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Marcus Maurer - One of the best experts on this subject based on the ideXlab platform.
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Physical Urticaria
Current Allergy and Asthma Reports, 2012Co-Authors: Marina Abajian, Agnieszka Młynek, Marcus MaurerAbstract:The Physical Urticarias are a heterogeneous subgroup of chronic Urticarias in which wheals can be reproducibly induced by different specific Physical stimuli such as cold, heat, pressure, vibration, or sunlight. Physical Urticarias comprise up to 25 % of chronic Urticarias and occur more frequently in young adults. Symptoms, i.e. wheal and flare responses or angioedema, are usually limited to the skin areas exposed to the eliciting stimulus. However, generalised Urticaria with variable extracutaneous manifestations can also occur. Some patients may also present with more than one Physical Urticaria. Skin lesions in Physical Urticaria result from mast cell activation and mediator release. The mechanisms by which Physical stimuli activate skin mast cells are not fully understood. Because of this, trigger avoidance and symptomatic treatment are key therapeutic concepts for Physical Urticarias. Identification of the inducing Physical trigger, including its individual thresholds, is necessary for an effective therapy. Here, we have summarized clinical features, diagnostic workup and therapy options for Physical Urticarias.
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anti immunoglobulin e treatment of patients with recalcitrant Physical Urticaria
International Archives of Allergy and Immunology, 2011Co-Authors: Martin Metz, Torsten Zuberbier, Sabine Altrichter, E Ardelean, Birgit Kessler, Karoline Krause, Markus Magerl, Frank Siebenhaar, Karsten Weller, Marcus MaurerAbstract: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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Modern Approaches to the Diagnosis and Treatment of Cold Contact Urticaria
Current Allergy and Asthma Reports, 2010Co-Authors: Karoline Krause, Torsten Zuberbier, Marcus MaurerAbstract:Cold contact Urticaria (CCU) is a common subtype of Physical Urticaria characterized by itchy wheals and/or angioedema due to skin mast cell activation and the release of proinflammatory mediators after cold exposure. The underlying causes are largely unknown. When CCU is suspected, cold stimulation tests and threshold testing should be done to confirm the diagnosis and to determine the severity and course of CCU, respectively. Avoidance of critical cold exposure should be recommended but is often impossible, especially for severely affected patients with high temperature and low exposure time thresholds. Symptomatic treatment of choice is the use of modern, nonsedating antihistamines. Patients should be informed that complete protection from CCU symptom development may require increased doses of antihistamines. Standardizing cold provocation tests and further characterization of the natural course of CCU and its variants may lead to a better understanding of the disease-driving mechanisms.
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The definition and diagnostic testing of Physical and cholinergic Urticarias – EAACI/GA2LEN/EDF/UNEV consensus panel recommendations
Allergy, 2009Co-Authors: Markus Magerl, Martin Metz, F. Lawlor, A. Młynek, Elena Borzova, A. Giménez-arnau, Clive Grattan, P. Mathelier-fusade, Marcus MaurerAbstract:The recommendations for the definition and diagnosis presented in this position paper are the result of a panel consensus meeting held in December 2008 in Berlin. This consensus meeting was a joint initiative of EAACI (European Academy of Allergology and Clinical Immunology) Dermatology Section, the EU-funded network of excellence, GA2LEN (Global Allergy and Asthma European Network), the EDF (European Dermatology Forum) and UNEV (Urticaria network e.V.). The aim of these recommendations is to improve the diagnosis and management of patients with Physical Urticaria or cholinergic Urticaria and to promote research and a better understanding of these diseases. Our recommendations used the paper produced by a 1996 expert meeting (1) and they acknowledge the latest changes in our understanding of Physical Urticarias and cholinergic Urticaria as well as the recent development of novel diagnostic tools. In addition, this consensus paper highlights areas of need for further research.
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Acquired cold Urticaria: clinical picture and update on diagnosis and treatment.
Clinical and Experimental Dermatology, 2007Co-Authors: Frank Siebenhaar, Marcus Maurer, Sabine Altrichter, Markus Magerl, Karsten Weller, A. Młynek, R. Vieira Dos Santos, Torsten ZuberbierAbstract:Acquired cold Urticaria (ACU) is a frequent subtype of Physical Urticaria that is caused by the release of proinflammatory mast cell mediators after cold exposure. Although the underlying causes of ACU still remain to be clarified in detail, a wide range of diseases has been reported to be associated with ACU. This review gives an overview of the clinical picture, the differential diagnoses, diagnostic tests and the aetiology of ACU, and summarizes current and novel therapeutic options based on the current literature.
Torsten Zuberbier - One of the best experts on this subject based on the ideXlab platform.
