Kawakami Yukari, Gokita Mari, Fukunaga Atsushi, Nishigori Chikako
Division of Dermatology, Department of Internal Related, Kobe University Graduate School of Medicine, Kobe, Japan.
J Dermatol. 2015 Jun;42(6):635-7. doi: 10.1111/1346-8138.12855. Epub 2015 Mar 21.
Adrenergic urticaria (AU) is a rare type of stress-induced physical urticaria characterized by widespread pruritic urticarial papules. Diagnosis can be made by i.d. injection of adrenaline or noradrenaline, which produces the characteristic rash. Although the lesions of AU typically respond to beta-blockers such as propranolol, the therapeutic options for AU are limited. Here, we report a case of AU that was resistant to beta-blockers and successfully treated with clotiazepam. The clinical picture of AU resembles that of cholinergic urticaria (CU), however, positive noradrenaline test and negative acetylcholine skin test were useful for the differential diagnosis of AU and CU. Although his symptoms were resistant to several therapeutic methods including olopatadine (H1 antagonist), lafutidine (H2 antagonist) and propranolol, the severity and frequency of his attacks and his subjective symptoms were reduced by oral clotiazepam, an anxiolytic benzodiazepine. Dermatologists should be aware that anxiolytic benzodiazepines may be a therapeutic option in AU.
肾上腺素能性荨麻疹（AU）是一种罕见的应激性物理性荨麻疹，其特征为广泛分布的瘙痒性风团丘疹。诊断可通过皮内注射肾上腺素或去甲肾上腺素来进行，注射后会出现特征性皮疹。虽然AU的皮损通常对普萘洛尔等β受体阻滞剂有反应，但AU的治疗选择有限。在此，我们报告一例对β受体阻滞剂耐药的AU病例，该病例经氯噻西泮成功治疗。AU的临床表现与胆碱能性荨麻疹（CU）相似，然而，去甲肾上腺素试验阳性和乙酰胆碱皮肤试验阴性有助于AU和CU的鉴别诊断。尽管他的症状对包括奥洛他定（H1拮抗剂）、法莫替丁（H2拮抗剂）和普萘洛尔在内的多种治疗方法均耐药，但口服氯噻西泮（一种抗焦虑苯二氮䓬类药物）使他发作的严重程度和频率以及主观症状有所减轻。皮肤科医生应意识到抗焦虑苯二氮䓬类药物可能是AU的一种治疗选择。
