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Urticaria

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13 Dermatographia Î Patients with dermatographia (also known as dermatographism, dermographia, and dermographism) promptly have a wheal-and-flare response to pressure applied to the skin. Dermatographia can be confirmed by stroking the skin with a firm object, such as a tongue blade. Dermatographia is the most common form of physical urticaria and reported to be present in 2%–5% of the general population, although only a minority of patients have symptoms to a degree that prompts medical attention. (B) Exercise-Induced Urticaria And Anaphylaxis (EIAN) Î Urticaria provoked by exercise can occur in patients with 2 conditions: cholinergic urticaria or EIAn. (B) Î There are 2 groups of patients with EIAn: one group can experience anaphylaxis provoked by exercise, and a second group can experience anaphylaxis with exercise temporally related to ingestion of food or medication. (C) Î Two subgroups of patients with food-dependent EIAn have been described: one group can experience anaphylaxis when exercising in temporal proximity to ingestion of any type of food, and another group can experience anaphylaxis with exercise in conjunction with prior ingestion of a specific food. (C) Î It is important to distinguish EIAn from cholinergic urticaria. The diagnosis of EIAn can be confirmed by means of exercise challenge in a controlled environment, whereas cholinergic urticaria can be elicited by means of both exercise challenge and passive heating. (C) Î Management depends on determining whether the patient has EIAn or cholinergic urticaria. If a food, drug, or another essential or modulating factor is identified, this should be avoided in the peri-exercise period. Patients with EIAn should carry injectable epinephrine, exercise with a partner, and wear medical identification jewelry. (D) Solar Urticaria Î Patients with solar urticaria promptly (generally within 1–3 minutes) experience urticaria with exposure of the skin to sunlight. (B) Î The diagnosis of solar urticaria can be confirmed with phototesting to various wavelengths of light. (B) Vibratory Angioedema Î Patients with vibratory angioedema experience pruritus and swelling with exposure of the skin to a vibratory stimulus. This condition can be familial. (B) Î Vibratory angioedema can be confirmed by demonstrating an exaggerated response after exposure of the skin to a vortex mixer. (B)

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