Urticaria classification: Difference between revisions
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==Overview== | ==Overview== | ||
There are numerous types of [[urticaria]]. Based on the way [[urticaria|wheals]] appear, they can be divided into [[spontaneous urticaria|spontaneous]] and [[urticaria|physical urticaria]]. [[urticaria|Spontaneous urticaria]] is further divided into acute and [[urticaria|chronic urticaria]], based on their duration. Mechanical forces and pressure on the [[skin]] or the ambient air temperature are responsible factors in development of [[urticaria|physical urticaria]], which can be divided into more subtypes, such as [[ | There are numerous types of [[urticaria]]. Based on the way [[urticaria|wheals]] appear, they can be divided into [[spontaneous urticaria|spontaneous]] and [[urticaria|physical urticaria]]. [[urticaria|Spontaneous urticaria]] is further divided into acute and [[urticaria|chronic urticaria]], based on their duration. Mechanical forces and pressure on the [[skin]] or the ambient air temperature are responsible factors in development of [[urticaria|physical urticaria]], which can be divided into more subtypes, such as demographic [[urticaria]], [[urticaria|delayed pressure urticaria]], [[urticaria|cold contact urticaria]], [[urticaria|heat contact urticaria]], [[urticaria|solar urticaria]] and [[urticaria|vibratory urticaria]]. Besides these two main classes of [[urticaria]] there are other particular types such as, [[urticaria|cholinergic urticaria]], [[urticaria|adrenergic urticaria]], [[urticaria|aquagenic urticaria]], [[urticaria|contact urticaria]] and drug-induced urticaria. | ||
==Classification== | ==Classification== | ||
[[Urticaria]] may be classified according to roles of triggers into two subtypes: | [[Urticaria]] may be classified according to roles of triggers into two subtypes: | ||
**[[urticaria|Acute urticaria]]: Spontaneous appearance of [[urticaria|wheals]], most days in a period less than 6 weeks. | === [[urticaria|'''Spontaneous urticaria''']]<ref name="pmid14616095">{{cite journal| author=Zuberbier T| title=Urticaria. | journal=Allergy | year= 2003 | volume= 58 | issue= 12 | pages= 1224-34 | pmid=14616095 | doi=10.1046/j.1398-9995.2003.00327.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14616095 }} </ref><ref name="pmid30984191">{{cite journal| author=Bracken SJ, Abraham S, MacLeod AS| title=Autoimmune Theories of Chronic Spontaneous Urticaria. | journal=Front Immunol | year= 2019 | volume= 10 | issue= | pages= 627 | pmid=30984191 | doi=10.3389/fimmu.2019.00627 | pmc=6450064 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30984191 }} </ref> === | ||
**[[urticaria|Chronic urticaria]]: Spontaneous appearance of [[urticaria|wheals]] with more than 6 weeks duration.<ref name="pmid10756214">{{cite journal| author=Greaves M| title=Chronic urticaria. | journal=J Allergy Clin Immunol | year= 2000 | volume= 105 | issue= 4 | pages= 664-72 | pmid=10756214 | doi=10.1067/mai.2000.105706 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10756214 }} </ref> | |||
***Chronic continuous: Involvement in every day or most days. | **[[urticaria|'''Acute urticaria''']]: Spontaneous appearance of [[urticaria|wheals]], most days in a period less than 6 weeks. | ||
***Chronic recurrent: There are [[symptom]] free intervals. | **[[urticaria|'''Chronic urticaria''']]: Spontaneous appearance of [[urticaria|wheals]] with more than 6 weeks duration.<ref name="pmid10756214">{{cite journal| author=Greaves M| title=Chronic urticaria. | journal=J Allergy Clin Immunol | year= 2000 | volume= 105 | issue= 4 | pages= 664-72 | pmid=10756214 | doi=10.1067/mai.2000.105706 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10756214 }} </ref> | ||
***[[Chronic]] continuous: Involvement in every day or most days. | |||
**[[urticaria|Dermographic urticaria]] ([[urticaria|factitial urticaria]]): Appearance of [[urticaria|wheals]] 1-5 minutes after a mechanical shearing force, which mainly involves young adults. | ***[[Chronic]] recurrent: There are [[symptom]] free intervals. | ||
**[[urticaria|Delayed pressure urticaria]]: | |||
=== [[urticaria|'''Inducible urticaria''']]<ref name="pmid14616095">{{cite journal| author=Zuberbier T| title=Urticaria. | journal=Allergy | year= 2003 | volume= 58 | issue= 12 | pages= 1224-34 | pmid=14616095 | doi=10.1046/j.1398-9995.2003.00327.