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

A case of urticarial vasculitis (UV) is presented. The pathogenesis, clinical characteristics, diagnosis, and management of this disease are reviewed, followed by clinical pearls and pitfalls for the practicing allergist (Venzor J, et al., Urticarial vasculitis, Clin Rev Allergy Immunol 23:201-216, 2002). The lesions in UV typically lasts > 24 hours in a fixed location, resolves with residual hyperpigmentation, and may or may not be pruritic. In contrast, standard urticaria lesions persist < 24 hours, leave no trace, and is always pruritic (Black AK, Urticarial vasculitis, Clin Dermatol 17:565-569, 1999). Since urticarial vasculitis is characterized by a variety of cutaneous, systemic, and serological features, different names of this disorder exist in the literature (Wisnieski JJ, Urticarial vasculitis, Curr Opin Rheumatol 12:24-31, 2000). A biopsy of an active lesion remains the gold standard for the diagnosis of urticarial vasculitis.
Allergy Asthma Proc
PMID:Urticarial vasculitis. 1739 Jul 66

In the last few decades an increasing understanding of the pathomechanisms involved in urticaria has highlighted the heterogeneity of different subtypes. According to the new European Academy of Allergology and Clinical Immunology/Global Allergy and Asthma European Network/European Dermatology Forum (EAACI/GA(2)LEN/ EDF) guidelines, urticaria subtypes can be grouped into spontaneous urticaria, which includes acute urticaria and chronic urticaria, the physical urticarias, and other urticaria disorders, including, for example, contact urticaria. Clarity of nomenclature is required not only to choose the correct measures in diagnosis and management, but also to compare data from different studies. Urticaria has a profound impact on quality of life and performance. Effective treatment is thus required in all cases where avoidance of eliciting factors is not feasible. For symptomatic relief, non-sedating H1-antihistamines are the first choice in most subtypes of urticaria; however, double-blind controlled studies have shown that the dosages required may exceed those recommended for other diseases, e.g. allergic rhinitis. The current guidelines therefore suggest increasing the dosage up to four-fold, whereas alternative treatments should be reserved as add-on therapy for unresponsive patients.
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PMID:Urticaria: current opinions about etiology, diagnosis and therapy. 1753 84

Allergic diseases include a variety of different illnesses (rhinitis, conjunctivitis, asthma, urticaria, and dermatitis) in which the physiological and pathological basis is the release of chemical mediators such as histamine; platelet-activating factor; metabolites of arachidonic acid; and chemotactic factors from mastocytes, basophils, and eosinophils. The numerous drugs used for allergy treatment now include the new pharmacologic category of cysteinyl leukotriene (LT) antagonists. LTs are released from eosinophils, mast cells, and macrophages, interacting functionally in allergic reactions against a background of an imbalance between T-cell clones and resulting in preferential cytokine production following the T-helper 2 profile. Anti-LTs also have been used successfully by some authors to control rhinitis, atopic dermatitis, and urticaria. although additional controlled testing will be required, these applications broaden the possible range of treatments for allergic disease in all its many aspects.
Allergy Asthma Proc
PMID:Montelukast in allergic diseases beyond asthma. 1761 56

Nickel allergy (NA) is common and causes more cases of allergic contact dermatitis (ACD) than all other metals combined. Many orthodontic appliances (ODAs) contain nickel but their clinical relevance in nickel-allergic patients is unclear. We aimed to characterize the relationship between NA and ODAs because the medical literature investigating this is controversial. A survey concerning adverse reactions to ODAs in patients with NA was distributed to members of the Wisconsin Society of Orthodontics. Forty-three surveys were analyzed. The surveyed group was experienced, representing a mean of 21.2 years in practice and averaging 242 appliances placed per year per orthodontist. Most new patients with orthodontia were 10-18 years old. Most wires used were nickel-titanium alloy. Although 76% of orthodontists inquired about NA at initial evaluation, 37% still placed nickel-containing ODAs in known nickel-allergic patients. Fifty percent placed a single intraoral appliance, observing for reactions. Three orthodontists applied ODAs to the skin similar to patch testing. Only 8 patients with reactions to ODAs were described in detail, 6 were female patients and 6 were aged 13-14 years. Intraoral and extraoral reactions were mild; diffuse urticaria was reported in one patient. Treatment included removing the appliances or changing to nonnickel alternatives with favorable outcomes. These cases, which included >33,000 patients, suggest a prevalence of 0.03%. Adverse reactions to ODAs in patients with NA have been observed but are uncommon. Using suitable alternatives, patients usually can be accommodated.
Allergy Asthma Proc
PMID:Adverse reactions to orthodontic appliances in nickel-allergic patients. 1788 19