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anti immunoglobulin e treatment of patients with recalcitrant Physical Urticaria
International Archives of Allergy and Immunology, 2011Co-Authors: Martin Metz, Torsten Zuberbier, Sabine Altrichter, E Ardelean, Birgit Kessler, Karoline Krause, Markus Magerl, Frank Siebenhaar, Karsten Weller, Marcus MaurerAbstract: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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Modern Approaches to the Diagnosis and Treatment of Cold Contact Urticaria
Current Allergy and Asthma Reports, 2010Co-Authors: Karoline Krause, Torsten Zuberbier, Marcus MaurerAbstract:Cold contact Urticaria (CCU) is a common subtype of Physical Urticaria characterized by itchy wheals and/or angioedema due to skin mast cell activation and the release of proinflammatory mediators after cold exposure. The underlying causes are largely unknown. When CCU is suspected, cold stimulation tests and threshold testing should be done to confirm the diagnosis and to determine the severity and course of CCU, respectively. Avoidance of critical cold exposure should be recommended but is often impossible, especially for severely affected patients with high temperature and low exposure time thresholds. Symptomatic treatment of choice is the use of modern, nonsedating antihistamines. Patients should be informed that complete protection from CCU symptom development may require increased doses of antihistamines. Standardizing cold provocation tests and further characterization of the natural course of CCU and its variants may lead to a better understanding of the disease-driving mechanisms.
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Acquired cold Urticaria: clinical picture and update on diagnosis and treatment.
Clinical and Experimental Dermatology, 2007Co-Authors: Frank Siebenhaar, Marcus Maurer, Sabine Altrichter, Markus Magerl, Karsten Weller, A. Młynek, R. Vieira Dos Santos, Torsten ZuberbierAbstract:Acquired cold Urticaria (ACU) is a frequent subtype of Physical Urticaria that is caused by the release of proinflammatory mast cell mediators after cold exposure. Although the underlying causes of ACU still remain to be clarified in detail, a wide range of diseases has been reported to be associated with ACU. This review gives an overview of the clinical picture, the differential diagnoses, diagnostic tests and the aetiology of ACU, and summarizes current and novel therapeutic options based on the current literature.
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Role of adverse reactions to food in Urticaria and exercise-induced anaphylaxis
International Archives of Allergy and Immunology, 2002Co-Authors: Sie Uen Chong, Margitta Worm, Torsten ZuberbierAbstract:In Urticaria, adverse reactions to food are only a frequent finding in the subset of patients with chronic continuous Urticaria. Mostly these reactions are of pseudoallergic nature, directed against artificial additives as well as naturally occurring aromatic components. IgE-mediated allergic reactions are a rare cause in acute Urticaria as well as in recurrent chronic Urticaria. In other types of Urticaria, e.g. Physical Urticaria, food plays hardly any role as an eliciting agent with the exception of ice-cold drinks in cold Urticaria. By contrast, exercise-induced anaphylaxis is frequently food-dependent. Two subtypes are distinguished: unspecific food-dependent exercise-induced anaphylaxis (FDEIA), where the filling of the stomach independently of the kind of food ingested prior to exercise is responsible for the symptoms. In specific FDEIA, an IgE-mediated food allergy causes symptoms only in combination with exercise. In the latter group, wheat is an important allergen
Arnaldo Capriles-hulett - One of the best experts on this subject based on the ideXlab platform.
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Review of Physical Urticarias and Testing Methods.
Current Allergy and Asthma Reports, 2017Co-Authors: Mario Sánchez-borges, Luis González-aveledo, Fernan Caballero-fonseca, Arnaldo Capriles-hulettAbstract:This review aims to update the information available on the prevalence, clinical picture, diagnostic methods, and treatment of Urticarias induced by external Physical stimuli. Physical Urticarias are present in up to 5% of the general population, and in 10 to 50% of patients with chronic Urticaria. Recent investigations have provided evidence that the presence of Physical Urticaria alone or when comorbid with chronic spontaneous Urticaria is associated with a worse prognosis and duration. Most frequent subtypes of Physical Urticaria are dermographism and delayed pressure Urticaria. The diagnosis is established through specific provocation tests and the management encompasses avoidance measures, pharmacologic therapy with nonsedating antihistamines, and alternative medications in refractory cases.
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Review of Physical Urticarias and Testing Methods
Current Allergy and Asthma Reports, 2017Co-Authors: Mario Sánchez-borges, Luis González-aveledo, Fernan Caballero-fonseca, Arnaldo Capriles-hulettAbstract:Purpose of Review This review aims to update the information available on the prevalence, clinical picture, diagnostic methods, and treatment of Urticarias induced by external Physical stimuli. Recent Findings Physical Urticarias are present in up to 5% of the general population, and in 10 to 50% of patients with chronic Urticaria. Recent investigations have provided evidence that the presence of Physical Urticaria alone or when comorbid with chronic spontaneous Urticaria is associated with a worse prognosis and duration. Summary Most frequent subtypes of Physical Urticaria are dermographism and delayed pressure Urticaria. The diagnosis is established through specific provocation tests and the management encompasses avoidance measures, pharmacologic therapy with nonsedating antihistamines, and alternative medications in refractory cases.
J Grabbe - One of the best experts on this subject based on the ideXlab platform.
