhibitors such as soluble IL-4 receptor have entered early trials. The worth of current immunomodulatory drugs is limited since: (i) not all patients respond, and response cannot be predicted a priori; (ii) the high incidence of unwanted effects makes it difficult to assess overall benefit/risk ratios; (iii) there is increased risk of opportunistic infection and (theoretically) neoplasia; (iv) there are many relative and absolute contraindications to therapy; and (v) there is lack of knowledge about the long-term effects, beneficial or otherwise, of therapy.
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PMID:Asthma refractory to glucocorticoids: the role of newer immunosuppressants. 1472 75

The benefits of a clinical information system would be enhanced by a clinical decision support system (CDSS). We have developed urticaria diagnosis knowledge model for clinical practice. In order to construct a more accurate, evidenced-based and comprehensive knowledge base for urticaria, we arranged and integrated knowledge from literatures-based knowledge, as provided by; The Korean Academy of Asthma and Allergy [1], the American Allergy Association based on an algorithm of chronic urticaria assessment. We presented this knowledge in a Boolean cross table frame and implemented these guidelines using the developed CDSS.
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PMID:The knowledge modeling for chronic urticaria assessment in clinical decision support system with PDA. 1472 8

Mastocytosis comprises several diseases characterized by an abnormal increase in tissue mast cells. Cutaneous mastocytosis (CM) is the most common form of mastocytosis, affects predominantly children, and presents as a mast cell hyperplasia limited to the skin. Systemic mastocytosis (SM) comprises multiple distinct entities in which mast cells in filtrate the skin and/or other organs. The diagnosis of SM is based on the presence of one major criterion and one minor criterion or three minor criteria. Major criteria include the presence of multifocal dense infiltrates of > 15 mast cells in bone marrow and/or other extracutaneous organs. Four minor criteria include the presence of elevated serum alpha-tryptase levels > 20 ng/mL, the expression of CD2 and CD25 surface markers in c-kit-positive mast cells from bone marrow or other organs, the presence of a c-kit mutations on bone marrow and/or other tissues mast cells, and the presence of > 25% abnormal spindle-shaped mast cells in bone marrow and/or tissues. Symptoms of CM include pruritus, flushing urticaria, and dermatographism. Symptoms of SM include cutaneous symptoms in association with syncope, gastric distress, nausea and vomiting, diarrhea, bone pain, and neuropsychiatric symptoms. Activating and nonactivating mutations of c-kit (Asp816Val) are seen in adult SM and in some pediatric CM (Gly839Lys), indicating a clonal dysregulation. There is no cure for mastocytosis but the majority of pediatric CM regress at puberty. Women with mastocytosis are fertile and pregnancy and delivery have been successful by blocking mast cell-mediated symptoms. Symptomatic treatment aimed at reducing the effect of mediators is effective with antihistamines and mast cell-stabilizing agents such as sodium cromolyn. To reduce mast cell burden, interferon alpha, steroids, and purine analogs have been used with varying results. Future directions include tyrosine kinase inhibitors and bone marrow transplant.
Allergy Asthma Proc
PMID:Mastocytosis: classification, diagnosis, and clinical presentation. 1505 60

Celiac sprue is a chronic malabsorptive disorder that occurs in predisposed individuals secondary to ingestion of gluten. An increase of atopic or immunologic disorders has been reported in the setting of gluten enteropathy. The incidence of urticaria and celiac sprue is unknown but appears to be rare.
Allergy Asthma Proc
PMID:Celiac disease presenting as urticaria. 1517 93

The pathogenesis of chronic idiopathic urticaria (CIU) is not understood completely; however, autoimmunity has been implicated. Because membrane and soluble forms of CD154 have been reported to be increased, in several autoimmune diseases, we have quantified the soluble CD154 (sCD154) molecule by a sandwich enzyme-linked immunosorbent assay in serum samples of 32 patients with CIU (aged 32 +/- 12 years) and compared them with 32 age- and sex-matched nonallergic controls. A marked increase was observed in patients with CIU as compared with controls (4.8 +/- 2.6 ng/mL versus 2.9 +/- 0.9 ng/mL; p < 0.0005). No significant differences were found between groups of patients with positive or negative autologous serum skin test. A biological assay to determine sCD154 showed that patients with positive autologous serum skin test have the highest levels (4.9 +/- 1.2 ng/mL) of biologically active sCD154 as compared with their negative counterparts (2.2 +/- 1.3 ng/mL; p < .001) and controls (0.6 +/- 0.3 ng/mL; p < 0.001). Active sCD154 can be derived from mast cell activation or other leukocytes. It is concluded that active sCD154 may be involved in the immune activation observed in patients with CIU.
Allergy Asthma Proc
PMID:Total and biologically active serum-soluble CD154 in patients with chronic idiopathic urticaria. 1517 97

