[Urticaria and "aspirin intolerance"--part of an interdisciplinary pathogenetic principle? (author's transl)]

Like the so-called "aspirin asthma", the aspirin-induced provocation of chronic urticaria is a symptom of the intolerance syndrome. This may also be induced by various other drugs, particularly by indomethacin and food additives. The intolerance syndromes of the "Aspirin type", however, must be assigned to the "anaphylactoid reactions" in man which also include the non-immunologic reactions to radiographic contrast media and colloids in blood substitutes. It has not yet been investigated in how far the mechanisms of these three clinical types of anaphylactoid reactions are similar or identical; however, this appears to be the case at least with aspirin intolerance and anaphylactoid reactions to contrast media. According to our observations in 150 urticaria patients, the non-immunologic aspirin-induced urticaria (and probably also the "aspirin asthma") should furthermore be divided into real provocation within the meaning of a chemical Koebner phenomenon, and "aspirin urticaria" as a symptom of the intolerance syndrome as such. A rel provocation of pre-existent urticaria is much less frequent than superimposed urticaria as a mere symptom of the intolerance syndrome. An exact differentiation is only possible in patients without any clinical symptoms after additive-free diet as well as on the basis of the phenomenon of "figuration". The most important substance as mediator for intolerance urticaria is histamine. In contrast to the usual urticaria, H2-antagonists are an important adjuvant to the traditional H1-antagonists in the symptomatic therapy.