Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0042109 (urticaria)
 6,569 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Cutaneous adverse reactions to foods, spices, and food additives can occur both in occupational and nonoccupational settings in those who grow, handle, prepare, or cook food. Because spices are also utilized in cosmetics and perfumes, other exposures are encountered that can result in adverse cutaneous reactions. This article describes the reaction patterns that can occur upon contact with foods, including irritant contact dermatitis and allergic contact dermatitis. The ingestion of culprit foods by sensitized individuals can provoke a generalized eczematous rash, referred to as systemic contact dermatitis. Other contact reactions to food include contact urticaria and protein contact dermatitis provoked by high-molecular-weight food proteins often encountered in patients with atopic dermatitis. Phototoxic and photoallergic contact dermatitis are also considered.
Curr Allergy Asthma Rep 2008 May
PMID:Contact reactions to food. 1858 39

Although commonly encountered in clinical practice, chronic urticaria (CU) remains difficult to treat. In contrast to acute urticaria, neither exogenous triggers nor specific immunoglobulin E are identified in most chronic cases. A body of evidence suggests that CU is represented within the spectrum of immune-mediated inflammatory diseases (IMID). Our understanding of the CU disease pathogenesis now recognizes a role for T cells, B cells, and autoantibodies, and intrinsic abnormalities of histamine-releasing effector cells, thus providing new targets of intervention beyond the current mainstay of often inadequate symptomatic treatment directed against histamine receptors and steroids, with their attendant morbidities. Agents previously used to treat other autoimmune and inflammatory diseases have demonstrated efficacy in CU. Newer biologic and nonbiologic immunomodulatory agents approved for other indications and in clinical development provide potential options for this often severe disease.
Curr Allergy Asthma Rep 2008 Jul
PMID:Immunomodulatory approaches to the management of chronic urticaria: an immune-mediated inflammatory disease. 1860 79

Exercise-induced (EI) hypersensitivity disorders are significant problems for both recreational and competitive athletes. These include EI-asthma, EI-bronchoconstriction, EI-rhinitis, EI-anaphylaxis and EI-urticaria. A group of experts from the European Academy of Allergology and Clinical Immunology and the American Academy of Allergy Asthma and Immunology met to discuss the pathogenesis of these disorders and how to diagnose and treat them, and then to develop a consensus report. Key words (exercise with asthma, bronchoconstriction, rhinitis, urticaria or anaphylaxis) were used to search Medline, the Cochrane database and related websites through February 2008 to obtain pertinent information which, along with personal reference databases and institutional experience with these disorders, were used to develop this report. The goal is to provide physicians with guidance in the diagnosis, understanding and management of EI-hypersensitivity disorders to enable their patients to safely return to exercise-related activities.
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PMID:Exercise-induced hypersensitivity syndromes in recreational and competitive athletes: a PRACTALL consensus report (what the general practitioner should know about sports and allergy). 1869 Dec 97

The association between chronic urticaria (CU) and autoimmune disease has been recognized for some time, especially with autoimmune thyroid disease. More recently, functional IgG autoantibodies against FcepsilonRIalpha and less commonly against IgE have been reported in a subset of patients with CU. These patients have been described as having more severe and difficult-to-control urticaria. The autologous serum skin test has been proposed as a surrogate test to define presence of these autoantibodies, although it identifies presence of histamine releasing factor, not necessarily antibody. Basophil histamine release and basophil activation assays using flow cytometry to measure CD63 and, more recently, CD203c expression have been used to identify patients with autoimmune urticaria. New research suggests that in some patients with CU, the activation of the extrinsic coagulation pathway with thrombin generation might play an important role in their CU.
Allergy Asthma Proc
PMID:The autoimmune nature of chronic urticaria. 1892 50