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14616095 }} </ref><ref name="pmid30984191">{{cite journal| author=Bracken SJ, Abraham S, MacLeod AS| title=Autoimmune Theories of Chronic Spontaneous Urticaria. | journal=Front Immunol | year= 2019 | volume= 10 | issue= | pages= 627 | pmid=30984191 | doi=10.3389/fimmu.2019.00627 | pmc=6450064 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30984191 }} </ref><ref name="pmid18713139">{{cite journal| author=Deacock SJ| title=An approach to the patient with urticaria. | journal=Clin Exp Immunol | year= 2008 | volume= 153 | issue= 2 | pages= 151-61 | pmid=18713139 | doi=10.1111/j.1365-2249.2008.03693.x | pmc=2492902 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18713139 }} </ref><ref name="pmid24404388">{{cite journal| author=Losol P, Yoo HS, Park HS| title=Molecular genetic mechanisms of chronic urticaria. | journal=Allergy Asthma Immunol Res | year= 2014 | volume= 6 | issue= 1 | pages= 13-21 | pmid=24404388 | doi=10.4168/aair.2014.6.1.13 | pmc=3881394 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24404388 }} </ref> === | |||
**[[urticaria|'''Dermographic urticaria''']] ([[urticaria|factitial urticaria]]): Appearance of [[urticaria|wheals]] 1-5 minutes after a mechanical shearing force, which mainly involves young adults. | |||
**[[urticaria|'''Delayed pressure urticaria''']]: | |||
***Appearance of [[urticaria|wheals]] 3-8 hours after a vertical pressure, which usually lasts for 8–48 hours. | ***Appearance of [[urticaria|wheals]] 3-8 hours after a vertical pressure, which usually lasts for 8–48 hours. | ||
***Frequently seen on [[Hand|palms]] and [[Sole (foot)|soles]], [[buttocks]] and [[Human back|back]] (sitting on a hard chair). | ***Frequently seen on [[Hand|palms]] and [[Sole (foot)|soles]], [[buttocks]] and [[Human back|back]] (sitting on a hard chair). | ||
**[[urticaria|Cold contact urticaria]]:<ref name="pmid30574166">{{cite journal| author=Stepaniuk P, Vostretsova K, Kanani A| title=Review of cold-induced urticaria characteristics, diagnosis and management in a Western Canadian allergy practice. | journal=Allergy Asthma Clin Immunol | year= 2018 | volume= 14 | issue= | pages= 85 | pmid=30574166 | doi=10.1186/s13223-018-0310-5 | pmc=6299577 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30574166 }} </ref> | **[[urticaria|'''Cold contact urticaria''']]:<ref name="pmid30574166">{{cite journal| author=Stepaniuk P, Vostretsova K, Kanani A| title=Review of cold-induced urticaria characteristics, diagnosis and management in a Western Canadian allergy practice. | journal=Allergy Asthma Clin Immunol | year= 2018 | volume= 14 | issue= | pages= 85 | pmid=30574166 | doi=10.1186/s13223-018-0310-5 | pmc=6299577 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30574166 }} </ref> | ||
***Appearance of [[urticaria|wheals]] due to cold temperatures, such as ice and cold air, water, or wind. | ***Appearance of [[urticaria|wheals]] due to cold temperatures, such as ice and cold air, water, or wind. | ||
***It is divided into primary and secondary subtypes. In primary form there is no known trigger causing the [[urticaria]], besides cold temperature. Nevertheless, secondary form of [[urticaria|cold contact urticaria]] is also associated to other triggers in addition to cold | ***It is divided into primary and secondary subtypes. In primary form there is no known trigger causing the [[urticaria]], besides cold temperature. Nevertheless, secondary form of [[urticaria|cold contact urticaria]] is also associated to other triggers in addition to cold temperature, such as [[medications]], [[Bacteria|bacterial]] or [[Virus|viral]] [[infection|infections]], [[hymenoptera]] stings, [[immunotherapy]] and [[Hematological malignancy|hematological malignancies]]. | ||
**[[urticaria|Heat contact urticaria]] | **[[urticaria|'''Heat contact urticaria''']] | ||
**[[urticaria|Solar urticaria]]: Appearance of [[urticaria|wheals]] due to [[Ultraviolet|sunlight/ultraviolet light]] with wavelengths ranging between 280 and 760 nm. | **[[urticaria|'''Solar urticaria''']]: Appearance of [[urticaria|wheals]] due to [[Ultraviolet|sunlight/ultraviolet light]] with wavelengths ranging between 280 and 760 nm. | ||
**[[urticaria|Vibratory urticaria]]: Appearance of [[urticaria|wheals]] due to vibratory forces, such as pneumatic hammer.