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Dissociation between history and challenge in patients with physical urticaria.

ABSTRACT: BACKGROUND:Physical urticaria is a subtype of chronic urticaria induced by a physical stimulus. OBJECTIVE:To evaluate the consistency between a history of physical urticaria and results of challenge testing. METHODS:Seventy-six subjects, ages 3 to 77 years old, were referred with the diagnosis of a physical urticaria and were evaluated by using challenge testing directed toward the presenting diagnosis, yet included other stimuli based on history. The majority of subjects were tested to 3 or more stimuli, thus 294 provocation tests were performed. Fifty-seven subjects were surveyed for the status of their physical urticaria at least 1 year after initial evaluation. RESULTS:Of the 76 subjects with a positive history of a physical urticaria, 38% (n = 29) were challenge negative to the presenting diagnosis. Eight subjects within the challenge negative group reacted positively to additional testing, thus 28% (n = 21) remained negative to all challenge testing, which allowed discontinuation of medications and avoidance behavior. A negative challenge result was less likely with subjects who presented with cold-induced urticaria (25%), delayed pressure urticaria (25%), and dermatographism (29%), yet more common with cholinergic (65%) and solar urticaria (67%). A 1-year follow-up survey of 57 subjects was consistent with initial results. Nineteen of this subgroup were rechallenged for the presenting diagnosis, and the outcome was unchanged in 17 subjects and, in 2 subjects the urticaria had resolved. CONCLUSIONS:The diagnosis by history of a physical urticaria should be verified by testing whenever possible and particularly if the condition is judged as severe and thus requires both significant life-style changes and pharmacologic intervention.

SUBMITTER: Komarow HD

PROVIDER: S-EPMC4254441 | biostudies-literature | 2014 Nov-Dec

REPOSITORIES: biostudies-literature

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Dissociation between history and challenge in patients with physical urticaria.

Komarow Hirsh D HD Arceo Sarah S Young Michael M Nelson Celeste C Metcalfe Dean D DD

The journal of allergy and clinical immunology. In practice 20140908 6

<h4>Background</h4>Physical urticaria is a subtype of chronic urticaria induced by a physical stimulus.<h4>Objective</h4>To evaluate the consistency between a history of physical urticaria and results of challenge testing.<h4>Methods</h4>Seventy-six subjects, ages 3 to 77 years old, were referred with the diagnosis of a physical urticaria and were evaluated by using challenge testing directed toward the presenting diagnosis, yet included other stimuli based on history. The majority of subjects w ...[more]

PMID: 25439372

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Project description:BackgroundThis study was performed to compare intestinal and sublingual microcirculation and their response to a fluid challenge.MethodsTwenty-two septic patients in the first postoperative day of an intestinal surgery, in which an ostomy had been constructed, were evaluated both before and 20 min after a challenge of 10 mL/kg of 6% hydroxyethylstarch 130/0.4. We measured systemic hemodynamics and sublingual and intestinal microcirculation. Correlations between variables were determined through the Pearson test.ResultsFluid administration increased the cardiac index (2.6?±?0.5 vs. 3.3?±?1.0 L/min/m(2), P?<?0.01) and mean arterial blood pressure (68?±?11 vs. 82?±?12 mm Hg, P?<?0.0001). The sublingual but not the intestinal red blood cell (RBC) velocity increased (912?±?270 vs. 1,064?±?200 ?m/s, P?<?0.002 and 679?±?379 vs. 747?±?419 ?m/s, P?=?0.12, respectively). The sublingual and intestinal perfused vascular density (PVD) did not change significantly (15.2?±?2.9 vs. 16.1?±?1.2 mm/mm(2) and 12.3?±?6.7 vs. 13.0?±?6.7 mm/mm(2)). We found no correlation between the basal sublingual and intestinal RBC velocities or between their changes in response to the fluid challenge. The individual changes in sublingual RBC velocity correlated with those in cardiac index and basal RBC velocity. Individual changes in intestinal RBC velocity did not correlate with either the cardiac index modifications or the basal RBC velocity. The same pattern was observed with the sublingual and the intestinal PVDs. The sublingual RBC velocities and PVDs were similar between survivors and nonsurvivors. But the intestinal RBC velocities and PVDs were lower in nonsurvivors.ConclusionsIn this series of postoperative septic patients, we found a dissociation between sublingual and intestinal microcirculation. The improvement in the sublingual microcirculation after fluid challenge was dependent on the basal state and the increase in cardiac output. In contrast, the intestinal microcirculation behaved as an isolated territory.

Project description:BackgroundAlthough the diagnosis and management of chronic spontaneous urticaria (CSU) is well documented in the literature, some aspects of the disease remain unclear. We aimed to further describe the natural history, prognostic factors, humanistic burden and uptake of traditional and alternative therapies in patients with CSU.MethodsThis was a prospective, cross-sectional analysis at a single centre. We reviewed patient medical records and conducted a survey in patients with CSU.Results72 patients participated in the study with a median duration of CSU of 48 months. 30% of patients had symptoms that resolved in under 2 years with these patients trending towards an older age of onset of CSU (48 ± 17 years). 16% of patients had symptoms lasting 10 years or longer with these patients trending towards a younger age of onset (22 ± 16 years). Patients with a relapsing/remitting disease course (31%) and those with co-existing angioedema (57%) trended towards a longer median duration of CSU (96 and 50 months respectively) and were observed to have a higher proportion of patients reporting CSU duration of 10 years or longer (33% and 25%, p = 0.033 and p = 0.036 respectively). Patients with co-existing autoimmune/thyroid disease (19%) trended towards a shorter median duration of CSU (37 months). 54 patients (75%) reported sleep disturbance and 29 patients (43%) required emergency room visit(s) for symptomatic control. 84% of patients who trialed second generation antihistamines reported a response to treatment, while 73% of patients who trialed omalizumab reported a response to treatment. Patients using alternative medicine such as acupuncture, traditional Chinese medicine and naturopathic medicine had lower reported response rates (20-29%) to treatment.ConclusionsThe natural history of CSU may be longer than previously reported with our study finding a median duration of symptoms of nearly 4 years with one-third of patients reporting a relapsing/remitting disease course. Younger age of onset, a relapsing/remitting disease course and angioedema may predict a longer duration of CSU, whereas older age of onset and co-existing autoimmune/thyroid disease may predict a shorter duration of CSU. Reported symptomatic benefit was higher from guidelines based pharmacologic therapy versus various alternative medicines.

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Dataset Information

Dissociation between history and challenge in patients with physical urticaria.

Publications

Dissociation between history and challenge in patients with physical urticaria.

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