Levocetirizine is the most recent antihistamine available in the United States and is indicated for the symptomatic treatment of allergic rhinitis (AR; seasonal [SAR] and perennial [PAR]) and chronic idiopathic urticaria (CIU). The purpose of this study was to review the current literature on pharmacologic properties of levocetirizine, its safety, tolerability, and effectiveness in AR and CIU. Relevant articles in English or with English abstracts were identified from systematic Medline searches using combinations of the terms antihistamine/s, CIU, H(1)-receptor antagonist/s, levocetirizine, PAR and persistent AR (PER), pharmacodynamic, pharmacokinetic, and SAR. Levocetirizine is the active enantiomer of cetirizine. Pharmacologic and clinical studies indicate that levocetirizine has a fast onset and long duration of action, with a well-tolerated adverse effect profile. These favorable features may be caused by levocetirizine's pharmacokinetic and pharmacodynamic properties including high bioavailability, low apparent volume of distribution, low degree of metabolism, and high in vivo potency and H(1)-receptor occupancy. Several large well-controlled clinical trials in adults and children aged 6-12 years have shown levocetirizine to be consistently efficacious and well tolerated in relieving the symptoms of SAR, PAR, and PER and CIU. Levocetirizine is a welcome new treatment option in the United States for symptomatic treatment of AR and CIU.
Allergy Asthma Proc
PMID:Levocetirizine: The latest treatment option for allergic rhinitis and chronic idiopathic urticaria. 1820 39

Antihistamines are used frequently in adult and pediatric patients as first-line treatment for both allergic rhinitis and urticaria. There are several different antihistamines on the market, generally divided into first- and second-generation products. Although many of these show efficacy, there are significant differences in the side effect profiles of these medications, with resultant differences in their effect on quality of life and other outcomes. Although the most significant differences are between generations, there are considerations even within generations, especially regarding sedation and possible effects on learning. Other than specific situations in which sedation may be a desired effect, the second-generation antihistamines generally are preferred and the risks and benefits of individual drugs within this group need to be considered for each patient's specific circumstances.
Allergy Asthma Proc
PMID:Antihistamines in the pediatric population: achieving optimal outcomes when treating seasonal allergic rhinitis and chronic urticaria. 1830 32

Histamine is the primary mediator involved the pathophysiology of allergic rhinitis and chronic urticaria, and this explains the prominent role that histamine H(1)-receptor antagonists have in the treatment of these disorders. However, histamine is clearly not the only mediator involved in the inflammatory cascade. There is an emerging view that drugs which can inhibit a broader range of inflammatory processes may prove to be more effective in providing symptomatic relief in both allergic rhinitis and chronic urticaria. This is an important consideration of the Allergic Rhinitis and its Impact on Asthma (ARIA) initiative which provides a scientific basis for defining what are the desirable properties of an 'ideal' antihistamine. In this review of rupatadine, a newer dual inhibitor of histamine H(1)- and PAF-receptors, we evaluate the evidence for a mechanism of action which includes anti-inflammatory effects in addition to a powerful inhibition of H(1)- and PAF-receptors. We assess this in relation to the clinical efficacy (particularly the speed of onset of action) and safety of rupatadine, and importantly its longer term utility in everyday life. In clinical trials, rupatadine has been shown to be an effective and well-tolerated treatment for allergic rhinitis and chronic idiopathic urticaria (CIU). It has a fast onset of action, producing rapid symptomatic relief, and it also has an extended duration of clinical activity which allows once-daily administration. In comparative clinical trials rupatadine was shown to be at least as effective as drugs such as loratadine, cetirizine, desloratadine and ebastine in reducing allergic symptoms in adult/adolescent patients with seasonal, perennial or persistent allergic rhinitis. Importantly, rupatadine demonstrated no adverse cardiovascular effects in preclinical or extensive clinical testing, nor negative significant effects on cognition or psychomotor performance (including a practical driving study). It improved the overall well-being of patients with allergic rhinitis or CIU based on findings from quality of life questionnaires and patient global rating scores in clinical trials. Thus, rupatadine is a recently introduced dual inhibitor of histamine H(1)- and PAF-receptors, which has been shown to be an effective and generally well-tolerated treatment for allergic rhinitis and chronic urticaria. It possesses a broader profile of anti-inflammatory properties inhibiting both inflammatory cells and a range of mediators involved in the early- and late-phase inflammatory response, but the clinical relevance of these effects remain to be clarified.
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PMID:Rupatadine in allergic rhinitis and chronic urticaria. 1833 40