Urticaria is a common symptom--it is not a single disease. Patients present knowing what caused their "hives" or not knowing the cause of their hives. The latter patients present to the physician expecting to find a cause--but it is extremely rare that a single cause is discovered; however, a search for identifiable "triggers" should be sought in the history. Routine laboratory investigations are consistently disappointing (unless appropriate testing is suggested by the history). The term idiopathic can be added only when a single putative cause is not discovered. Fortunately, all urticarias eventually resolve (spontaneously). All treatment is palliative. Antihistamines remain the first-line of therapy, the more H1-receptors blocked, the better the results (the majority of patients with urticaria are "undertreated"). Rarely are steroids warranted for management. A review of the evaluation and management of patients with persistent urticaria without an identifiable cause is presented.
Allergy Asthma Proc
PMID:Urticaria: reassessed. 1531 16

Aquagenic urticaria is a very rare form of physical urticaria induced by contact with water. In this case report, we describe a child with a typical form of the disease in whom other types of physical urticaria were ruled out. Clinical manifestations, investigational methodology, and available treatments were reviewed. Treatment with hydroxyzine, 25 mg daily, was successful after a month follow-up in preventing wheals and erythema. However, mild pruritus is still present after contact with water.
Allergy Asthma Proc
PMID:Aquagenic urticaria: report of a case. 1531 26

Although chronic urticaria may be associated with the presence of serum anti-thyroid antibodies, it is not known whether these antibodies play a causal role in the urticaria. We therefore sought to determine whether the anti-thyroid antibodies seen in patients with urticaria were of the IgE class. Using commercial ELISA kits for measuring serum IgG anti-thyroglobulin and anti-thyroid peroxidase antibodies, we modified the procedure to detect IgE antibodies. We examined sera from 20 patients with urticaria who had IgG anti-thyroid antibodies and from 12 patients with IgG antithyroid antibodies who did not have urticaria. Only 2 of 20 patients with urticaria and IgG anti-thyroid antibodies had detectable IgE anti-thyroid antibodies: 1 patient had anti-thyroid peroxidase IgE antibody and 1 patient had anti-thyroglobulin IgE. IgE anti-thyroid antibodies do not appear to play a causal role in urticaria in the majority of patients.
Allergy Asthma Proc
PMID:IgE antithyroid antibodies in patients with Hashimoto's disease and chronic urticaria. 1560 1

Diagnosing food allergies can be challenging to the practitioner. Our armamentarium includes standardized skin prick testing, radioallergoimmunosorbent (RAST) testing, and food challenges. These methods have certainly been helpful in the IgE-mediated disorders, including urticaria and anaphylaxis. However, diagnosing patients who have the non-IgE (cell-mediated) or mixed (IgE and cell-mediated) disorders remains challenging with our current diagnostic methods. Recent studies have examined the use of patch testing for these food-allergic patients, specifically those with atopic dermatitis and eosinophilic esophagitis. In this article, we review literature regarding patch testing: its methods, its statistical usefulness, and its potential future role.
Curr Allergy Asthma Rep 2005 Jan
PMID:The use of patch testing in the diagnosis of food allergy. 1565 70

When patients present with itching and the perception that they have hives, what other processes can mimic urticaria? With the exception of urticarial vasculitis, urticaria typically lasts less than 24 to 36 hours at one site. A rash that persists longer should raise the suspicion of another inflammatory process. When the hive-like rash does not respond to antihistamines, a biopsy may reveal an alternative diagnosis. All biopsies should also be submitted for immunofluorescence to exclude atypical presentations of inflammatory bullous disease presenting with urticaria. However, even biopsies can be subject to misinterpretation and if the clinical picture does not support the biopsy, an alternative consultation with a dermatopathologist may be required. The extent of the laboratory and radiologic evaluation should be dictated by the clinician's suspicion of alternative causes for the hive(s) because rarely malignancies may present with urticaria. Common things are indeed common with urticaria and the more urticaria does not appear to be typical, the more often the clinician should consider alternative diagnoses.
Allergy Asthma Proc
PMID:When your patients are itching to see you: not all hives are urticaria. 1581 81


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