Reviewer: S. Randhawa, M.D., Allergist/Immunologist and Assistant Professor at LSU (Shreveport) Department of Allergy and Immunology
A 48-year-old man is in the clinic today for a follow-up of chronic urticaria and delayed pressure urticaria and angioedema. A biopsy done 3 years showed neutrophils infiltrating the skin lesions without evidence of vasculitis.
He has been on Dapson 150 mg po daily and Doxepin 25 mg po qhs for 2.5 years and this regimen has decreased the intensity if his symptoms by about 25%. He had no effect with high dose oral antihistamines and Singulair in the past. He currently has hives daily, 5-15 lesions that resolve spontaneously, and no night symptoms. He has pressure-related angiodema on his back after porolonged recumbent position (sleep) approximately once a week. He reports no systemic symptoms, no shortness of breath, chest pain or fever.
Dapson 150 mg po daily and Doxepin 25 mg po qhs.
He has urticarial lesions on his arms and trunk (15-17 lesions). The rest of the examination is normal.
What is the most likely diagnosis?
Chronic urticaria and delayed pressure urticaria and angioedema. We discussed different therapeutic options and their side effects and he would like to stay on the current treatment regimen.
Chronic spontaneous urticaria (CSU) is defined as the presence of urticaria with daily or almost daily symptoms for 6 weeks or more. CSU affects 0.1%-0.8% of the population. http://buff.ly/1rDwQ4P