592 A Case of Multiple Simultaneous Urticarial Syndromes Refractory to Treatment
Abstract
Background We report the case of a patient with 3 forms of physical urticaria and his response to treatment. Methods An atopic asthmatic 11 year old male was evaluated for a history of recurrent pruritus with a variable, erythematous rash unresponsive to therapy. Since the age of 5 years, he has experienced small red, raised, pinpoint, pruritic “bumps” over his entire body except the palms of his hands and soles of his feet. The duration of the lesions was generally 5 minutes to about 1 hour. They occurred with exercise, stress, cold air, and cold water. At the time of the evaluation, the patient was treated with oral levocetirizine 5 mg daily and hydroxyzine 50 mg at bedtime without resolution of symptoms. Results In clinic, the patient had a positive ice cube test, a positive dermatographia test and a negative warm test tube test. Methacholine and autologous sweat testing were declined. Otherwise he had a normal physical examination with a negative Darier sign. Laboratory studies did not reveal a disease process responsible for the urticaria. Based upon his historical symptoms and clinical findings, he was diagnosed with 3 distinct types of physical urticaria; cholinergic urticaria, cold urticaria and dermatographia. The dose of anti-histamine therapy was doubled and the patient returned to clinic in 4 weeks to report that his symptoms were slightly improved but had not resolved. Conclusions Physical urticarias are usually controlled by antihistamine therapy but refractory…
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