<ref name="pmid2576934">{{cite journal| author=Lawlor F, Black AK, Breathnach AS, Greaves MW| title=Vibratory angioedema: lesion induction, clinical features, laboratory and ultrastructural findings and response to therapy. | journal=Br J Dermatol | year= 1989 | volume= 120 | issue= 1 | pages= 93-9 | pmid=2576934 | doi=10.1111/j.1365-2133.1989.tb07770.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2576934 }} </ref> | **[[urticaria|'''Vibratory urticaria''']]: Appearance of [[urticaria|wheals]] due to vibratory forces, such as pneumatic hammer.<ref name="pmid2576934">{{cite journal| author=Lawlor F, Black AK, Breathnach AS, Greaves MW| title=Vibratory angioedema: lesion induction, clinical features, laboratory and ultrastructural findings and response to therapy. | journal=Br J Dermatol | year= 1989 | volume= 120 | issue= 1 | pages= 93-9 | pmid=2576934 | doi=10.1111/j.1365-2133.1989.tb07770.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2576934 }} </ref> | ||
**[[urticaria|Cholinergic urticaria]]: | **[[urticaria|'''Cholinergic urticaria''']]: | ||
***Usually due to causes that elevate core body temperatures, such as [[Physical exercise|exercise]], [[Stress (medicine)|emotional stress]] and passive warmth (hot shower) and less commonly due to [[alcohol|alcoholic drinks]] or warm or spicy foods. | ***Usually due to causes that elevate core body temperatures, such as [[Physical exercise|exercise]], [[Stress (medicine)|emotional stress]] and passive warmth (hot shower) and less commonly due to [[alcohol|alcoholic drinks]] or warm or spicy foods. | ||
**[[urticaria|Adrenergic urticaria]] | **[[urticaria|'''Adrenergic urticaria''']]: | ||
***Elicited by [[Stress (medicine)|stress]] | ***Elicited by [[Stress (medicine)|stress]] | ||
**[[urticaria|Aquagenic urticaria]] | **[[urticaria|'''Aquagenic urticaria''']] | ||
***[[Urticaria]] appearance is not due to water itself, nevertheless water delivers some [[Solubility|water-soluble]] [[Allergen|allergens]] to the [[dermis]]. | ***[[Urticaria]] appearance is not due to water itself, nevertheless water delivers some [[Solubility|water-soluble]] [[Allergen|allergens]] to the [[dermis]]. | ||
**[[urticaria|Contact urticaria]] ([[Allergy|allergic]] or pseudo[[allergy|allergic]]) | **[[urticaria|'''Contact urticaria''']] ([[Allergy|allergic]] or pseudo[[allergy|allergic]]) | ||
***[[Chemical substance|Chemical substances]] contact (such as industrial [[Chemical substance|chemicals]], animal product, textiles, plants, [[drugs]], [[cosmetic|cosmetics]] and food) with [[skin]] leads to [[urticaria]] appearance. | ***[[Chemical substance|Chemical substances]] contact (such as industrial [[Chemical substance|chemicals]], animal product, textiles, plants, [[drugs]], [[cosmetic|cosmetics]] and food) with [[skin]] leads to [[urticaria]] appearance. | ||
**[[urticaria|Drug-induced urticaria]] ( | **[[urticaria|'''Drug-induced urticaria''']] (such as [[urticaria|aspirin-intolerant chronic urticaria]] ([[urticaria|AICU]])) | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Anahita Deylamsalehi, M.D.[2]
Overview
There are numerous types of urticaria. Based on the way wheals appear, they can be divided into spontaneous and physical urticaria. Spontaneous urticaria is further divided into acute and chronic urticaria, based on their duration. Mechanical forces and pressure on the skin or the ambient air temperature are responsible factors in development of physical urticaria, which can be divided into more subtypes, such as demographic urticaria, delayed pressure urticaria, cold contact urticaria, heat contact urticaria, solar urticaria and vibratory urticaria. Besides these two main classes of urticaria there are other particular types such as, cholinergic urticaria, adrenergic urticaria, aquagenic urticaria, contact urticaria and drug-induced urticaria.
