fibrin and Urticaria

Topics: Capillary Permeability; Endothelium; Fibrin; Fibrin Fibrinogen Degradation Products; Fibrinolysin; Fibrinolysis; Heparin; Histamine; Humans; Hyaluronoglucosaminidase; Mast Cells; Protease Inhibitors; Skin; Urticaria

Topics: Adult; Aged; Biopsy; Blood Cell Count; Cetirizine; Complement System Proteins; Female; Fibrin; Fluorescent Antibody Technique; Histamine H1 Antagonists; Humans; Hydroxyzine; Immunoglobulins; Male; Middle Aged; Pressure; Skin; Urticaria

Normocomplementemic urticarial vasculitis is a rare autoimmune disorder characterized by leukocytoclasia, fibrin deposits, and extravasated erythrocytes affecting multiple organ systems. Current treatment modalities, including corticosteroids and immunosuppressive agents, are of limited efficacy and an expansive side effect profile. Omalizumab has been reported to be effective in urticarial vasculitis, but its long-term effectiveness and tolerability have not yet been evaluated. We report a case of long-standing normocomplementemic urticarial vasculitis treated with omalizumab only, for almost 3 years. The patient reported a significant improvement in quality of life after the first few doses with a significant improvement in the urticaria control test. The treatment was well tolerated and no adverse events were reported after 3 years. Our patient was treated with 300 mg of omalizumab, as it was previously linked with a better improvement in quality of life. We were able to extend our patient’s treatment intervals, suggesting that this is feasible in patients treated with omalizumab who achieve a complete response. We recommend that larger and long-term studies are conducted to assess the efficacy and effectiveness of omalizumab in patients with urticarial vasculitis. J Drugs Dermatol. 2022;21(10):1124-1126. doi:10.36849/JDD.6739.

Topics: Adrenal Cortex Hormones; Fibrin; Humans; Immunosuppressive Agents; Omalizumab; Quality of Life; Urticaria; Vasculitis

Pemphigoid gestationis is a rare autoimmune blistering disease of pregnancy. It is characterized by pruritic, urticarial plaques with the development of tense vesicles and bullae within the lesions. Pemphigoid gestationis has been associated with premature delivery, small-for-gestational-age infants. Recurrences with subsequent pregnancies are often more severe. Oral glucocorticoids are the mainstay of therapy. Differentiation of pemphigoid gestationis from pruritic urticarial papules and plaques of pregnancy is essential because management and outcomes differ. In instances in which clinical diagnosis is difficult, direct immunofluorescence tests, immunoblots, or ELISA studies of anti-basement-membrane zone antibodies are useful in establishing the diagnosis.

Topics: Adult; Autoimmune Diseases; Basement Membrane; Complement C3; Diphenhydramine; Eosinophils; Female; Fibrin; Humans; Immunoglobulin G; Infant, Newborn; Lymphocytes; Male; Pemphigoid Gestationis; Prednisone; Pregnancy; Skin Diseases, Vesiculobullous; Treatment Outcome; Triamcinolone; Urticaria

Fifteen cases with suspected urticarial vasculitis which were seen during the last ten years at the Department of Dermatology in Hamburg were reviewed. The cases were reevaluated after strict formulation of criteria for vasculitis (fibrin in and around small vessels, leukocytoclasis of neutrophilic granulocytes, extravasation of erythrocytes) and discussed in the context of the international literature on urticarial vasculitis. The conclusion of our study is that urticarial vasculitis is often overdiagnosed clinically if persistent urticarial lesions occur that show some erythematous changes or a hint of hemorrhage. Furthermore, urticarial vasculitis is often overdiagnosed histopathologically because some cases of urticaria were found that presented with heavy infiltration of small vessel walls with neutrophilic granulocytes. In these cases extravasation of erythrocytes, fibrin in and around vessels and leukocytoclasis is always absent. In summary urticarial vasculitis seems to be a variation of leukocytoclastic vasculitis with less extravasation of erythrocytes and not, as frequently stated, and entity of its own.

Topics: Diagnosis, Differential; Fibrin; Humans; Retrospective Studies; Skin; Urticaria; Vasculitis

Topics: Adult; Animals; Cattle; Dermatitis, Contact; Dyspnea; Female; Fibrin; Humans; Tooth Extraction; Urticaria

A 33-year-old female patient with acquired cold urticaria, together with her 8-year-old healthy daughter, was subjected to a brief period of cold exposure. The effect of this treatment upon a number of key factors of the plasma coagulation, kallikrein and complement systems was investigated. Cold air provocation caused increased fibrinolysis, together with a measurable consumption of the protease inhibitors alpha1-antitrypsin (alpha1AT), alpha2-macroglobulin (alpha2M) and C1Inactivator (C1INA). Kaolin activation of the patient's plasma elaborated exceptionally high levels of esterolytic activity, both before and after cold exposure, indicating pre-enzyme lability. Both subjects had abnormally high serum ratios alpha2M/alpha AT. Impressive leucocytosis was observed in the symptomless child.

Topics: Adult; Child; Cold Temperature; Complement System Proteins; Esterases; Female; Fibrin; Fibrinogen; Humans; Kallikreins; Macroglobulins; Thrombin; Trypsin Inhibitors; Urticaria

Topics: Complement System Proteins; Cryoglobulins; Fibrin; Fluorescent Antibody Technique; Humans; Immunoelectrophoresis; Immunoglobulin G; Immunoglobulin M; Immunoglobulins; Inflammation; Purpura; Skin; Urticaria; Vascular Diseases

Topics: Acetylcholine; Biopsy; Bradykinin; Burns; Capillary Permeability; Complement System Proteins; Edema; Epithelium; Fibrin; Fibrinolysis; Fluorescent Antibody Technique; Globulins; Histamine; Histological Techniques; Humans; Hypertrophy; Inflammation; Kallikreins; Leukocytes; Plasminogen; Serotonin; Skin; Time Factors; Urticaria

Topics: Blister; Cantharidin; Chronic Disease; Female; Fibrin; Fibrinogen; Fibrinolysin; Fibrinolysis; Humans; Male; Prothrombin; Thrombin; Urticaria

Topics: Allergens; Body Fluids; Fibrin; Histamine; Humans; Hypersensitivity; Immune System Diseases; Urticaria