Chronic urticaria (CU) is a common condition faced by the practicing allergist. There is a considerable degree of variation in the evaluation of patients with CU. The intent of this article is to provide the practicing allergist with an appropriate, evidence-based strategy for diagnosis and initial management of patients with CU. A review was performed of pertinent literature of CU pertaining to its natural history, impact on quality of life, subtypes, utility of diagnostic tests, and initial treatment recommendations. The reported duration of CU varies based on the nature of the referring center; however, physical urticarias persist longer than idiopathic CU. CU has adverse effects on quality of life and is comparable with other chronic diseases. Idiopathic urticaria, autoimmune CU, and physical urticarias are the most common types of CU. A detailed history is the best diagnostic tool in determining an etiology of CU and routine laboratory tests are of little value in the evaluation of CU patients. Antihistamines, particularly first-generation antihistamines, are the preferred initial treatment for CU and higher doses may be required for adequate control. Several alternative agents exist for patients who have antihistamine-resistant CU. A detailed history is the best tool for diagnosing the etiology of CU although most patients will not have a specific etiology found. The ultimate goal should be to control urticaria to reduce its impact on the quality of life of the patient, minimize adverse effects of medications, and eliminate chronic or frequent oral corticosteroids.
Allergy Asthma Proc
PMID:Chronic urticaria: diagnosis and management. 1892 51

Previous studies indicate that 30-50% of chronic urticaria patients have an autoimmune etiology. Clinical diagnosis of autoimmune urticaria is supported with the autologous serum skin test. The purpose of this study was to compare two laboratory tests for measurement of IgG autoantibodies to IgE or IgE receptors and compare the results with the autologous serum and plasma skin tests. We performed skin tests and two functional in vitro tests, basophil histamine release, and CD63 up-regulation to detect autoantibodies relevant to autoimmune urticaria. Both sera and citrated plasma were evaluated in the autologous skin test and histamine release assay. Thyroid autoantibodies were also measured. Basophils were incubated with patient plasma, sera, buffer, or anti-IgE. The cells were analyzed for CD63 expression and the supernatants were recovered for histamine analysis. There was high correlation between CD63 up-regulation and histamine release assays, but histamine release was more sensitive. There was a high concordance between sera and citrated plasma for the skin test. Sera from chronic urticaria patients produced higher mean histamine release (23%) compared with citrated plasma (12%). Thirty-one percent of patients positive in the histamine release assay were also positive for thyroid autoantibodies. This compares with 12% who were negative in the histamine release assay. These data show that in vitro basophil histamine release can be used to measure antibodies to FceRI, FceRII/CD23, or IgE and identify patients with autoimmune urticaria.
Allergy Asthma Proc
PMID:Comparison of the in vivo autologous skin test with in vitro diagnostic tests for diagnosis of chronic autoimmune urticaria. 1902 96

Chronic urticaria is a common heterogeneous condition that can be quite debilitating. There are a number of potential causes of urticaria, and the severity and clinical pattern can vary considerably from patient to patient. Eighty to 90% of patients with chronic urticaria have no specific external cause for their disease, which is therefore labeled "chronic idiopathic urticaria." We now know, however, that up to 30-50% of idiopathic cases may be autoimmune or related to mast cell and basophil abnormalities. There is evidence of an autoantibody to the high-affinity receptor for IgE (FcepsilonRI), specifically binding to the alpha-chain (FcepsilonRIalpha), which may be pathogenic. At this point in time, the gold standard for detecting clinically relevant autoantibodies to FcepislonRI is the functional in-vitro donor basophil histamine release assay. The exact prevalence and role of these autoantibodies is still under investigation. Histamine antagonists are the mainstays of therapy. For patients whose symptoms are not controlled by antihistamines alone, there are a number of adjunct therapy options, but there is still a need to develop better agents for this disease.
Allergy Asthma Proc
PMID:The spectrum of chronic urticaria. 1933 14

