physical urticaria

Physical Urticaria Description

Physical urticaria, also known as chronic inducible urticaria (CIndU), is a distinct subgroup of urticaria characterized by itchy wheal and flare-type skin reactions and/or angioedema induced by external physical factors.

• Causes: Physical stimuli such as cold, heat, pressure, friction, or light can trigger hives in individuals with physical urticaria [1].
• Symptoms: Hives, also known as urticaria, are red and sometimes itchy bumps on the skin. They may be accompanied by angioedema, a condition characterized by swelling of the deeper layers of skin and mucous membranes [6][7].
• Characteristics: Physical urticaria is marked by recurrent wheals and/or angioedema that develop following exposure of the skin to a physical stimulus [8][9].

In summary, physical urticaria is a type of urticaria triggered by external physical factors, resulting in itchy hives and/or angioedema.

References:

[1] Jun 2, 2023 — Physical urticaria: If physical stimuli such as cold, heat, pressure, friction, or light cause hives, specifically of a cold, heat, or pressure. [6] Hives, also known as urticaria, are red and sometimes itchy bumps on your skin. Learn about the hives symptoms, diagnosis and treatment here. [7] Urticaria consists of migratory, well-circumscribed, erythematous, pruritic plaques on the skin. Urticaria also may be accompanied by angioedema. [8] by SM McSweeney · 2023 · Cited by 7 — Physical urticaria is a type of urticaria in which recurrent wheals and/or angioedema occur following exposure of the skin to a physical ... [9] by SM McSweeney · 2023 · Cited by 7 — Physical urticaria is characterized by recurrent wheals and/or angioedema that develop following cutaneous exposure to one or more physical ...

Physical Urticaria Signs and Symptoms

Physical urticaria is characterized by the appearance of red (erythematous) allergic skin lesions and itching (pruritus) in response to exposure to certain physical triggers. The symptoms can vary depending on the individual and the specific trigger, but common signs and symptoms include:

• Hives: Swollen, pale red bumps or welts on the skin that appear suddenly [7][8]
• Itching: Intense itching sensation on the affected area [1][6]
• Swelling: Swelling of the face, mouth, or throat can occur in some cases [5]
• Shortness of breath: In severe cases, physical urticaria can cause shortness of breath due to swelling of the airways [5]
• Wheezing: Wheezing sounds can be heard when breathing out due to constriction of the airways [5]
• Vomiting: Vomiting can occur in some cases, especially if the physical trigger is severe [5]
• Low blood pressure: In rare cases, physical urticaria can cause a drop in blood pressure [5]

Important associated symptoms

In addition to the above symptoms, important associated symptoms of physical urticaria include:

• Pruritus: Intense itching sensation on the affected area [6]
• Rhinorrhea: Runny nose and nasal congestion can occur due to release of histamine [9]
• Swelling of the face and tongue: Swelling of the face, mouth, or throat can occur in some cases [5][6]

It's essential to seek medical attention if you experience any of these symptoms, especially if they are severe or persistent.

Diagnostic Tests for Physical Urticaria

Physical urticaria, also known as cholinergic urticaria, is a type of hives that occurs in response to physical stimuli such as heat, cold, or exercise. While there are no definitive diagnostic tests for physical urticaria, various tests can help confirm the diagnosis and rule out other conditions.

Recommended Tests

• A complete blood cell (CBC) count with differential: This test is recommended to evaluate the overall health of your blood cells and detect any abnormalities that may be contributing to your symptoms [1].
• Erythrocyte sedimentation rate (ESR): This test measures how quickly red blood cells settle in a test tube, which can indicate inflammation or infection in the body [2].

Other Tests

• Blood tests: These may include thyroid-stimulating hormone (TSH), urinalysis, and liver function tests to rule out other conditions that may be causing your symptoms [4].
• Autologous serum skin test (ASST): This is a specific test for investigating chronic urticaria, which has been reported to have 81% sensitivity and 78% specificity [3].

Evaluation

The diagnosis of physical urticaria largely relies on history and physical examination. A detailed patient history and physical examination can help identify the triggers that cause your symptoms [5]. Blood tests may also be ordered to rule out other conditions.

References

[1] Oct 13, 2021 — The only screening tests that are recommended to be performed are a complete blood cell (CBC) count with differential, erythrocyte sedimentation rate (ESR) and ...

[2] Sep 18, 2023 — Acute urticaria is generally diagnosed based on a detailed patient history and physical examination (see Clinical Presentation)

[3] At present, an autologous serum skin test (ASST) is the most useful test for investigating chronic urticaria and has a reported 81% sensitivity and 78% ...

