Urticaria and Angioedema PDF

Preface

Urticaria and angioedema affect at least 20 per cent of the population, and frequently become chronic and persistent, causing significant personal, domestic, social, and occupational disability. That "urticaria" encompasses a group of very different disorders is incompletely understood by many clinicians who nevertheless confidently make this diagnosis. For this reason and because, until recently, little progress has been made in understanding of the pathomechanisms of the chronic forms, progress in diagnosis and treatment has been disappointingly slow.

Our foremost objective in Urticaria and Angioedema is to provide clinicians with a clear guide to diagnosis and management of this often perplexing group of diseases, based upon contemporary understanding of pathogenetic mechanisms of the different subtypes. The uses and limitations of existing treatments including both "classical" and "new generation" antihistamines, as well as newer alternative therapeutic approaches, are discussed in the setting of recent insights into the molecular basis of urticaria and angioedema. We have included a discussion of the clinical significance of important and recently discovered autoimmune mechanisms in chronic "idiopathic" urticaria, and their impact upon patient management.

We also believe the book will intrigue immunologists, cell biologists, and pharmacologists with an interest in clinical immunology and allergy. The unravelling of the ways in which dermal mast cells and basophil leucocytes become promiscuously activated, the interactions of the multiple inflammatory mediators thus released, and the ensuing cavalcade of cellular pruritic and vascular responses represent a paradigm for immunologically driven disease. Moreover. urticaria and angioedema are models potentially accessible for study in human skin.

However, in many patients with chronic urticaria and especially in the physical urticarias, causation of dermal mast cell activation at a molecular level still remains elusive, and we have endeavoured, in the relevant chapters, to point the way forward to future developments in these fields.

Overall we hope we have achieved a reasonable balance-satisfying both the clinician, who requires reassurance that recommended clinical practice is scientifically soundly based, and the investigator, who seeks a secure clinical context for research in this important and challenging area.