Is there a possibility of patients presenting with chronic urticaria in those who had a mild atopic dermatitis in childhood?
There conditions are probably unrelated. Both are common and therefore will co-exist from time to time in the same patient.
I agree with Rodney in which concerns chronic urticaria that is a disease completely different than acute urticaria.
I think that acute urticaria is a disease of the spectrum of atopy. Otherwise, chronic urticaria is another disease that haven´t nothing or few relations with atopy.
I feel that both the conditions are the manifestations of the same disease process. I humbly disagree with Rodney Sinclair and Americo Figueiredo
Prof Criton
Prof Criton: it seems that you don´t complete your thinking - because ....?!
Definitely both conditions present in same time as both can be transducted by same Ag through epidermal growth Factor receptor EGFR as in case of H. Pylori infection. ( Bashir et al EdHpSm 2011 CRO).
Bashir AHH, MD
Dermatologist
Institute of endemic diseases, U of K
Because of the similarity of etiology and pathogenesis- at least to a great extent.
Criton
Acute and chronic urticaria seems to be the same.
However, an autoimmune phenomena, that of autoantibodies to the high affinity IgE receptor on basophils and mast cells, has been implicated as an important cause of chronic, idiopathic urticaria. Plasmapheresis - a modality that presumably removes autoantibodies - does have some beneficial effects in chronic urticaria patients that have these autoantibodies.
Autoimmunity to thyroid tissue has also been associated with urticaria. In fact, treatment with thyroid supplements in euthyroid individuals (who have elevated anti-thyroid peroxidase and/or anti-thyroglobulin antibodies) has been shown to be beneficial (Rumbyrt J, et al. J Allergy Clin Immunol 1995;96:901-5).
Urticaria results not only from sensitivity to antigens, but also from physical factors such as cold, heat, sunlight, water, pressure, and vibration. The underlying mechanisms are not well understood, but the final common pathway is believed to involve release of mediators by activated mast cells and basophilic leukocytes. These mediators increase vascular permeability, and plasma leaks into the dermis, resulting in urticarial wheals.
So chronic urtucaria seems to be not a "allergic" but a imunoinflammatory disease that we can see in some familiar and adquired rare syndromes like Schnitzler syndrome.
Chronic idiopathic urticaria,dermatitis,endcrinopathy all are known as autoimmune diseases genetically linked and could be associated and be manifested in the same patient I.e same underlying cause and this has been noticed in H.pylori as extra digestive manifestations (EdHpSm) Bashir et al CRO 2011.
The post by Americo is very interesting.
But I have lot of difference of opinion. I have been telling all throughout that acute urticaria and chronic urticaria are different. Ac. urticaria begins and ends as ac. urticaria itself; wheres chr urticaria is an entirely different disease. I can prove this by inviting your attention to the etiology, clinical features and the pathomechanism of both these entities. Even the end point or culmination of the reaction may be different; only time will prove. We are all carried away by the presence of weals which in my opinion is the only point of commonality of the two. If anybody is interested in this thought I am ready to part my views and hypothesis with them. Right now I don't have that infrastructure to prove my hypothesis.
I even propose another hypothesis: the frequent relapses are just like the acute -on-chronic exacerbation of chronic kidney disease. This hypothesis is also worth exploring.
Secondly the treatment with thyroid supplements as an adjutant to treatment for chr urticaria- based on that article I had treated a lot of patients with thyroid supplementation. Nothing had happened in 95% of the patients. Yes, the thyroid antibody may be detected in chr urticaria patient, but the response to treatment with supplementation is either poor or not at all. This is my personal experience; I haven't compiled the data.
A lot of difference of opinion ? You agree with me !!!
Only some patients with positive anti-thyroid antibodies respond to thyroid hormones. Try and see. And publish the results because is necessary for all.
Dr Americos, the very nature of chronic urticaria, which may or may not have a specific trigger, with minimal or absent relation to food, with time specificites in some, with cold or hot water or air in some, with minimal or no abnormal laboratory deviations of significance, but responsive to anti histamines,
why is the basophil or eosinophil sensitised,. what role does anxiety have a role in urticaria.
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