Adrenergic urticaria
Medical condition
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Through Vasoconstriction and Hives
Mechanism
The underlying mechanisms are not fully understood, but existing research suggests that adrenergic urticaria is linked with elevated serum catecholamine levels. The characteristic halo hives are most likely caused by catecholamine-induced peripheral vasoconstriction around erythematous wheals, which is consistent with other types of urticaria.
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Diagnosis
The diagnosis of AU can be made either clinically or by giving an intradermal injection of adrenaline or noradrenaline, which causes the rash, or by monitoring the body's reaction to propranolol, which suppresses the rash and prevents further exacerbations. To avoid excessive vasoconstriction, highly diluted solutions must be used. Skin biopsy specimens of adrenergic urticaria show edematous tissues with a vague inflammatory infiltrate, and electron microscopy reveals mast cell degranulation, supporting the currently accepted theory that mast cells regulate pathogenesis.
Treatment
Most guidelines do not even mention this subtype of urticaria, let alone provide guidance on its management. Based on cases, beta-blocker therapy may offer a rapid-acting, well-tolerated, and effective treatment option for patients.