Successful treatment of delayed pressure urticaria with montelukast – berkun – 2000 – allergy – wiley online library infant hives treatment

D elayed pressure urticaria (DPU) is a type of physical urticaria, characterized by the appearance of painful skin swelling a few hours after application of mechanical pressure. Hives lung cancer It may be accompanied by systemic signs. What causes hives in horses Most patients also suffer from chronic idiopathic urticaria ( 1). Treating hives in horses Antihistamines are not very effective in the treatment of this disorder.


Hives and rashes Most patients usually require corticosteroids for prolonged periods and frequently developundesirableside-effects from these medications.

In this report, we present a patient with severe steroid-dependent DPU which responded to the new antileukotriene agent montelukast (Singulair ®). Hives causes Steroid treatment was subsequently discontinued.

A 45-year-old nurse without an atopic history was healthy until 1992. Remedies for hives on face During her first pregnancy, she had developed deep, erythematous swellings of skin on pressure areas, sometimes accompanied by fever and arthralgia. Hives from stress on arms She also noticed urticarial eruptions on various areas. Hives disease symptoms Skin lesions were not associated with food ingestion. Stress symptoms hives Extensive laboratory evaluation was unremarkable. Allergies that cause hives Skin prick tests with aeroallergens and foods were negative. Hives in dogs causes The standard pressure challenge test performed on her arm was strongly positive. Hives fever toddler After the diagnosis of DPU was established, she was treated with maximal doses of several antihistaminic agents, including ketotifen, with minimal or transient improvement.

Various combinations of H 1 and H 2 blockers, doxepin, sulfasalazine, tranexamic acid, and colchicine did not improve her condition. Cure for hives itching An elimination diet for 14 days was ineffective. Chronic hives caused by stress For the next 3 years, she was treated with monthly betamethazone dipropionate injections and 10–30 mg of cetirizine daily, combined with other antihistamines. Recurring hives causes Repeated trials to discontinue steroid treatment resulted in immediate exacerbation of pressure urticaria. Itchy hives treatment The patient developed side-effects of chronic steroid therapy, including weight gain, facial acne, and flushing.

As a last resort, montelukast 10 mg a day was initiated. Hives remedy natural Within 1 week, the urticaria completely resolved. Hives hiv Steroid treatment was tapered off and discontinued with no recurrence of DPU for the following 20 months. Medication for hives urticaria Repeated pressure challenge tests were negative. Hives on torso child A brief trial to discontinue montelukast resulted in recurrence of urticaria within 3 days. Urticaria and hives The patient is currently treated with montelukast and cetirizine, 10 mg daily, without suffering any skin lesions.

DPU is a type of physical urticaria, more common than previously thought. Baby hives around mouth In addition, up to 50% of patient with chronic idiopathic urticaria have a pressure component. Physical hives The pathogenesis of DPU is unknown. Types of hives bee The late appearance and prolonged duration of lesions, the associated systemic manifestations, and the poor response to antihistamines are not consistent with the early phase of immediate-type hypersensitivity reaction. The hives discography These features are more characteristic of the late-phase reaction, in which inflammatory cells and mediators play major role. Allergic reaction hives Cysteinyl leukotrienes (LTC 4, LTD 4, and LTE 4) are potent inflammatory mediators, produced by activated mast cells, basophils, and eosinophils, and in lesser amounts by monocytes, endothelial cells, and platelets. Treatment hives rash These mediators are smooth-muscle contractors and eosinophil chemoattractants. Treatment for hives all over body Intradermal injection of leukotrienes induces wheal and flare reactions ( 2). Itchy red hives Increased levels of LTE 4, the stable metabolite of LTC 4, and LTB 4 were found in cold urticaria patients ( 3). Hives condition However, the role of leukotrienes in the pathogenesis of DPU has not been elucidated. Mild hives The effect of leukotriene inhibitors, the new class of medication for asthma treatment, in urticaria patients has not been extensively studied. What is hives in spanish Chu et al. Pregnancy hives third trimester reported improvement in eight patients with chronic urticaria treated with zafirlukast ( 4). Hives with no other symptoms Another patient responding to the same medication was described by Spector & Tan ( 5). Hives that last for weeks Three more patients with chronic urticaria were successfully treated with zileuton ( 5, 6).

The patient reported herein is the first case of successful treatment of DPU with the new leukotriene antagonist, montelukast. What causes hives under the skin The late appearance of skin lesions in DPU, the lack of response to antihistamines, and the favorable response to montelukast may reflect the involvement of leukotrienes in the pathogenesis of this disorder. Types of hives pictures Further studies to elucidate the role of antileukotrienes in DPU and chronic urticaria are required. Allergies that cause hives and itching Footnotes

• 2 Maxwell DL, Atkinson BA, Spur BW, Lessof MH, Lee TH. Itchy bumps all over body not red Skin responses to intradermal histamine and leukotrienes C 4, D 4, and E 4 in patients with chronic idiopathic urticaria and in normal subjects. Causes of hives in women J Allergy Clin Immunol 1990; 86: 759 765.

• 4 Chu TJ, Warren MS, Wilmington DE. Raised hives Zafirlukast (Accolate) in the treatment of chronic idiopathic urticaria – a case series. Why do i get hives after working out J Allergy Clin Immunol 1998; 101(Suppl): S155.