Classification
Urticaria may be classified according to roles of triggers into two subtypes:
Spontaneous urticaria[1][2]
- Acute urticaria: Spontaneous appearance of wheals, most days in a period less than 6 weeks.
- Chronic urticaria: Spontaneous appearance of wheals with more than 6 weeks duration.[3]
Inducible urticaria[1][2][4][5]
- Dermographic urticaria (factitial urticaria): Appearance of wheals 1-5 minutes after a mechanical shearing force, which mainly involves young adults.
- Delayed pressure urticaria:
- Cold contact urticaria:[6]
- Appearance of wheals due to cold temperatures, such as ice and cold air, water, or wind.
- It is divided into primary and secondary subtypes. In primary form there is no known trigger causing the urticaria, besides cold temperature. Nevertheless, secondary form of cold contact urticaria is also associated to other triggers in addition to cold temperature, such as medications, bacterial or viral infections, hymenoptera stings, immunotherapy and hematological malignancies.
- Heat contact urticaria
- Solar urticaria: Appearance of wheals due to sunlight/ultraviolet light with wavelengths ranging between 280 and 760 nm.
- Vibratory urticaria: Appearance of wheals due to vibratory forces, such as pneumatic hammer.[7]
- Cholinergic urticaria:
- Usually due to causes that elevate core body temperatures, such as exercise, emotional stress and passive warmth (hot shower) and less commonly due to alcoholic drinks or warm or spicy foods.
- Adrenergic urticaria:
- Elicited by stress
- Aquagenic urticaria
- Urticaria appearance is not due to water itself, nevertheless water delivers some water-soluble allergens to the dermis.
- Contact urticaria (allergic or pseudoallergic)
- Drug-induced urticaria (such as aspirin-intolerant chronic urticaria (AICU))
| Urticaria | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Acute (Less than 6 weeks) | Chronic (More than 6 weeks) | Dermographic urticaria ‡ | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Spontaneous (No identifiable trigger) | Inducible (Identifiable trigger) | Delayed pressure urticaria ‡ | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Cold contact urticaria ‡ | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Heat contact urticaria ‡ | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Solar urticaria ‡ | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Vibratory urticaria ‡ | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Cholinergic urticaria | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Adrenergic urticaria | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Aquagenic urticaria ‡ | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Contact urticaria | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Drug-induced urticaria | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
‡ Can also be classified as physical urticaria.
References
- ↑ 1.0 1.1 Zuberbier T (2003). "Urticaria". Allergy. 58 (12): 1224–34. doi:10.1046/j.1398-9995.2003.00327.x. PMID 14616095.
- ↑ 2.0 2.1 Bracken SJ, Abraham S, MacLeod AS (2019). "Autoimmune Theories of Chronic Spontaneous Urticaria". Front Immunol. 10: 627. doi:10.3389/fimmu.2019.00627. PMC 6450064. PMID 30984191.
- ↑ Greaves M (2000). "Chronic urticaria". J Allergy Clin Immunol. 105 (4): 664–72. doi:10.1067/mai.2000.105706. PMID 10756214.
- ↑ Deacock SJ (2008). "An approach to the patient with urticaria". Clin Exp Immunol. 153 (2): 151–61. doi:10.1111/j.1365-2249.2008.03693.x. PMC 2492902. PMID 18713139.
- ↑ Losol P, Yoo HS, Park HS (2014). "Molecular genetic mechanisms of chronic urticaria". Allergy Asthma Immunol Res. 6 (1): 13–21. doi:10.4168/aair.2014.6.1.13. PMC 3881394. PMID 24404388.
- ↑ Stepaniuk P, Vostretsova K, Kanani A (2018). "Review of cold-induced urticaria characteristics, diagnosis and management in a Western Canadian allergy practice". Allergy Asthma Clin Immunol. 14: 85. doi:10.1186/s13223-018-0310-5. PMC 6299577. PMID 30574166.
- ↑ Lawlor F, Black AK, Breathnach AS, Greaves MW (1989). "Vibratory angioedema: lesion induction, clinical features, laboratory and ultrastructural findings and response to therapy". Br J Dermatol. 120 (1): 93–9. doi:10.1111/j.1365-2133.1989.tb07770.x. PMID 2576934.