[4] by P SCHAEFER · 2017 · Cited by 154 — Complete blood count with differential, erythrocyte sedimentation rate or C-reactive protein, thyroid-stimulating hormone, urinalysis, and liver ...

[5] Jan 13, 2023 — Hives, or urticaria, are diagnosed by assessing medical history and status, physical examination, and blood tests, among others.

Treatment Options for Physical Urticaria

Physical urticaria, also known as inducible urticaria, is a type of urticaria that occurs in response to specific physical stimuli such as heat, cold, pressure, exercise, water, vibration, and sunlight. While the exact cause of physical urticaria is not fully understood, various treatment options are available to manage symptoms.

Medications Used to Treat Physical Urticaria

• Antihistamines: These medications are often the first line of treatment for physical urticaria. They can help relieve itching and reduce the severity of hives.
  • Second-generation antihistamines such as cetirizine or loratidine are commonly used due to their effectiveness and relatively low side effects [4][9].
• Corticosteroids: These medications can be used to treat severe cases of physical urticaria. They work by reducing inflammation and can help alleviate symptoms.
  • Oral corticosteroids such as prednisolone have been shown to be effective in controlling severe attacks of urticaria and angioedema [6].
• Leukotriene receptor antagonists: These medications, such as montelukast, may also be used to treat physical urticaria. They work by blocking the action of leukotrienes, which are chemical mediators involved in the inflammatory response.
  • Improvement of cold urticaria has been reported with treatment using montelukast [14].

Other Treatment Options

• Avoiding triggers: Identifying and avoiding specific physical stimuli that trigger urticaria can be an effective way to manage symptoms.
• Cold compresses or cool showers: Applying a cold compress or taking a cool shower may help alleviate itching and reduce the severity of hives.

It's essential to consult with a healthcare provider for proper diagnosis and treatment. They will work with you to develop a personalized treatment plan that takes into account your specific needs and medical history.

References:

[4] Most patients with urticaria can be treated with oral (PO) H1 antihistamines. Modern second-generation antihistamines are the first choice. [6] Prednisolone in the dose of 20-30 mg for three days is effective to control severe attacks of urticaria and angioedema. [9] The main treatment of all forms of urticaria in adults and children is with an oral second-generation H1-antihistamine such as cetirizine or loratidine. [14] Improvement of cold urticaria by treatment with the leukotriene receptor antagonist montelukast.

Understanding Differential Diagnosis in Physical Urticaria

Physical urticaria refers to a group of skin conditions that are triggered by external stimuli, such as temperature, pressure, or light. When it comes to differential diagnosis, the goal is to identify other possible causes of symptoms that resemble physical urticaria.

Possible Conditions to Consider:

• Papular urticaria: This condition is characterized by small, itchy bumps on the skin, often caused by insect bites or stings.
• Mastocytosis: A rare disorder in which mast cells accumulate in the skin, leading to symptoms such as hives, itching, and flushing.
• Urticarial vasculitis: An inflammatory condition that causes blood vessels to become inflamed, resulting in symptoms like hives, itching, and swelling.

Key Factors to Consider:

• Symptom duration: How long have the symptoms been present? Physical urticaria typically resolves on its own within a short period.
• Triggering factors: What external stimuli may be triggering the symptoms?
• Skin examination: A thorough examination of the skin can help identify other possible conditions.

Differential Diagnosis Considerations:

• Allergic contact dermatitis: An allergic reaction to certain substances, which can cause symptoms similar to physical urticaria.
• Erythema multiforme: A rare skin condition characterized by target-shaped lesions and often accompanied by fever and other systemic symptoms.

Conclusion:

Differential diagnosis of physical urticaria requires a thorough understanding of the possible conditions that may mimic its symptoms. By considering factors such as symptom duration, triggering factors, and skin examination findings, healthcare professionals can narrow down the list of potential causes and provide an accurate diagnosis.

References:

• [3] Urticaria is an inflammatory skin disorder that may occur in isolation or associated with angioedema and/or anaphylaxis.
• [9] What is the differential diagnosis of urticaria? · Scombroid fish poisoning · Papular urticaria · Mastocytosis · Urticarial vasculitis · Autoinflammatory syndromes ...
• [4] by P SCHAEFER · 2011 · Cited by 80 — Urticaria involves intensely pruritic, raised wheals, with or without edema of the deeper cutis. It is usually a self-limited, benign reaction, but can be ...