There is little data in the literature regarding outpatient consultation in allergy/immunology (A/I). The purpose of this study was to determine the relative frequency of different reasons for A/I outpatient consultation to help guide graduate medical education (GME) and assist with A/I practice management. We retrospectively reviewed the electronic medical records of all outpatient A/I consultations from January 1, 2006 to December 31, 2006. The study was performed at our tertiary care referral center which is a GME training site. There were 1412 A/I consults requested during the 1-year period. The consults per month ranged from a low of 69 to a high of 157. The referrals consisted of 35% pediatric and 65% adult patients. There were 52.8% female and 47.2% male patients. We received 74.3% of referrals from primary care, 19.8% from specialty care, and 5.9% from the emergency department. The most common reasons for consultation included 808 (57.2%) patients for chronic rhinitis, 288 (20.4%) for asthma, 196 (13.9%) for food allergy, 89 (6.3%) for venom allergy, 68 (4.8%) for atopic dermatitis, 66 (4.7%) for drug allergy, 62 (4.4%) for chronic urticaria, 45 (3.2%) for acute urticaria, 34 (2.4%) for immunodeficiency, 31 (2.2%) for anaphylaxis, and 162 (11.5%) for other reasons. More than one reason was given for 27.1% of consults, and there was an average of 1.3 reasons for consultation per patient. Although the allergist/immunologist is consulted for a variety of reasons, the top three reasons make up a majority of outpatient consults, and consults are often requested to address more than one diagnosis.
Allergy Asthma Proc
PMID:Reasons for outpatient consultation in allergy/immunology. 1933 22

Second generation H1 antihistamines are considered first-line therapy for allergic rhinitis and chronic idiopathic urticaria, largely because of their nonsedating effects. Evaluating pharmacokinetic and pharmacodynamic parameters and clinical efficacy of a drug is important, but models to predict clinical efficacy are lacking. Receptor occupancy (RO), a predictor for human pharmacodynamics and antihistamine potency that takes into account the affinity of the drug for the receptor and its free plasma concentration, may be a more accurate way to predict a drug's clinical efficacy. This study was designed to assess the concept of RO as a surrogate for clinical efficacy, using examples of second generation oral antihistamines. A literature review was conducted using MEDLINE. Search terms included allergy, allergic rhinitis, drug efficacy, over-the-counter drugs, perennial allergic rhinitis, seasonal allergic rhinitis, second generation antihistamines, chronic idiopathic urticaria, and treatment outcomes. Abstracts and posters from recent allergy-related society meetings were also used. RO of several second generation H1 antihistamines was derived from noncomparative and head-to-head studies. Fexofenadine and levocetirizine showed similar RO at 4 hours, both higher than that of desloratadine. Levocetirizine established higher RO than fexofenadine or desloratadine at 12 and 24 hours. RO for these agents appeared to correlate with pharmacodynamic activity in skin wheal and flare studies and with efficacy in allergen challenge chamber studies. Parameters affecting RO included time from dosing, pH, and dosing regimen. RO did not appear to be linearly related to drug concentration. Results indicate that RO is an accurate predictor of in vivo pharmacodynamic activity and clinical efficacy.
Allergy Asthma Proc
PMID:The concept of receptor occupancy to predict clinical efficacy: a comparison of second generation H1 antihistamines. 1933 43

Increasing evidence suggests that most of today's allergic rhinitis patients are sensitized to more than one trigger, likely due to constant exposure to increased levels of traditional and new allergens from exotic foods and pets, resulting in manifestation of the more persistent and moderate/severe symptoms. The Allergic Rhinitis and its Impact on Asthma (ARIA) initiative has consequently recommended that allergic rhinitis be classified as "intermittent" or "persistent" allergic rhinitis (IAR and PER, respectively), based on symptom duration and the impact of disease severity on the patient's quality of life. Moreover, ARIA has recommended that the efficacy of H(1)-antihistamines be investigated in patients classified according to ARIA, with the H(1)-antihistamine under investigation being evaluated long-term in terms of clinical efficacy, safety and pharmacological properties in order to fully appreciate its efficacy. Studies of levocetirizine, one of the most recent commercially available H(1)-antihistamines, indicate that this drug is among the most useful H(1)-antihistamines for the management of allergic rhinitis (IAR and PER) and chronic idiopathic urticaria because of its overall more favorable pharmacokinetic and pharmacodynamic profiles compared with other commonly used H(1)-antihistamines, as well as its high efficacy and long-term safety in children and adults. Moreover, continuous treatment with levocetirizine appears to be more effective than on-demand treatment, a property that is likely to benefit today's patients with more persistent and severe symptoms.
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PMID:Levocetirizine: from scientific evidence to a potent modern-day treatment of today's allergic patients. 1943 43


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