Urticarial Reactions

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Abstract
Because of its association with serum sickness, urticaria has been regarded as a primarily allergic reaction since von Pirquet''s original work. Although the urticarial lesion could be replicated with histamine, the Prausnitz-Kustner reaction appeared to confirm the role of antibody. Current knowledge of the physiology and pharmacology of the mast cells, the eosinophil leucocyte, and the small cutaneous blood-vessels has shown that the urticarial response is the consequence of histamine release from mast cells, and that serum-type antibody is only one of the many agents which can effect this release. Patients with urticarial reactions may be divided on clinical grounds into four groups: (1) dermographism, (2) physical, (3) cholinergic, and (4) "ordinary." They are all dependent and histamine-released from mast cells, though the mechanisms of inducing this process in response to stimuli are different. Chronic "ordinary"-type urticaria may depend on a varying susceptibility of the mast cell to histamine-releasing agents, rather than on the presence or absence of specific inducing substance.