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Physical urticaria is a condition in which red (erythematous) allergic skin lesions and itching (pruritus) are produced by exposure to heat, cold, or contact with chemicals or plants. These are called wheals by the medical community and may range in size from a couple of millimeters to a couple of centimeters. The center of the lesion may range in color from white to red, and it is usually surrounded by a flare of red skin. The disorder occurs most commonly in children.
The most common symptoms of physical urticaria are itching (pruritus) and hives consisting of red rings around white ridges (wheals). Sensitivity to cold is usually manifested by these eruptions on the skin, itching, and swelling under the skin (angioedema). These symptoms develop most typically after exposure to cold is terminated and during or after swimming or bathing. Contraction of the muscles around the bronchi (bronchospasm) and even histamine-mediated shock may occur in extreme cases. If this happens during swimming, drowning may present a danger.
Sensitivity to cold can be passively transferred with serum that contains a specific immunoglobulin (IgE) antibody, suggesting an allergic reaction involving a physically altered skin protein as the cause of the allergic reaction. The serum of a few patients with cold-induced symptoms of physical urticaria contains cryoglobulins or cryofibrinogen, these abnormal proteins can also be associated with a serious underlying disorder such as a malignancy, a collagen vascular disease, or chronic infection. Cold may aggravate asthma or vasomotor rhinitis, but cold urticaria is independent of any other known allergic tendencies.
Dermatographia, dermographism, or autographism describes welts or wheels produced by scratching or firmly stroking the skin. According to some dermatologists, dermographism is the most common form of physical urticaria. This sign can appear quite suddenly and may become apparent in hot weather or after a hot shower or bath. Occasionally it is the first sign of an urticarial drug reaction. Physical urticaria has also occurred following persistent vibration of the skin, and even after exposure to water (aquagenic urticaria).
The underlying cause of physical urticaria is unknown in most cases. Some clinicians believe that an auto-immunological process is responsible.
Cold urticaria occurs most often in infants, although it sometimes occurs in adults.
The patient history and physical examination are the tools most often used to diagnose physical urticaria. If there is a history of reactions to physical triggers, the diagnosis may be confirmed with a challenge. The challenge is the application of the suspected agent, for example ice or light, to the skin, in hope of getting a response.
Treatment
Protection from and avoidance of the physical cause of the reaction is necessary. Symptoms such as itching and swelling can usually be relieved with an oral antihistamine. The more powerful systematic (intravenous) corticosteroids should be avoided unless they are vital.
Information on current clinical trials is posted on the Internet at www.clinicaltrials.gov. All studies receiving U.S. government funding, and some supported by private industry, are posted on this government web site.
For information about clinical trials being conducted at the NIH Clinical Center in Bethesda, MD, contact the NIH Patient Recruitment Office:
Tollfree: (800) 411-1222
TTY: (866) 411-1010
Email: prpl@cc.nih.gov
For information about clinical trials sponsored by private sources, contact:
www.centerwatch.com
TEXTBOOKS
Beers MH, Berkow R., ed. The Merck Manual, 17th ed. Whitehouse Station, NJ: Merck Research Laboratories; 1999:1054-57, 1057.
Berkow R., ed. The Merck Manual-Home Edition.2nd ed. Whitehouse Station, NJ: Merck Research Laboratories; 2003:1071-72.
Champion RH, Burton JL, Ebling FJG. eds. Textbook of Dermatology. 5th ed. Blackwell Scientific Publications. London, UK; 1992:1873-76.
REVIEW ARTICLES
Kozel MM, Sabroe RA. Chronic urticaria: aetiology, management and current and future treatment options. Drugs. 2004;64:2515-36.
Wanderer AA, Hoffman HM. The spectrum of acquired and familial cold-induced urticaria/urticaria-like syndromes. Immunol Allergy Clin North Am. 2004;24:259-86, vii.
Lawlor F, Black AK. Delayed pressure urticaria. Immunol Allergy Clin North Am. 2004;24:247-58, vi-vii.
Dice JP. Physical urticaria. Immunol Allergy Clin North Am. 2004;24:225-46, vi.
Yashar SS, lim HW. Classification and evaluation of the photodermatoses. Dermatol Ther. 2003;16:1-7.
Brooks C, Kujawska A, Patel D. Cutaneous allergic reactions induced by sporting activities. Sports Med. 2003;33:699-708.
Muller BA. A comprehensive review of physical urticaria. Compr Ther. 2002;28:214-21.
FROM THE INTERNET
Strachan DD. Urticaria, Chronic. Last Updated: March 31, 2005. 15pp.
www.emedicine.com/DERM/topic443.htm
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