Dermatologic Emergencies

dermatology-emergencieskapak-1-0-25

Urticaria and Angioedema

Alp ŞENER
Ankara Bilkent City Hospital, Clinic of Emergency Medicine, Ankara, Türkiye

Reyhan İrem MUTLU
Ankara Bilkent City Hospital, Clinic of Emergency Medicine, Ankara, Türkiye

Şener A, Mutlu Rİ. Urticaria and angioedema. In: Oğuztürk H, Görmeli Kurt N, eds. Dermatologic Emergencies. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.5-10.

ABSTRACT Urticaria is an inflammatory skin condition primarily driven by the release of histamine and other mediators within the skin, manifesting through both immunologic and non-immunologic pathways. Its hallmark presentation includes erythematous, pruritic raised plaques of varying sizes. Angioedema, in contrast, involves swelling of submucosal tissues due to increased vascular permeability and vasodilation. Both urticaria and angioedema are prevalent conditions across different populations, with no specific predilection for age, gender, or ethnicity. While numerous factors can trigger urticaria, the underlying etiology often remains unidentified in many cases. Angioedema develops through two distinct mechanisms. The first is his- tamine-mediated, often occurring alongside urticaria, while the second involves bradykinin. The formation of urticaria is facilitated by mast cells and basophils. In the emergency department setting, the diagnosis of both angioedema and urticaria is primarily clinical, and diagnostic tests are typically unnecessary. In cases of angioedema, particularly when associated with urticaria, immediate concerns should focus on anaphylactic shock and airway management. Histamine-mediated angioedema should be treated similarly to anaphylaxis, with adrenaline as the mainstay of therapy, supplemented by antihistamines and corticosteroids.

Keywords: Angioedema; edema; pruritus; urticaria; allergy and immunology; emergency medicine

Referanslar

  1. Grattan C. The urticarias: pathophysiology and management. Clin Med (Lond). 2012;12(2):164-7. [Crossref]  [PubMed]  [PMC]
  2. Ensina LF, Min TK, Félix MMR, de Alcântara CT, Costa C. Acute Urticaria and Anaphylaxis: Differences and Similarities in Clinical Management. Front Allergy. 2022;3:840999. [Crossref]  [PubMed]  [PMC]
  3. Antia C, Baquerizo K, Korman A, Bernstein JA, Alikhan A. Urticaria: A comprehensive review: Epidemiology, diagnosis, and work-up. J Am Acad Dermatol. 2018;79(4):599-614. [Crossref]  [PubMed]
  4. Moellman JJ, Bernstein JA, Lindsell C, Banerji A, Busse PJ, Camargo CA Jr, et al. A consensus parameter for the evaluation and management of angioedema in the emergency department. Acad Emerg Med. 2014;21(4):469-84. [Crossref]  [PubMed]  [PMC]
  5. LoVerde D, Files DC, Krishnaswamy G. Angioedema. Crit Care Med. 2017;45(4):725-35. [Crossref]  [PubMed]
  6. Guo C, Saltoun C. Urticaria and angioedema. Allergy Asthma Proc. 2019;40(6):437-40. [Crossref]  [PubMed]
  7. Long BJ, Koyfman A, Gottlieb M. Evaluation and Management of Angioedema in the Emergency Department. West J Emerg Med. 2019;20(4):587-600. [Crossref]  [PubMed]  [PMC]
  8. Confino-Cohen R, Chodick G, Shalev V, Leshno M, Kimhi O, Goldberg A. Chronic urticaria and autoimmunity: associations found in a large population study. J Allergy Clin Immunol. 2012;129(5):1307-13. [Crossref]  [PubMed]
  9. Ying S, Kikuchi Y, Meng Q, Kay AB, Kaplan AP. TH1/TH2 cytokines and inflammatory cells in skin biopsy specimens from patients with chronic idiopathic urticaria: comparison with the allergen-induced late-phase cutaneous reaction. J Allergy Clin Immunol. 2002;109(4):694-700. [Crossref]  [PubMed]
  10. Morgan BP. Hereditary angioedema--therapies old and new. N Engl J Med. 2010;363(6):581-3. Erratum in: N Engl J Med. 2010;363(27):2673. [Crossref]  [PubMed]
  11. Kocatürk Göncü E, Aktan Ş, Atakan N, Bülbül Başkan E, Erdem T, Koca R, et al. The Turkish Guideline for the Diagnosis and Management of Urticaria2016. Turkderm-Turk Arch Dermatol Venereol. 2016;50(3):82-98. [Crossref]
  12. Nowicki RJ, Grubska-Suchanek E, Porêbski G, Kowalski ML, Jahnz-Różyk K, Matuszewski T, et al. Angioedema. Interdisciplinary diagnostic and therapeutic recommendations of the Polish Dermatological Society (PTD) and Polish Society of Allergology (PTA). Postepy Dermatol Alergol. 2020;37(4):445-51. [Crossref]  [PubMed]  [PMC]
  13. Dass C, Mahaffa M, Dang E, Campbell R, Ballas Z, Lee S. Evaluation of staging criteria for disposition and airway intervention in emergency department angioedema patients. Acute Med Surg. 2021;8(1):e704. [Crossref]  [PubMed]  [PMC]
  14. Weiler CR, Schrijvers R, Golden DBK. Anaphylaxis: Advances in the Past 10 Years. J Allergy Clin Immunol Pract. 2023;11(1):51-62. [Crossref]  [PubMed]
  15. Kanani A, Betschel SD, Warrington R. Urticaria and angioedema. Allergy Asthma Clin Immunol. 2018;14(Suppl 2):59. [Crossref]  [PubMed]  [PMC]
  16. Griesdale DE, Liu D, McKinney J, Choi PT. Glidescope® video-laryngoscopy versus direct laryngoscopy for endotracheal intubation: a systematic review and meta-analysis. Can J Anaesth. 2012;59(1):41-52. [Crossref]  [PubMed]  [PMC]