Urticaria, Physical

Urticaria, Physical

National Organization for Rare Disorders, Inc.

Important

It is possible that the main title of the report Urticaria, Physical is not the name you expected. Please check the synonyms listing to find the alternate name(s) and disorder subdivision(s) covered by this report.

Synonyms

  • Autographism
  • Physical Allergy Urticaria

Disorder Subdivisions

  • Aquagenic Urticaria
  • Cold Urticaria
  • Dermatographia
  • Dermographism

General Discussion

Physical urticaria is a condition in which red (erythematous) allergic skin lesions and itching (pruritus) are produced by exposure to heat, cold, or contact with chemicals or plants. These are called wheals by the medical community and may range in size from a couple of millimeters to a couple of centimeters. The center of the lesion may range in color from white to red, and it is usually surrounded by a flare of red skin. The disorder occurs most commonly in children.

Symptoms

The most common symptoms of physical urticaria are itching (pruritus) and hives consisting of red rings around white ridges (wheals). Sensitivity to cold is usually manifested by these eruptions on the skin, itching, and swelling under the skin (angioedema). These symptoms develop most typically after exposure to cold is terminated and during or after swimming or bathing. Contraction of the muscles around the bronchi (bronchospasm) and even histamine-mediated shock may occur in extreme cases. If this happens during swimming, drowning may present a danger.



Sensitivity to cold can be passively transferred with serum that contains a specific immunoglobulin (IgE) antibody, suggesting an allergic reaction involving a physically altered skin protein as the cause of the allergic reaction. The serum of a few patients with cold-induced symptoms of physical urticaria contains cryoglobulins or cryofibrinogen, these abnormal proteins can also be associated with a serious underlying disorder such as a malignancy, a collagen vascular disease, or chronic infection. Cold may aggravate asthma or vasomotor rhinitis, but cold urticaria is independent of any other known allergic tendencies.



Dermatographia, dermographism, or autographism describes welts or wheels produced by scratching or firmly stroking the skin. According to some dermatologists, dermographism is the most common form of physical urticaria. This sign can appear quite suddenly and may become apparent in hot weather or after a hot shower or bath. Occasionally it is the first sign of an urticarial drug reaction. Physical urticaria has also occurred following persistent vibration of the skin, and even after exposure to water (aquagenic urticaria).

Causes

The underlying cause of physical urticaria is unknown in most cases. Some clinicians believe that an auto-immunological process is responsible.

Affected Populations

Cold urticaria occurs most often in infants, although it sometimes occurs in adults.

Standard Therapies

Diagnosis

The patient history and physical examination are the tools most often used to diagnose physical urticaria. If there is a history of reactions to physical triggers, the diagnosis may be confirmed with a challenge. The challenge is the application of the suspected agent, for example ice or light, to the skin, in hope of getting a response.



Treatment

Protection from and avoidance of the physical cause of the reaction is necessary. Symptoms such as itching and swelling can usually be relieved with an oral antihistamine. The more powerful systematic (intravenous) corticosteroids should be avoided unless they are vital.

Investigational Therapies

Information on current clinical trials is posted on the Internet at www.clinicaltrials.gov. All studies receiving U.S. government funding, and some supported by private industry, are posted on this government web site.



For information about clinical trials being conducted at the NIH Clinical Center in Bethesda, MD, contact the NIH Patient Recruitment Office:



Tollfree: (800) 411-1222

TTY: (866) 411-1010

Email: prpl@cc.nih.gov



For information about clinical trials sponsored by private sources, contact:

www.centerwatch.com

References

TEXTBOOKS

Beers MH, Berkow R., ed. The Merck Manual, 17th ed. Whitehouse Station, NJ: Merck Research Laboratories; 1999:1054-57, 1057.



Berkow R., ed. The Merck Manual-Home Edition.2nd ed. Whitehouse Station, NJ: Merck Research Laboratories; 2003:1071-72.



Champion RH, Burton JL, Ebling FJG. eds. Textbook of Dermatology. 5th ed. Blackwell Scientific Publications. London, UK; 1992:1873-76.



REVIEW ARTICLES

Kozel MM, Sabroe RA. Chronic urticaria: aetiology, management and current and future treatment options. Drugs. 2004;64:2515-36.



Wanderer AA, Hoffman HM. The spectrum of acquired and familial cold-induced urticaria/urticaria-like syndromes. Immunol Allergy Clin North Am. 2004;24:259-86, vii.



Lawlor F, Black AK. Delayed pressure urticaria. Immunol Allergy Clin North Am. 2004;24:247-58, vi-vii.



Dice JP. Physical urticaria. Immunol Allergy Clin North Am. 2004;24:225-46, vi.



Yashar SS, lim HW. Classification and evaluation of the photodermatoses. Dermatol Ther. 2003;16:1-7.



Brooks C, Kujawska A, Patel D. Cutaneous allergic reactions induced by sporting activities. Sports Med. 2003;33:699-708.



Muller BA. A comprehensive review of physical urticaria. Compr Ther. 2002;28:214-21.



FROM THE INTERNET

Strachan DD. Urticaria, Chronic. Last Updated: March 31, 2005. 15pp.

www.emedicine.com/DERM/topic443.htm

Resources

NIH/National Institute of Allergy and Infectious Diseases

Office of Communications and Government Relations

6610 Rockledge Drive, MSC 6612

Bethesda, MD 20892-6612

Tel: (301)496-5717

Fax: (301)402-3573

Tel: (866)284-4107

TDD: (800)877-8339

Email: ocpostoffice@niaid.nih.gov

Internet: http://www.niaid.nih.gov/



American Academy of Allergy, Asthma and Immunology

611 East Wells Street

Milwaukee, WI 53202

Tel: (414)272-6071

Fax: (414)276-3349

Tel: (800)822-2762

Email: info@aaaai.org

Internet: http://www.aaaai.org



Genetic and Rare Diseases (GARD) Information Center

PO Box 8126

Gaithersburg, MD 20898-8126

Tel: (301)251-4925

Fax: (301)251-4911

Tel: (888)205-2311

TDD: (888)205-3223

Internet: http://rarediseases.info.nih.gov/GARD/



For a Complete Report

This is an abstract of a report from the National Organization for Rare Disorders, Inc.® (NORD). Cigna members can access the complete report by logging into myCigna.com. For non-Cigna members, a copy of the complete report can be obtained for a small fee by visiting the NORD website. The complete report contains additional information including symptoms, causes, affected population, related disorders, standard and investigational treatments (if available), and references from medical literature. For a full-text version of this topic, see http://www.rarediseases.org/search/rdblist.html.

This information does not replace the advice of a doctor. Healthwise, Incorporated disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use . How this information was developed to help you make better health decisions.

Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated.