11
Physical Urticaria and Angioedema
In a subgroup of patients a tendency exists to have urticaria, angioedema, or both as a result
of the effect of environmental stimuli on inflammatory cells predisposed to respond to
these factors. Patients can present with isolated physical urticaria/angioedema (Table 3)
syndromes or a combination of syndromes but might also have concomitant chronic
idiopathic urticaria (CIU).
Table 3. Challenge Procedures for Physical Urticaria/
Angioedema Syndromes
Syndrome Challenge procedure Positive result
Aquagenic Water compress at 35°C
applied to skin of upper
body for 30 min
Urticaria at challenge site
Cholinergic Immersion with hot
water (42°C), exercise, or
methacholine intradermal
challenge
Appearance of ''satellite wheal,''
which is defined as development
of pinpoint pruritic wheals with
surrounding erythema
Dermatographia Stroking of skin with tongue
blade
Erythematous wheal formation at
site of stroking within 1–3 min
Delayed pressure Fieen pounds hung over
shoulder for 10 or 15 min
Area of angioedema 4–12 h later
(peak = 8-9 h)
Vibratory Vortex mixer applied to
forearm for 4 min
Development of angioedema
sharply demarcated from normal
skin
Cold Cold provocation testing
(e.g., ice cube) on forearm
for 5 min
Development of urticaria at
challenge site during rewarming
of skin
Solar Exposure to specific
wavelengths of light
Urticaria at challenge site
Exercise induced Treadmill challenge Symptoms reflecting systemic
mediator release, such as pruritus,
urticaria, and angioedema
Aquagenic Urticaria
Î Aquagenic urticaria is a rare condition. Patients with aquagenic
urticaria have hives (typically 1–3 mm in size) after direct contact of
skin with any source of water independent of temperature. Aquagenic
urticaria can be confirmed by the appearance of wheals at the site of
challenge with a water compress at 35°C applied to the skin of the
upper body for 30 minutes. (C)
