Current Vascular Pharmacology

Dimitri P. Mikhailidis  
Academic Head, Deptartment of Clinical Biochemistry
Royal Free Hospital Campus
University College London Medical School
University College London (UCL)
Pond Street
London, NW3 2QG
UK

Back

Inflammation and Coagulation in Urticaria and Angioedema

Author(s): Massimo Cugno, Riccardo Asero, Alberto Tedeschi, Riccardo Lazzari and Angelo V. Marzano

Affiliation: Department of Internal Medicine, University of Milan, Via Pace 9, 20122 Milano, Italy.

Abstract:

Urticaria is a skin disease characterised by short-lived surface swellings of the dermis (wheals) frequently accompanied by itching. It is classified as acute or chronic depending on whether the wheal recurrence occurs for less or more than six weeks. Acute urticaria is often due to a hypersensitivity reaction, whereas about 50% of the cases of chronic urticaria are regarded as autoimmune. Urticaria may occur alone or in association with a deeper swelling (angioedema) involving the subcutaneous and/or submucosal tissues, and last from hours to a few days. Angioedema can also develop alone, and may be idiopathic or be caused by allergies, inherited or acquired deficiencies of C1-inhibitor protein, or adverse drug reactions. An interplay between inflammation and coagulation has been proposed as a pathomechanism in urticaria and urticaria-associated angioedema (in which histamine and thrombin are involved), as well as in angioedema due to C1-inhibitor deficiency, which involves various biological systems. An increase in the plasma markers of thrombin generation, fibrinolysis and inflammation has been documented during exacerbations of urticaria and angioedema, with the marker levels decreasing to normal during remission. However, the hypercoagulable state in chronic urticaria and angioedema has not been reported to be associated with any increased risk of thrombosis, although there have been a number of reports of cardiovascular events occurring during episodes of acute urticaria. These observations have provided the rationale for the clinical evaluation of anticoagulant and antifibrinolytic drugs, the efficacy of which has sometimes been demonstrated.

Keywords: Urticaria, angioedema, thrombin, tissue factor, histamine, C1-inhibitor deficiency, inflammation, coagulation, interleukin-1, tumor necrosis factor α

Order Reprints Order Eprints Rights & PermissionsPrintExport

Article Details

VOLUME: 10
ISSUE: 5
Page: [653 - 658]
Pages: 6
DOI: 10.2174/157016112801784558
Price: $58