| Abstract [eng] |
Aim. Review the literature to understand chronic urticaria and angioedema etiology, provocative factors, clinical features of the disease, diagnostic and treatment methods, and to describe a clinical case. Methods. The literature search was performed in the PubMed database. The selection criteria were: english language and publications between the years of 2014 and 2024. According to the selection criteria and relevant key words, 45 scientific publications were identified in the PubMed database and selected for the final literature review. Data storage was performed with Zotero reference management software. Case report. In 2023, a 35-year-old woman visited Vilnius University Hospital Santaros Klinikos to consult an allergist regarding recurrent urticaria, itching, and burning sensations of unknown origin. Her symptoms first appeared in 2019 during physical activity, when she experienced urticaria, lost consciousness, and recovered spontaneously. The next similar episode occurred a year later, prompting an evaluation by a cardiologist, which revealed no abnormalities. By 2023, the patient experienced multiple episodes of urticaria and went to the emergency department. She received treatment with systemic glucocorticosteroids, followed a pseudoallergen-free diet, and underwent Helicobacter pylori eradication therapy. Despite these interventions, the patient continued to experience episodes of severe urticaria and angioedema. During one episode, a brain CT scan was performed due to severe swelling of the upper part of the head. Her medical history indicated childhood occurrences of skin rashes in response to cold exposure, she felt difficulty breathing after consuming cold beverages, shortness of breath and burning sensations during exercise, the patient previously had hay fever, and body-wide itching appeared when taking nonsteroidal anti- inflammatory drugs. Further investigations included laboratory tests, skin prick tests, an oral provocation test with aspirin, exercise and exercise provocation tests with cofactors (aspirin and wheat), the patient was diagnosed with exercise-induced anaphylaxis, chronic spontaneous and induced cold urticaria, angioedema. In June 2023, due to insufficient disease control, reccurent urticaria and angioedema, multidisciplinary team recommended treatment with omalizumab. The patient has since been tolerating the treatment well, and her symptoms have improved. Conclusions. We report an unusual case of a female patient with severe chronic urticaria. She had several types of chronic urticaria – chronic spontaneous urticaria, cold urticaria, exercise-induced urticaria with angioedema and exercise-induced anaphylaxis. With time, the patient’s disease was progressing, and symptoms became very disturbing to daily life. Urticaria, severe swelling, especially in the upper part of the head, and systemic symptoms such as hypotension, tachycardia and dyspnoea were triggered by exercise, food intake, sexual intercourse. A stepwise approach treatment was initiated, beginning with second-generation antihistamines, glucocorticosteroids, adrenaline and bronchodilatators during acute episodes. However, in the absence of disease control, treatment with the monoclonal antibody against immunoglobulin E, omalizumab 300 mg subcutaneously every 4 weeks, was given, during which the patient's condition stabilised, her symptoms regressed and her quality of life improved. |
