Pressure urticaria

{{Infobox medical condition (new)

| name = Pressure urticaria

| synonyms = Delayed pressure urticaria

| image = Test pressure urticaria 2 Copyright Magerl.jpg

| caption = Testing for pressure-induced urticaria.

| pronounce =

| field =

| symptoms =

| complications =

| onset =

| duration =

| types =

| causes =

| risks =

| diagnosis =

| differential =

| prevention =

| treatment =

| medication =

| prognosis =

| frequency =

| deaths =

}}

Pressure urticaria or delayed pressure urticaria is a physical urticaria caused by pressure applied to the skin, and is characterized by the development of swelling and pain that usually occurs 3 to 12 hours after local pressure has been applied.James, William; Berger, Timothy; Elston, Dirk (2005). Andrews' Diseases of the Skin: Clinical Dermatology. (10th ed.). Saunders. {{ISBN|0-7216-2921-0}}.{{rp|155}}{{cite book |author=Rapini, Ronald P. |author2=Bolognia, Jean L. |author3=Jorizzo, Joseph L. |title=Dermatology: 2-Volume Set |publisher=Mosby |location=St. Louis |year=2007 |pages=266–7 |isbn=978-1-4160-2999-1 }}

Signs and symptoms

Following the administration of a prolonged pressure stimulus to the skin, there is a noticeable subcutaneous swelling that is accompanied by delayed cutaneous erythema and edema. These symptoms usually appear 4–6 hours later, however they can appear as early as 30 minutes. Lesions could last for forty-eight hours.{{cite journal | last1=Lawlor | first1=Frances | last2=Black | first2=Anne Kobza | title=Delayed pressure urticaria | journal=Immunology and Allergy Clinics of North America | publisher=Elsevier BV | volume=24 | issue=2 | year=2004 | issn=0889-8561 | doi=10.1016/j.iac.2004.01.006 | pages=247–258| pmid=15120150 }} The degree of pressure, the length of the stimulus, the bodily site impacted, and the disease's fluctuating activity all influence the reaction.{{cite journal | last1=Estes | first1=Stephen A. | last2=Yung | first2=Cheuk W. | title=Delayed pressure urticaria: An investigation of some parameters of lesion induction | journal=Journal of the American Academy of Dermatology | publisher=Elsevier BV | volume=5 | issue=1 | year=1981 | issn=0190-9622 | doi=10.1016/s0190-9622(81)70073-2 | pages=25–31| pmid=7276271 }}

Causes

Several theories have been put forth, however the pathophysiology of pressure urticaria is unknown. Although there isn't an obvious early cutaneous reaction, the time of the reaction following the application of pressure to the skin, the shape of the lesions, and the infiltrating cells observed on histopathologic examination are indicative of a late-phase reaction.{{cite journal | last=Mekori | first=Yoseph A. | title=Delayed Pressure Urticaria Histologically Resembles Cutaneous Late-Phase Reactions | journal=Archives of Dermatology | volume=124 | issue=2 | date=1988-02-01 | pages=230–235 | issn=0003-987X | doi=10.1001/archderm.1988.01670020048016 | pmid=3341804 }} Because of its timing and histology, pressure urticaria has been hypothesized to reflect a type III or other reaction to an unidentified allergy;{{cite journal | last1=RYAN | first1=T. J. | last2=SHIM-YOUNG | first2=N. | last3=TURK | first3=J. L. | title=Delayed Pressuke Urticaria | journal=British Journal of Dermatology | publisher=Oxford University Press (OUP) | volume=80 | issue=8 | year=1968 | issn=0007-0963 | doi=10.1111/j.1365-2133.1968.tb12334.x | pages=485–490| pmid=4175453 }} nevertheless, complement levels are normal, direct immunofluorescence is negative, and there is no evidence of primary vascular injury.

Diagnosis

The history of the patient and the outcomes of skin provocation testing are used to diagnose pressure urticaria. In clinical practice, a variety of provocation test types are employed. Applying 15 pounds of weight on the shoulder, forearm, or thigh for 15 minutes is known as the "sandbag test."{{cite journal | last1=Kulthanan | first1=Kanokvalai | last2=Ungprasert | first2=Patompong | last3=Tuchinda | first3=Papapit | last4=Chularojanamontri | first4=Leena | last5=Charoenpipatsin | first5=Norramon | last6=Maurer | first6=Marcus | title=Delayed Pressure Urticaria: A Systematic Review of Treatment Options | journal=The Journal of Allergy and Clinical Immunology: In Practice | publisher=Elsevier BV | volume=8 | issue=6 | year=2020 | issn=2213-2198 | doi=10.1016/j.jaip.2020.03.004 | pages=2035–2049.e5| pmid=32179196 }} A dermographic tester (HTZ Ltd, London, UK) is a calibrated equipment with a 0.9 mm diameter spring-loaded tip that may also be used to test for pressure urticaria.{{cite journal | last=Dice | first=John P | title=Physical urticaria | journal=Immunology and Allergy Clinics of North America | publisher=Elsevier BV | volume=24 | issue=2 | year=2004 | issn=0889-8561 | doi=10.1016/j.iac.2004.01.005 | pages=225–246| pmid=15120149 | url=https://zenodo.org/record/1259011 }} A different technique for assessing pressure urticaria is to apply a 2.5–4.5 kg weighted rod with a convex end to the back, leg, or forearm and leave it there for 15 minutes.{{cite journal | last1=Maurer | first1=Marcus | last2=Fluhr | first2=Joachim W. | last3=Khan | first3=David A. | title=How to Approach Chronic Inducible Urticaria | journal=The Journal of Allergy and Clinical Immunology: In Practice | publisher=Elsevier BV | volume=6 | issue=4 | year=2018 | issn=2213-2198 | doi=10.1016/j.jaip.2018.03.007 | pages=1119–1130| pmid=30033913 }}