Although the reported incidence of hypersensitivity reactions (HSR) to antineoplastic agents is considered to be uncommon, it is difficult to evaluate their exact prevalence, mainly because their definition is vast and pathogenic mechanisms are vague. HSR include facial flushing, erythema, pruritus, fever, tachycardia, dyspnea, tongue swelling, rash/hives, headache, chills, weakness, vomiting, burning sensations, dizziness, and edema. Treatment and prevention consists of slowing the infusion rate, steroids, and type 1 and 2 histamine receptor antagonists. Desensitization could allow the small number of patients who experience severe HSR to receive effective therapy for their cancer. Reintroductions have only been reported as single case studies or small cohorts. Large-scale validation on desensitization strategies is still missing. With regard to oxaliplatin, knowledge of its rare but eminent toxicity is paramount, because this drug is widely used in treating colorectal cancer, the second-highest cause of cancer mortality in the United States.
Curr Allergy Asthma Rep 2008 Mar
PMID:Hypersensitivity reactions to oxaliplatin and other antineoplastic agents. 1837 76

Beginning in 1916 Harmonia axyridis, an orange/red lady beetle with variable black spotting, was imported into the United States from Asia. This agricultural pest-control predator established independent feral populations in North America by 1988. Subsequently, Harmonia axyridis has become a pest to homeowners and various horticultural enterprises. Seeking winter hibernation sites, ladybug swarms invade human homes/habitats primarily in the fall. With increased Harmonia axyridis exposures, human ladybug allergy was first reported in 1998. Ladybug-specific IgE hypersensitivity has been reported in all ages (1-78 years old) and both sexes. Clinical ladybug allergy manifests variously as rhinoconjunctivitis, asthma, urticaria, and angioedema. A majority, but not all, allergic individuals are primarily exposed at home. Large fall swarms and smaller spring dispersions produce corresponding peaks in ladybug allergy. Ladybug hemolymph is a primary source of allergen. Har a 1 and Har a 2 major ladybug allergens have been characterized. Ladybug allergy prevalence in one endemic area was reported as 10%. Self-report of ladybug pests at home did not predict ladybug allergy, suggesting other exposures are important also. Some individuals have no history of atopy before manifestation of ladybug allergy. Ladybug, cat, cockroach, and house-dust mites are the most likely allergens to present as isolated single positive skin tests in an allergist's office. Ladybug should be a standard skin test allergen for all allergy patients tested in endemic areas. Avoidance of ladybug exposure is paramount to treatment.
Allergy Asthma Proc
PMID:Harmonia axyridis ladybug invasion and allergy. 1843 Mar 8

There is need for an in vitro diagnostic test for hypersensitivity to nonsteroidal anti-inflammatory drugs (NSAIDs). The purpose of this study was to assess the reliability of one such diagnostic, the basophil activation test. Forty-three drug hypersensitive patients referring several immediate reactions (anaphylaxis, urticaria, angioedema, asthma, and rhinoconjunctivitis) to one or more NSAIDs and 29 controls participated. Using the Basotest commercial kit, 63 determinations were performed with the drugs implicated in the adverse reactions (ASA, ibuprofen, metamizol, diclofenac, paracetamol, and ketorolac). In 16 patients additional determinations were made with other chemically unrelated NSAIDs. Forty-two determinations were made for controls. The analysis was performed by flow colorimetric cytometry and double staining with the monoclonal antibodies anti-IgE and anti-CD63. A Basophil Activation Index (percentage of activated basophils after allergen stimulation/percentage of basally activated basophils) of two or more was considered a positive result. Specificity of 100% and sensitivity of 42.85% were achieved. The positive predictive value was 100%, and the negative predictive value was 53.84%. In 35.29% of intolerant patients there was a positive reaction to at least two drugs implicated in adverse reactions, and in 27.27% of these patients there was a positive reaction to other chemically unrelated NSAIDs. The basophil activation test is useful for the in vitro diagnosis of NSAID hypersensitivity, providing good specificity and positive predictive value and diagnostic reliability in the assessment of NSAID intolerance.
Allergy Asthma Proc
PMID:Basophil activation test for the in vitro diagnosis of nonsteroidal anti-inflammatory drug hypersensitivity. 1853 81


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