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physikalische urtikaria Physical Urticaria
Hautarzt, 2004Co-Authors: M Fleischer, J GrabbeAbstract: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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Physikalische Urtikaria@@@Physical Urticaria
Hautarzt, 2004Co-Authors: M Fleischer, J GrabbeAbstract: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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Physikalische Urtikaria
Der Hautarzt, 2004Co-Authors: M Fleischer, J GrabbeAbstract:Mechanische und thermische Reize sowie elektromagnetische Wellen sind die Auslöser der verschiedenen Formen der physikalischen Urtikaria, die sich lokalisiert an Haut und Schleimhäuten oder auch generalisiert mit verschiedenen Begleitsymptomen manifestiert. Sie tritt überwiegend sporadisch, nur sehr selten familiär auf. Die physikalische Urtikaria kommt zwar als isolierte Erkrankung, häufig aber assoziiert mit der chronischen Urtikaria vor. Vielfach ist den Betroffenen der zeitliche und kausale Zusammenhang zwischen Auslöser und Reaktion geläufig, Formen mit stark verzögertem Auftreten werden aber manchmal erst durch entsprechende Provokationstestungen erkannt. Die klinische Bedeutung der physikalischen Urtikaria ergibt sich aus Untersuchungen, nach denen die Lebensqualität der Patienten deutlich stärker gemindert ist als bei anderen Formen der Urtikaria. Bei den meisten Formen der physikalischen Urtikaria besitzen wir nur lückenhafte Kenntnisse über die Pathophysiologie: Entzündungsreaktionen mit Beteiligung verschiedener Leukozytenarten, der Gefäße und Nerven spielen wohl eine wichtige Rolle. 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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pathomechanisms in Physical Urticaria
Journal of Investigative Dermatology Symposium Proceedings, 2001Co-Authors: J GrabbeAbstract:Various exogenous stimuli, e.g., rubbing, pressure, cold, heat, or electromagnetic waves, have been described to elicit whealing reactions, the so-called Physical Urticarias. They may occur as isolated diseases or in association with other types of Urticaria. In many cases, the respective Physical factors can be defined exactly, e.g., the degree of temperature changes or the range of eliciting ultraviolet wavelengths. In contrast, the underlying pathomechanisms are mostly still obscure. In the past, often contradictory results have been reported regarding the role of IgE, complement factors, histamine, or even mast cells. Recently, many investigations have been performed on solar Urticaria where subgroups of patients with different clinical and pathophysiologic features could be defined and mechanisms of tolerance induction have been studied that also offered an efficient treatment modality. Therefore this review will mainly focus on this type of disease as a paradigm of the pathomechanisms of Physical Urticaria.
David M Lang - One of the best experts on this subject based on the ideXlab platform.
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diagnostic utility of challenge procedures for Physical Urticaria angioedema syndromes a systematic review
Current Opinion in Allergy and Clinical Immunology, 2016Co-Authors: Lyda Cuervopardo, Alexei Gonzalezestrada, David M LangAbstract:PURPOSE OF REVIEW: Physical Urticaria/angioedema syndromes (PUAs) are commonly encountered. They are identified by a history of Physical factors provoking cutaneous symptoms, and confirmed by provocation testing. Recent guidelines have recommended use of challenge procedures for diagnosis; however, their positive/negative likelihood ratios have not been established. RECENT FINDINGS: We conducted a systematic review to determine the diagnostic utility of recommended office procedures for three common PUAs: dermatographia (DERMATO), cholinergic Urticaria (CHOL), and delayed pressure Urticaria/angioedema (DPUA). In this study, we were unable to identify studies of sufficient methodologic quality to calculate positive/negative likelihood ratios for recommended diagnostic challenges for PUAs. SUMMARY: The study highlights the need for well designed studies to aid the clinician in interpretation of diagnostic challenges for patients with DERMATO, CHOL, and DPUA. There are limited high-quality data available to support the diagnostic utility of office challenges for PUAs. There is a low sensitivity associated with methacholine intradermal challenge for confirming a diagnosis of CHOL.
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Diagnostic utility of challenge procedures for Physical Urticaria/angioedema syndromes: A systematic review
Current Opinion in Allergy and Clinical Immunology, 2016Co-Authors: Lyda Cuervo-pardo, Alexei Gonzalez-estrada, David M LangAbstract:PURPOSE OF REVIEW: Physical Urticaria/angioedema syndromes (PUAs) are commonly encountered. They are identified by a history of Physical factors provoking cutaneous symptoms, and confirmed by provocation testing. Recent guidelines have recommended use of challenge procedures for diagnosis; however, their positive/negative likelihood ratios have not been established. RECENT FINDINGS: We conducted a systematic review to determine the diagnostic utility of recommended office procedures for three common PUAs: dermatographia (DERMATO), cholinergic Urticaria (CHOL), and delayed pressure Urticaria/angioedema (DPUA). In this study, we were unable to identify studies of sufficient methodologic quality to calculate positive/negative likelihood ratios for recommended diagnostic challenges for PUAs. SUMMARY: The study highlights the need for well designed studies to aid the clinician in interpretation of diagnostic challenges for patients with DERMATO, CHOL, and DPUA. There are limited high-quality data available to support the diagnostic utility of office challenges for PUAs. There is a low sensitivity associated with methacholine intradermal challenge for confirming a diagnosis of CHOL.