Pathomechanisms in Physical Urticaria

Grabbe, Jürgen

doi:10.1046/j.0022-202x.2001.00025.x

Cited by 24 publications

(22 citation statements)

References 17 publications

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“…Mast cells located within the connective tissue layer surrounding skeletal muscle fascicles or near blood vessels may degranulate, releasing histamine locally (Metcalfe et al , 1997). Exercise-related factors that have been associated with mast cell degranulation in other contexts include reactive oxygen species (Son et al , 2006), a variety of cytokines (and perhaps myokines), increases in temperature, and vibration (Grabbe, 2001). Alternatively, histamine can be formed de novo without storage in mast cells through histidine decarboxylase (Watanabe & Ohtsu, 2002).…”

Section: Part 1: Review Of the Mechanisms Underlying Post-exercise Hymentioning

confidence: 99%

Blood pressure regulation X: what happens when the muscle pump is lost? Post-exercise hypotension and syncope

et al. 2013

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Syncope which occurs suddenly in the setting of recovery from exercise, known as post-exercise syncope, represents a failure of integrative physiology during recovery from exercise. We estimate that between 50 and 80% of healthy individuals will develop pre-syncopal signs and symptoms if subjected to a 15-min head-up tilt following exercise. Post-exercise syncope is most often neurally mediated syncope during recovery from exercise, with a combination of factors associated with post-exercise hypotension and loss of the muscle pump contributing to the onset of the event. One can consider the initiating reduction in blood pressure as the tip of the proverbial iceberg. What is needed is a clear model of what lies under the surface; a model that puts the observational variations in context and provides a rational framework for developing strategic physical or pharmacological countermeasures to ultimately protect cerebral perfusion and avert loss of consciousness. This review summarizes the current mechanistic understanding of post-exercise syncope and attempts to categorize the variation of the physiological processes that arise in multiple exercise settings. Newer investigations into the basic integrative physiology of recovery from exercise provide insight into the mechanisms and potential interventions that could be developed as countermeasures against post-exercise syncope. While physical counter maneuvers designed to engage the muscle pump and augment venous return are often found to be beneficial in preventing a significant drop in blood pressure after exercise, countermeasures that target the respiratory pump and pharmacological countermeasures based on the involvement of histamine receptors show promise.

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Section: Part 1: Review Of the Mechanisms Underlying Post-exercise Hymentioning

confidence: 99%

Blood pressure regulation X: what happens when the muscle pump is lost? Post-exercise hypotension and syncope

et al. 2013

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“…Ihre Indexwerte entsprachen denen von Patienten mit schwerem atopischem Ekzem oder koronarer Herzerkrankung [30,31].Dies spiegelt einerseits die Beeinträchtigung der Betroffenen im täglichen Leben wider, ist aber auch Ausdruck der therapeutischen Probleme, die von den immer noch großen Lücken im Verständ-nis der Pathophysiologie herrühren [7].…”

Section: Klinische Bedeutungunclassified

Physikalische Urtikaria

Fleischer¹,

Grabbe²

2004

Der Hautarzt

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The different types of physical urticaria are triggered by mechanical and thermal stimuli, as well as electromagnetic waves. Localized forms restricted to the skin and mucous membranes are most common, but generalized urticaria with variable extracutaneous manifestations can also occur. Physical urticaria is usually sporadic but may rarely have a familial form; it is often associated with chronic urticaria. In most instances, the short time interval between the physical stimulus and reaction points to a causal relationship, but in delayed types the exact diagnosis may be missed without provocation tests. The clinical implication of physical urticaria is demonstrated by investigations showing a greater degree of disability in affected patients as compared to other types of urticaria. There is still an incomplete understanding of the crucial pathophysiological aspects; most likely inflammatory reactions involving leukocytes, endothelial cells and nerves stimulated by various mediators play an important role in this form of urticaria.

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“…However, this is often impossible or associated with unbearable impairment of daily life activities [3]. (3) Symptomatic treatment of physical urticarias can be challenging as the standard treatment with antihistamines is often insufficient [4,5]. …”

Section: Introductionmentioning

confidence: 99%

Anti-Immunoglobulin E Treatment of Patients with Recalcitrant Physical Urticaria

Metz

Altrichter

Ardelean

et al. 2010

Int Arch Allergy Immunol

135

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In physical urticaria, exogenous physical factors such as thermal triggers, solar radiation and mechanic triggers including friction or pressure are responsible for the elicitation of symptoms in the skin of patients. Avoidance of the respective stimulus is usually difficult or impossible, and many patients are not sufficiently treated with standard antihistamines. We report that treatment with omalizumab (Xolair®) of 7 patients with physical urticarias [solar urticaria (n = 2), urticaria factitia/symptomatic dermographism (n = 2), cold urticaria, delayed pressure urticaria and localized heat urticaria] resulted in complete symptom control within days after the first injection in 5 patients. In 1 patient, symptoms improved after increasing the dose of omalizumab, and 1 patient with localized heat urticaria did not respond significantly to treatment. Before anti-immunoglobulin E treatment, all patients had suffered from their physical urticaria for years and had had numerous unsuccessful therapies. The overall excellent responses to omalizumab treatment reported here indicate that anti-immunoglobulin E is a safe and effective treatment for recalcitrant physical urticarias.

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Pathomechanisms in Physical Urticaria

Cited by 24 publications

References 17 publications

Blood pressure regulation X: what happens when the muscle pump is lost? Post-exercise hypotension and syncope

Blood pressure regulation X: what happens when the muscle pump is lost? Post-exercise hypotension and syncope

Physikalische Urtikaria

Anti-Immunoglobulin E Treatment of Patients with Recalcitrant Physical Urticaria

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