Being co-chair on the Dermatology Topic Advisory Group for the new edition of the International Classification of Diseases (ICD) I would like to approach the expert community. We are still updating some of the major skin disease with respect to optimal classifications. What would you regard the most sensible classification of urticaria ?
It should be simple.
Clinically:Allergic and Non-Allergic. Avoid Chronic and Acute
Histopathologically:Neutrophilic, Lymphocitic and Mixed with eosinophils.
Example:Cholinergic urticaria is neutrophilic.
Acute, physical and chronic were and still the most accepted classification although in my opnion physical should be considered as exacerbating or provocative not more and acute and chronic are just lmmunogenetic expression for gene transduction.
"EAACI/GA2LEN/EDF/WAO guideline: definition, classification and diagnosis of urticaria" published on Allergy 2009, 64: 1417-26 are quite good and practical for urticaria classification. They have been written by the best experts in dermatolgy and allergy (as the professor Clive Grattan , for instance..)
A classification based on onset, progress, distribution, time of occurrence, associations, aggravations, intensity, duration. age of onset.
recurrent, sustained satus urticaria like status epilepsy,
histopathological findings, vascultis, cell of prominence,
the present classification of urticarial is good but further findings like association to helicobacterium which is gaining importance or an Id reaction as sub classification would help.
Though im not an expert I wish that naming a disease must be complete so that we don't miss any factor that causes urtcaria.
Recently a boy hd developed urticarial due to pesticide spraying which was overlooked. the classification with an algorithm will help better.
Dear Venkata as you mentioned in your comment the finding of possible underlying
cause as proved to be H. Pylori as antigenic to immune response to urticaria should be taken in consideration in the classification.
Acute or chronic,intermittent or continuous,Primary(idiopathic)or secondary,allergic or non allergic,vasculitic or non vasculitic,
it may be worthwhile to include syndromic or non syndromic also.
These are not suggestions of an expert but some one who is in clinical practice with patients and tried to answer their queries regarding the aetiologies of the disease and correlate with their clinical presentations.Auto immune urticaria should be included as a subset of primary or secondary is still a dilema
Clinically many ask why has this come, will it not go. There is a need to answer them and also know for sure why urticarial has come.
The most common Idiopathic or chronic recurrent urticaria, understanding this disorder as either an association or coexisting disorder, or a marker of something external, internal or immunological would help both the patient and the doctor.
One of the most tough and testing task for a doctor would be to ask questions and take a detailed history from the time of onset.
Many patients would be very hesitant to answer such questions and therefore an exhaustive written questionnaire will be helpful.
I would be glad to inform that one of my client who had urticaria while exercising was able to win a running race without getting urticaria.
I cherish those moments
Dear all, thank you very much for your helpful comments.
I would like to introduce you to the current suggestion for the ICD-11 revision process:
FA60 Spontaneous urticaria
FA60.1 Acute urticaria
FA60.2 Chronic urticaria
FA61 Physical urticaria and angioedema
*** Vibratory angioedema
FA62 Cholinergic urticaria and related conditions
FA63 Contact urticaria
FA64 Angioedema due to disordered complement activation and kinin metabolism
*** Syndromes with urticarial reactions or angioedema
*** Miscellaneous urticarial disorders
FA6Y Other specified urticarial disorders
FN32 Drug-induced urticaria, angioedema and anaphylaxis
Everyone can also have a closer look on
http://apps.who.int/classifications/icd11/browse/f/en
. As Gianfranco mentions the current proposal is derived from the published consensus. Most experts agree that from a clinical viewpoint the distinction acute - chronic is helpful.
Any specific comments on this draft proposal ?
Dear Weichenthal and colleagues it was a real fruitful discussion I myself realy enjoyed and pocces recent and advanced knowledges regards for all.
Urticaria is traditionally classified into acute and
chronic, but classification by disease duration is of limited value, but an exogenous cause is more likely to be found in acute urticaria than in chronic
urticaria. classification based on clinical features and trigger
factors is convenient.
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