Etiological causes in patients with acute urticaria and angioedema: A cross-sectional study
Main Article Content
Keywords
Angioedema, allergens, exacerbation, symptom, urticaria, blood tests
Abstract
Background: Acute urticaria and angioedema are emergency dermatological conditions associated with various etiologic factors.
Objective: To determine the etiological causes in patients with acute urticaria and angioedema, and to investigate whether more than one etiological cause was present, along with the patients’ laboratory values.
Methods: The study was conducted in a tertiary hospital with one center. Etiological causes and laboratory parameters in 284 patients diagnosed with acute urticaria and angioedema were retrospectively studied.
Results: A total of 284 patients were included in the study. The mean age of the patients was 42.7 ± 15.6 years, where 163 (57.4%) were women and 121 (42.6%) were men. Acute urticaria and angioedema occurred together in 149 (52.5%) patients. At least one precipitating factor among the predisposing risk factors was present in 220 (77.5%) patients, and more than one precipitating factor was found in 51 (18%) patients. Medication use was found in 157 (55.3%) patients and infection in 54 (19%). The development of urticaria after food consumption was noted in nine (3.2%) individuals. A history of infection and medication intake was present in 50 (17.6%) patients. A joint history of food consumption and medication intake was present in only one patient. Elevated C-reactive protein level was found in 178 (62.7%) patients and elevated anti-streptolysin O titer in 41 (14.4%) patients. Vitamin B12 deficiency was found in 116 (40.8%) patients and vitamin D deficiency in 254 (89.4%).
Conclusion: Acute urticaria and angioedema may occur as a result of multiple etiological factors, in which different triggers may be present simultaneously.
References
2. Gaig P, Olona M, Muñoz Lejarazu D, Caballero MT, Domínguez FJ, Echechipia S, et al. Epidemiology of urticaria in Spain. J Investig J Investig Allergol Clin Immunol. 2004;14(3):214–20.
3. Ferrer M. Epidemiology, healthcare, resources, use and clinical features of different types of urticaria. J Investig Allergol Clin Immunol. 2009;19(2):21–6.
4. Kulthanan K, Chiawsirikajorn Y, Jiamton S. Acute urticaria: Etiologies, clinical course and quality of life. Asian Pac J Allergy Immunol. 2008;26:1–9.
5. Stevens W, Buchheit K, Cahill KN. Aspirin-exacerbated diseases: Advances in asthma with nasal polyposis, urticaria angioedema, and anaphylaxis. Curr Allergy Asthma Rep. 2015;15:69. 10.1007/s11882-015-0569-2
6. Sánchez-Borges M, Capriles-Hulet, A, Caballero-Fonseca F. Demographic and clinical profiles in patients with acute urticaria. Allergol Immunopathol. 2015;43(4):409–15. 10.1016/j.aller.2014.04.010
7. Köse Ş, Senger SS, Çavdar G. Focal infections accompanying urticaria, a common skin disease. KLIMIK Derg. 2011;24(2):98–100. 10.5152/kd.2011.23
8. Losappio L, Heffler E, Bussolino C, Cannito CD, Carpentiere R, Raie A, et al. Acute urticaria presenting in the emergency room of a general hospital. Eur J Intern Med. 2014;25:147–50. 10.1016/j.ejim.2013.11.003
9. Frigas E, Park MA. Acute urticaria and angioedema: Diagnostic and treatment considerations. Am J Clin Dermatol. 2009;10(4):239–50. 10.2165/00128071-200910040-00004
10. Bernstein JA, Lang DM, Khan DA, Craig T, Dreyfus D, Hsieh F, et al. The diagnosis and management of acute and chronic urticarial. J Allergy Clin Immunol. 2014;133(5):1270–7. 10.1016/j.jaci.2014.02.036
