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Psychogenic urticaria: The issues of diagnosis and optimization of therapy

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Objective: to reveal clinical and immunological criteria for psychogenic urticaria (PU) and to determine the therapeutic efficacy of alimemazine in this abnormality.

Patients and methods. Ninety-three patients with PU, 46 apparently healthy individuals, and 90 patients with chronic autoimmune urticaria (CAU) were examined. The methods included clinical examination; use of the Goldberg anxiety rating scale; enzyme immunoassay of serum substance P levels. The efficacy of alimemazine was evaluated in an open-label comparative randomized trial for 4 weeks.

Results and discussion. Patients with PU significantly more frequently showed a predominance of manifestations of itching over skin rashes and higher levels of anxiety disorders than those with CAU. The mean serum concentration of substance P was 0.006±0.005 ng/ml in the patients with CAU, 0.026±0.02 ng/ml in healthy individuals, and 8.46±0.95 ng/ml in the patients with PU (p<0.0001). Addition of standard therapy (second-generation antihistamines, disintoxication) with alimemazine 15–30 mg/day ensured statistically significant advantages over the control (standard therapy) in the following indicators: reductions in the severity of the disease, the degree of anxiety disorders, and the serum levels of substance P. Alimemazine was noted to be satisfactorily tolerated. Thus, the authors established the following diagnostic criteria for PU: a psychotraumatic situation; dermal manifestations after psychogeny; high anxiety; a predominance of the manifestations of itching over the dermal symptoms of urticaria; and elevated serum substance P concentrations. Standard therapy added by alimemazine versus that without the drug was found to be effective. There were reductions in the symptoms of urticaria, the degree of anxiety disorders, and the levels of substance P.

About the Authors

A. A. Pribytkov
Penza Institute for Postgraduate Training of Physicians, Ministry of Health of Russia
Russian Federation

Penza, Russia 8A, Stasov St., Penza 440060

E. A. Orlova
Penza Institute for Postgraduate Training of Physicians, Ministry of Health of Russia
Russian Federation
Penza, Russia 8A, Stasov St., Penza 440060


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For citation:

Pribytkov A.A., Orlova E.A. Psychogenic urticaria: The issues of diagnosis and optimization of therapy. Neurology, Neuropsychiatry, Psychosomatics. 2014;6(3):21-26. (In Russ.)

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