Urticaria classification
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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.