11. Sabroe RA. Acute urticaria. Immunol Allergy Clin North Am. 2014;34(1):11–21. 10.1016/j.iac.2013.07.010
12. Karadağ AS, Bilgili SG, Calka Ö, Akdeniz N, Özkol HU, Aktar, S. Clinical evaluation of inpatients with acute urticaria. Türkderm Arch Skin Dis Syphilis. 2011;45(4):179–83. 10.4274/turkderm.82653
13. Frigas E, Park MA, Narr BJ, Volcheck GW, Danielson DR, Markus PJ, et al. Preoperative evaluation of patients with history of allergy to penicillin: Comparison of 2 models of practice. Mayo Clin Proc. 2008;83(6):651–57. 10.4065/83.6.651
14. Kowalski ML, Woessner K, Sanak M. Approaches to the diagnosis and management of patients with a history of nonsteroidal anti-inflammatory drug-related urticaria and angioedema. J Allergy Clin Immunol. 2015;136:245–51. 10.1016/j.jaci.2015.06.021
15. Dona I, Blanca-Lopez N, Cornejo-Garcia JA, Torres MJ, Laguna JJ, Fernandez J, et al. Characteristics of subjects experiencing hypersensitivity to non-steroidal anti-inflammatory drugs: Pattern of response. Clin Exp Allergy. 2011;41(1):86–95. 10.1111/j.1365-2222.2010.03651.x
16. Brennan R, Wazaify M, Shawabkeh H, Boardley I, McVeigh J, Van Hout MC. A scoping review of non-medical and extra-medical use of non-steroidal anti-inflammatory drugs (NSAIDs). Drug Saf. 2021;44:917–28. 10.1007/s40264-021-01085-9
17. Bush K, Bradford PA. β-lactams and β-lactamase inhibitors: An overview. Cold Spring Harb Perspect Med. 2016;6(8):a025247. 10.1101/cshperspect.a025247
18. Minaldi E, Phillips EJ, Norton A. Immediate and delayed hypersensitivity reactions to beta-lactam Antibiotics. Clin Rev Allergy Immunol. 2022 Jun;62(3):449–462. 10.1007/s12016-021-08903-z
19. Solensky R. Hypersensitivity reactions to betalactam antibiotics. Clin Rev Allergy Immunol. 2003;24:201–20. 10.1385/CRIAI:24:3:201
20. Minciullo PL, Cascio A, Barberi G, Sebastiano G. Urticaria and bacterial infections. Allergy Asthma Proc. 2014;35(4):295–302. 10.2500/aap.2014.35.3764
21. Zuberbier T. Urticaria. Allergy. 2003;58:1224–34. 10.1046/j.1398-9995.2003.00327.x
22. Aldehaim AY, Alnegheimish NA, Fathaddin AA. Refractory urticaria with raised antistreptolysin O (ASO) titer: An intriguing case of adult-onset Still’s disease. Am J Case Rep. 2020;21:e927936. 10.12659/AJCR.92793
23. Wheatley C. A scarlet pimpernel for the resolution of inflammation? The role of supra-therapeutic doses of cobalamin, in the treatment of systemic inflammatory response syndrome (SIRS), sepsis, severe sepsis, and septic or traumatic shock. Med Hypotheses. 2006;67(1):124–42. 10.1016/j.mehy.2006.01.036
24. Charoenngam N, Holick MF. Immunologic effects of vitamin D on human health and disease. Nutrients. 2020;12(7):2097. 10.3390/nu12072097
25. Baeke F, Korf H, Overbergh L, Van Etten E, Verstuyf A, Gysemans C, et al. Human T lymphocytes are direct targets of 1,25-dihydroxy vitamin D3 in the immune system. J Steroid Biochem Mol Biol. 2010;121:221–7. 10.1016/j.jsbmb.2010.03.037
26. Özdemir B, Köksal BT, Karakaş NM, Özbek OY. Serum vitamin D levels decrease in children with acute urticaria. Allergol Immunopathol (Madr). 2016;44(6):512–16. 10.1016/j.aller.2016.04.007
27. Yeşiltepe-Mutlu G, Aksu ED, Bereket A, Hatun Ş. Vitamin D status across age groups in Turkey: Results of 108,742 samples from a single laboratory. J Clin Res Pediatr Endocrinol. 2020;12(3):248–55. 10.4274/jcrpe.galenos.2019.2019.0097