ARTICLE
When physical urticaria tests were performed (dermographism, cholinergic
urticaria test, tests with pressure, cold or heat) our patient presented
an urticaria factitia. Hence, we established a diagnosis of urticaria
factitia triggered by negative pressure of suction disks in a patient
suffering, in addition, from chronic nonphysical urticaria.
In laboratory investigations only the antistreptolysin titre was increased
(384 IkU/l). The total IgE was within the normal range (53 IkU/l).
During his stay in hospital the patient developed numerous wheals. He
was treated with cetirizine 10 mg/day, and after 8 days we could reduce
the dosage to 5 mg/day. We chose cetirizine because it is described as
being adequate in treating urticaria factitia [1] as well as chronic
urticaria [2, 3].
Comments
In order to determine the nosological significance of this case, we
applied suction disks in three additional patients affected with urticaria
factitia. All of them developed wheals within the area of negative pressure.
This shows that urticaria factitia can be provoked by negative pressure
of suction disks.
Physical urticaria is found in 50% of all chronic forms of urticaria.
Urticaria factitia is the most frequent type of physical urticaria, and
it occurs at any age. The incidence ranges between 1.5 and 5%. A peak
of urticaria factitia is found between the ages of 20 and 30.
Patients with urticaria factitia complain about intermittent generalized
itching and chronic relapsing urticae. Wheals tend to arise predominantly
in mechanically affected parts of the skin (e.g., waist and groins).
The cause of urticaria factitia remains unknown in most cases. The disorder
can be initiated by drugs such as penicillin and be associated with other
forms of urticaria caused by parasitosis or occurring during pregnancy
or in areas of contact dermatitis, tattoos or insect bites [4]. The case
history may show stressful life events or acute infections of the upper
respiratory tract, as found in the present patient.
Chronic urticaria often constitutes a problem since a cause can be elucidated
in only 20-30% of the cases. There is a wide spectrum of possible triggering
factors.
Urticaria includes immunological and nonimmunological forms. Immunological
mechanisms are mediated by IgE and may involve responses to specific antigens,
biogenous amines [5], endogenous irritant agents, activation of complement
and the aquagenic urticaria.
Nonspecific release of histamine, intolerance reactions to drugs and
food additives, angioedema [6] and physical urticaria are categorized
as forms of nonimmunological urticaria.
Urticaria patients report a reduced quality of life [7], and for this
reason a careful diagnostic approach and appropriate therapy are necessary.
Article accepted on 25/10/99
REFERENCES
1. Henz BM, Zuberbier T, Grabbe J, Monroe E. Urticaria: clinical,
diagnostic and therapeutic aspects. Springer, Berlin 1998; 55-89.
2. Brenemann DL. Cetirizine versus hydroxyzine and placebo in
chronic idiopathic urticaria. Ann Pharmacother 1996; 30: 1075-9.
3. Tharb MD. Cetirizine: a new therapeutic alternative for chronic
urticaria. Cutis 1996; 58: 94-8.
4. Wong RC, Fairley JA, Ellis CN. Dermographisms: a review. J
Am Acad Dermatol 1984; 11: 643-52.
5. Amon U, Bangha E, Küster T, Menne A, Vollrath IB, Gibbs
BF. Enteral histaminosis: clinical implications. Inflamm Res 1999;
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6. Czarnetzki BM, Meentken J, Rosenbach T, Pokropp A. Clinical,
pharmacological and immunological aspects of delayed pressure urticaria.
Br J Dermatol 1984; 111: 315-23.
7. O'Donnell BF, Lawlor F, Simpson J, Morgan M, Greaves MW. The
impact of chronic urticaria on the quality of life. Br J Dermatol
1997; 136: 197-201.
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