Treatment

Based on current standards, antihistamines are the recommended first-line treatment for pressure urticaria, since they are the mainstay therapy for all kinds of chronic urticaria.{{cite journal | last1=Magerl | first1=M. | last2=Altrichter | first2=S. | last3=Borzova | first3=E. | last4=Giménez-Arnau | first4=A. | last5=Grattan | first5=C. E. H. | last6=Lawlor | first6=F. | last7=Mathelier-Fusade | first7=P. | last8=Meshkova | first8=R. Y. | last9=Zuberbier | first9=T. | last10=Metz | first10=M. | last11=Maurer | first11=M. | title=The definition, diagnostic testing, and management of chronic inducible urticarias — The EAACI/GA 2 LEN/EDF/UNEV consensus recommendations 2016 update and revision | journal=Allergy | volume=71 | issue=6 | date=2016 | doi=10.1111/all.12884 | pages=780–802| pmid=26991006 }} In people with pressure urticaria, antihistamines at conventional dosages are frequently ineffective.{{cite journal |last1=Kontou-Fili |first1=K |last2=Maniatakou |first2=G |last3=Demaka |first3=P |last4=Gonianakis |first4=M |last5=Paleologos |first5=G |title=Therapeutic effects of cetirizine in delayed pressure urticaria. Part 1. Effects on weight tests and skin-window cytology |journal=Annals of Allergy |date=December 1990 |volume=65 |issue=6 |pages=517–519 |pmid=1979476}} Therefore, additional medications are commonly utilized in the treatment of pressure urticaria, including corticosteroids,{{cite journal | last1=Dover | first1=Jeffrey S. | last2=Black | first2=Anne Kobza | last3=Ward | first3=A. Milford | last4=Greaves | first4=Malcolm W. | title=Delayed pressure urticaria | journal=Journal of the American Academy of Dermatology | publisher=Elsevier BV | volume=18 | issue=6 | year=1988 | issn=0190-9622 | doi=10.1016/s0190-9622(88)70137-1 | pages=1289–1298| pmid=3385044 }} dapsone,{{cite journal | last1=Grundmann | first1=Sonja Alexandra | last2=Kiefer | first2=Sabine | last3=Luger | first3=Thomas Anton | last4=Brehler | first4=Randolf | title=Delayed pressure urticaria – Dapsone heading for first-line therapy? | journal=JDDG: Journal der Deutschen Dermatologischen Gesellschaft | publisher=Wiley | volume=9 | issue=11 | date=2011-07-20 | issn=1610-0379 | doi=10.1111/j.1610-0387.2011.07749.x | pages=908–912| pmid=21771275 }} sulfasalazine,{{cite journal |last1=Engler |first1=R J |last2=Squire |first2=E |last3=Benson |first3=P |title=Chronic sulfasalazine therapy in the treatment of delayed pressure urticaria and angioedema |journal=Annals of Allergy, Asthma & Immunology |date=February 1995 |volume=74 |issue=2 |pages=155–159 |pmid=7697475}} colchicine,{{cite journal | last1=Lawlor | first1=Frances | last2=Black | first2=Anne Kobza | last3=Ward | first3=A. Milford | last4=Morris | first4=R. | last5=Greaves | first5=M.W. | title=Delayed pressure urticaria, objective evaluation of a variable disease using a dermographometer and assessment of treatment using colchicine | journal=British Journal of Dermatology | volume=120 | issue=3 | date=1989 | issn=0007-0963 | doi=10.1111/j.1365-2133.1989.tb04167.x | pages=403–408| pmid=2653402 }} intravenous immunoglobulin (IVIG),{{cite journal | last1=Dawn | first1=G. | last2=Urcelay | first2=M. | last3=Ah-Weng | first3=A. | last4=O'Neill | first4=S.M. | last5=Douglas | first5=W.S. | title=Effect of high-dose intravenous immunoglobulin in delayed pressure urticaria | journal=British Journal of Dermatology | publisher=Oxford University Press (OUP) | volume=149 | issue=4 | year=2003 | issn=0007-0963 | doi=10.1046/j.1365-2133.2003.05486.x | pages=836–840| pmid=14616377 }} and omalizumab.{{cite journal | last1=Metz | first1=Martin | last2=Ohanyan | first2=Tatevik | last3=Church | first3=Martin K. | last4=Maurer | first4=Marcus | title=Omalizumab is an effective and rapidly acting therapy in difficult-to-treat chronic urticaria: A retrospective clinical analysis | journal=Journal of Dermatological Science | publisher=Elsevier BV | volume=73 | issue=1 | year=2014 | issn=0923-1811 | doi=10.1016/j.jdermsci.2013.08.011 | pages=57–62| pmid=24060603 }}

References

External links

[https://dermnetnz.org/topics/pressure-urticaria DermNet]
[https://www.visualdx.com/visualdx/diagnosis/pressure+urticaria?diagnosisId=52479&moduleId=101 VisualDx]

{{Medical resources

| ICD11 = {{ICD11|EB01.2}}

| ICD10 = {{ICD10|L50.8}}

| ICD10CM =

| ICD9 =

| ICDO =

| OMIM =

| MeshID =

| DiseasesDB = 29574

| SNOMED CT = 387787005

| Curlie =

| MedlinePlus =

| eMedicineSubj = article

| eMedicineTopic = 1050387

| PatientUK =

| NCI =

| GeneReviewsNBK =

| GeneReviewsName =

| NORD =

| GARDNum =

| GARDName =

| RP =

| AO =

| WO =

| OrthoInfo =

| Orphanet =

| Scholia = Q7241740

| OB =

}}

Category:Urticaria and angioedema