Urticaria Caused Specifically by the Action of Physical Agents

Duke, W. W.

doi:10.1001/jama.1924.02660010007002

Cited by 88 publications

(15 citation statements)

References 4 publications

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“…9 ChU is believed to account for ϳ5% of all CU and 30% of all physical urticaria. ChU patients predictably record the greatest disability by QOL scores and are the only urticarial group relatively restricted in sexual activities.…”

Section: Discussionmentioning

confidence: 99%

A case of severe refractory chronic urticaria: A novel method for evaluation and treatment

Otto

Calabria²

2009

allergy asthma proc

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With cholinergic urticaria (ChU), the ultimate diagnosis often depends on the demonstration of characteristic urticaria by appropriate provocation. Several treatment options may be helpful but traditional options (antihistamines, leukotriene inhibitors, and immunosuppressives) may be exhausted by the refractory ChU patient. Here, we describe such a case. Demonstration of immediate hypersensitivity to autologous sweat skin testing (ASwST) may provide a rationale for use of omalizumab (Xolair, Genentech Novartis, South San Francisco, CA). Patients with severe ChU may have difficulty producing sufficient quantities of sweat for ASwST given that the very effort that produces the sample exacerbates ChU. Generation of sweat by iontophoresis with pilocarpine nitrate can be performed at many large medical centers. The procedure is simple, safe, and produces varying amounts of sweat depending on the individual. This sweat can then be used for ASwST. Our patient had a positive ASwST with appropriate positive and negative controls. Our testing methods were validated by negative ASwST, saline control, and positive histamine control in a nonatopic, nonurticarial control patient. By the patient's second injection of omalizumab, her quality of life score was significantly improved, as were her daily medication scores and exercise tolerance. We describe the first case of a patient with severe refractory ChU who had a positive ASwST by a novel collection method who has been successfully treated with omalizumab. We present a novel tool for the evaluation and demonstration of sweat-specific IgE in ChU patients who are unable to provide sweat by more traditional means.

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Section: Discussionmentioning

confidence: 99%

A case of severe refractory chronic urticaria: A novel method for evaluation and treatment

Otto

Calabria²

2009

allergy asthma proc

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“…Cholinergic urticaria (CU) was fi rst described by Duke [1] in 1924 and is characterized by a number of small, short-lasting hives that develop in response to an increase of core body temperature, usually when one sweats following exercise, bathing, staying in a heated environment, or emotional stress [2,3]. Although the symptoms subside rapidly, commonly within 1 hour, CU may signifi cantly impair quality of life, especially in relation to sporting and sexual activities [4].…”

Section: Introductionmentioning

confidence: 99%

New concepts of hive formation in cholinergic urticaria

Horikawa

Fukunaga²,

Nishigori³

2009

Curr Allergy Asthma Rep

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Patients with cholinergic urticaria (CU) show a number of small, short-lasting hives when their body core temperature increases, usually during sweating following exercise or bathing. The precise mechanism(s) of hive formation in CU has been unclear except for the involvement of acetylcholine. We recently reported that most CU patients show immediate-type skin responses to their own sweat, whereas the rest of CU patients have positive autologous serum skin tests (ASSTs). The former group produced satellite wheals following acetylcholine injection, whereas the latter group produced hives in conjunction with hair follicles. We propose two subtypes of CU: 1) a sweat-hypersensitivity type with strong hypersensitivity to autologous sweat, nonfollicular hives, development of satellite wheals, and lack of positive ASST; and 2) a follicular type with follicular hives and positive ASST, but no hypersensitivity to autologous sweat or satellite wheals. We discuss the mechanisms of hive formation in these subtypes.

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“…Localized heat urticaria is a rare skin disorder first described by Duke in 1924 1 . Since then, 48 cases of localized heat urticaria have been reported in the world 2 .…”

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confidence: 99%

Localized heat urticaria in a patient is associated with a wealing response to heated autologous serum

et al. 2002

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We report a case of localized heat urticaria in a 71-year-old woman who developed weals and loss of consciousness after taking a bath. Exposing her skin to heat at 40 degrees C or immersing her hands in water at 40 degrees C produced urticarial lesions and increased her plasma histamine level. Desensitization with hot water improved her symptoms and normalized her plasma histamine level after heat challenge. An intracutaneous injection of her serum produced no reaction, while an injection of her serum that had been heated at 40 degrees C for 15 min induced a weal flare response. Further examination revealed that the weal-inducing activity of her heated serum remained for at least for 6 h and that treatment of her serum at 60 degrees C for 2 h did not abrogate its weal-inducing activity. These findings indicate that certain materials in her serum that are activated by heat are responsible for the development of her anaphylactic and urticarial reactions and that these reactions may be mediated by histamine.

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Urticaria Caused Specifically by the Action of Physical Agents

Cited by 88 publications

References 4 publications

A case of severe refractory chronic urticaria: A novel method for evaluation and treatment

A case of severe refractory chronic urticaria: A novel method for evaluation and treatment

New concepts of hive formation in cholinergic urticaria

Localized heat urticaria in a patient is associated with a wealing response to heated autologous serum

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