Hirsh D Komarow1, Sarah Arceo2, Michael Young3, Celeste Nelson2, Dean D Metcalfe2. 1. Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md. Electronic address: komarowh@niaid.nih.gov. 2. Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md. 3. Clinical Research Directorate/Clinical Monitoring Research Program, Leidos Biomedical Research Inc, formerly SAIC-Frederick Inc, Frederick National Laboratory for Cancer Research, Frederick, Md.
Abstract
BACKGROUND: Physical urticaria is a subtype of chronic urticaria induced by a physical stimulus. OBJECTIVE: To evaluate the consistency between a history of physical urticaria and results of challenge testing. METHODS: Seventy-six subjects, ages 3 to 77 years old, were referred with the diagnosis of a physical urticaria and were evaluated by using challenge testing directed toward the presenting diagnosis, yet included other stimuli based on history. The majority of subjects were tested to 3 or more stimuli, thus 294 provocation tests were performed. Fifty-seven subjects were surveyed for the status of their physical urticaria at least 1 year after initial evaluation. RESULTS: Of the 76 subjects with a positive history of a physical urticaria, 38% (n = 29) were challenge negative to the presenting diagnosis. Eight subjects within the challenge negative group reacted positively to additional testing, thus 28% (n = 21) remained negative to all challenge testing, which allowed discontinuation of medications and avoidance behavior. A negative challenge result was less likely with subjects who presented with cold-induced urticaria (25%), delayed pressure urticaria (25%), and dermatographism (29%), yet more common with cholinergic (65%) and solar urticaria (67%). A 1-year follow-up survey of 57 subjects was consistent with initial results. Nineteen of this subgroup were rechallenged for the presenting diagnosis, and the outcome was unchanged in 17 subjects and, in 2 subjects the urticaria had resolved. CONCLUSIONS: The diagnosis by history of a physical urticaria should be verified by testing whenever possible and particularly if the condition is judged as severe and thus requires both significant life-style changes and pharmacologic intervention. Published by Elsevier Inc.
BACKGROUND: Physical urticaria is a subtype of chronic urticaria induced by a physical stimulus. OBJECTIVE: To evaluate the consistency between a history of physical urticaria and results of challenge testing. METHODS: Seventy-six subjects, ages 3 to 77 years old, were referred with the diagnosis of a physical urticaria and were evaluated by using challenge testing directed toward the presenting diagnosis, yet included other stimuli based on history. The majority of subjects were tested to 3 or more stimuli, thus 294 provocation tests were performed. Fifty-seven subjects were surveyed for the status of their physical urticaria at least 1 year after initial evaluation. RESULTS: Of the 76 subjects with a positive history of a physical urticaria, 38% (n = 29) were challenge negative to the presenting diagnosis. Eight subjects within the challenge negative group reacted positively to additional testing, thus 28% (n = 21) remained negative to all challenge testing, which allowed discontinuation of medications and avoidance behavior. A negative challenge result was less likely with subjects who presented with cold-induced urticaria (25%), delayed pressure urticaria (25%), and dermatographism (29%), yet more common with cholinergic (65%) and solar urticaria (67%). A 1-year follow-up survey of 57 subjects was consistent with initial results. Nineteen of this subgroup were rechallenged for the presenting diagnosis, and the outcome was unchanged in 17 subjects and, in 2 subjects the urticaria had resolved. CONCLUSIONS: The diagnosis by history of a physical urticaria should be verified by testing whenever possible and particularly if the condition is judged as severe and thus requires both significant life-style changes and pharmacologic intervention. Published by Elsevier Inc.
Authors: M Magerl; E Borzova; A Giménez-Arnau; C E H Grattan; F Lawlor; P Mathelier-Fusade; M Metz; A Młynek; M Maurer Journal: Allergy Date: 2009-09-30 Impact factor: 13.146
Authors: Joseph Meyer; Alexander M Gorbach; Wei-Min Liu; Nevenka Medic; Michael Young; Celeste Nelson; Sarah Arceo; Avanti Desai; Dean D Metcalfe; Hirsh D Komarow Journal: PLoS One Date: 2013-02-22 Impact factor: 3.240