Urticaria classification: Difference between revisions

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Latest revision as of 17:20, 27 January 2021

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]
  - Chronic continuous: Involvement in every day or most days.
  - Chronic recurrent: There are symptom free intervals.

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:
  - Appearance of wheals 3-8 hours after a vertical pressure, which usually lasts for 8–48 hours.
  - Frequently seen on palms and soles, buttocks and back (sitting on a hard chair).
- 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)
  - Chemical substances contact (such as industrial chemicals, animal product, textiles, plants, drugs, cosmetics and food) with skin leads to urticaria appearance.
- 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.

Template:WH Template:WS

[pmid14616095-1] 1.0 ^1.1 Zuberbier T (2003). "Urticaria". Allergy. 58 (12): 1224–34. doi:10.1046/j.1398-9995.2003.00327.x. PMID 14616095.

[pmid30984191-2] 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.

[pmid10756214-3] Greaves M (2000). "Chronic urticaria". J Allergy Clin Immunol. 105 (4): 664–72. doi:10.1067/mai.2000.105706. PMID 10756214.

[pmid18713139-4] 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.

[pmid24404388-5] 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.

[pmid30574166-6] 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.

[pmid2576934-7] 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.

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@@ Line 1: / Line 1: @@
 __NOTOC__
 {{Urticaria}}
-{{CMG}}
+{{CMG}}; {{AE}} {{Anahita}}
+==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 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==
-*Acute urticaria
+[[Urticaria]] may be classified according to roles of triggers into two subtypes:
-*Chronic urticaria
-*Drug-induced urticaria
+=== [[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> ===
-*Physical urticarias are often categorized into the following.
-**[[Water urticaria|Aquagenic:]] Reaction to water (rare)
+**[[urticaria|'''Acute urticaria''']]: Spontaneous appearance of [[urticaria|wheals]], most days in a period less than 6 weeks.
-**[[Cholinergic urticaria|Cholinergic]]: Reaction to body heat, such as when [[Exercise urticaria|exercising]] or after a hot shower
+**[[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>
-**Cold ([[Chronic cold urticaria]]): Reaction to cold, such as ice, cold air or water
+***[[Chronic]] continuous: Involvement in every day or most days.
-**Delayed Pressure: Reaction to standing for long periods, bra-straps, panty or thong bands, belts
+***[[Chronic]] recurrent: There are [[symptom]] free intervals.
-**[[Dermatographic urticaria|Dermatographic]]: Reaction when skin is scratched (very common)
-**Heat: Reaction to hot food or objects (rare)
+===[[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>===
-**Solar: Reaction to direct sunlight (rare)
-**Vibration: Reaction to vibration (rare)
+**[[urticaria|'''Dermographic urticaria''']] ([[urticaria|factitial urticaria]]): Appearance of [[urticaria|wheals]] 1-5 minutes after a mechanical shearing force, which mainly involves young adults.
-**Adrenergic: Reaction to adrenaline / noradrenaline (extremely rare)
+**[[urticaria|'''Delayed pressure urticaria''']]:
+***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).
+**[[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.
+***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|'''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|'''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.
+**[[urticaria|'''Adrenergic urticaria''']]:
+***Elicited by [[Stress (medicine)|stress]]
+**[[urticaria|'''Aquagenic urticaria''']]
+***[[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]])
+***[[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''']] (such as [[urticaria|aspirin-intolerant chronic urticaria]] ([[urticaria|AICU]]))
+{{familytree/start |summary=Urticaria classification.}}
+{{familytree | | | | | | | | | | A01 | | | | |A01=[[Urticaria]]}}
+{{familytree | | | |,|-|-|-|-|-|-|^|-|-|-|-|-|-|-|.| | | | | | | | | | | | }}
+{{familytree | | | B01 | | | | | | | | | | | | | B02 | | | | |,|-| B03 | | |B01=Acute<br/>(Less than 6 weeks)|B02=Chronic<br/>(More than 6 weeks)|B03=[[urticaria|Dermographic urticaria]] ‡}}
+{{familytree | | | | | | | | | | | | | | | |,|-|-|^|-|-|.| | |!| | | | |}}
+{{familytree | | | | | | | | | | | | | | | C01 | | | | C02 |-|+|-| C03 | | | C01=Spontaneous<br/>(No identifiable trigger)|C02=Inducible<br/>(Identifiable trigger)|C03=[[urticaria|Delayed pressure urticaria]] ‡}}
+{{familytree | | | | | | | | | | | | | | | | | | | | | | | | |!| | | | |}}
+{{familytree | | | | | | | | | | | | | | | | | | | | | | | | |)|-| D01 | |D01=[[urticaria|Cold contact urticaria]] ‡}}
+{{familytree | | | | | | | | | | | | | | | | | | | | | | | | |!| | | |}}
+{{familytree | | | | | | | | | | | | | | | | | | | | | | | | |)|-| E01 | |E01=[[urticaria|Heat contact urticaria]] ‡}}
+{{familytree | | | | | | | | | | | | | | | | | | | | | | | | |!| | | |}}
+{{familytree | | | | | | | | | | | | | | | | | | | | | | | | |)|-| F01 | |F01=[[urticaria|Solar urticaria]] ‡}}
+{{familytree | | | | | | | | | | | | | | | | | | | | | | | | |!| | | |}}
+{{familytree | | | | | | | | | | | | | | | | | | | | | | | | |)|-| G01 | |G01=[[urticaria|Vibratory urticaria]] ‡}}
+{{familytree | | | | | | | | | | | | | | | | | | | | | | | | |!| | | |}}
+{{familytree | | | | | | | | | | | | | | | | | | | | | | | | |)|-| H01 | |H01=[[urticaria|Cholinergic urticaria]]}}
+{{familytree | | | | | | | | | | | | | | | | | | | | | | | | |!| | | |}}
+{{familytree | | | | | | | | | | | | | | | | | | | | | | | | |)|-| J01 | |J01=[[urticaria|Adrenergic urticaria]]}}
+{{familytree | | | | | | | | | | | | | | | | | | | | | | | | |!| | | |}}
+{{familytree | | | | | | | | | | | | | | | | | | | | | | | | |)|-| K01 | |K01=[[urticaria|Aquagenic urticaria]] ‡}}
+{{familytree | | | | | | | | | | | | | | | | | | | | | | | | |!| | | |}}
+{{familytree | | | | | | | | | | | | | | | | | | | | | | | | |)|-| L01 | |L01=[[urticaria|Contact urticaria]]}}
+{{familytree | | | | | | | | | | | | | | | | | | | | | | | | |!| | | |}}
+{{familytree | | | | | | | | | | | | | | | | | | | | | | | | |`|-| O01 | |O01=[[urticaria|Drug-induced urticaria]]}}
+{{familytree/end}}
+‡ Can also be classified as [[urticaria|physical urticaria]].
 ==References==
 {{Reflist|2}}
+{{WH}}
+{{WS}}
 [[Category:Dermatology]]
 [[Category:Allergology]]
 [[Category:Immunology]]
-[[Category:Emergency medicine]]
+[[Category: Emergency medicine]]
 [[Category:Disease]]
-[[Category:Needs overview]]
+[[Category: Needs overview]]
-[[Category:Primary care]]
-{{WH}}
-{{WS}}