Case and Research Letter
Acquired Nonfamilial Vibratory Angioedema
Angioedema vibratorio adquirido (no familiar)
M.A. Pastor-Nietoa,b,
, L. Vergara-de-la-Campac, M.E. Gatica-Ortegac, A. Giménez-Arnaud
Corresponding author
a Servicio de Dermatología, Hospital Universitario de Guadalajara, Guadalajara, Spain
b Departamento de Medicina y Especialidades Médicas, Facultad de Medicina y Ciencias de la Salud, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain
c Servicio de Dermatología, Complejo Hospitalario de Toledo, Toledo, Spain
d Servicio de Dermatología, Hospital del Mar, IMIM, Universitat Autònoma, Barcelona, Spain
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Histología reveladora de necrosis epidérmica, estrato córneo normal e infiltrado linfocítico perivascular y perianexal leve (H-E, x200). B. Inmunofluorescencia indirecta. La inmunofluorescencia de la sangre del paciente, realizada en esófago de mono demuestra la presencia de autoanticuerpos IgG en circulación ligados a los núcleos de queratinocitos epiteliales (dilución 1:20, amplificación original x200).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "D. Morgado-Carrasco, J.M. Mascaró Jr" "autores" => array:2 [ 0 => array:2 [ "nombre" => "D." "apellidos" => "Morgado-Carrasco" ] 1 => array:2 [ "nombre" => "J.M." 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Se considera positiva cuando se objetiva inflamación con el estímulo vibratorio desencadenado por el movimiento del vórtice. Según las recomendaciones en las guías de consenso (EAACI/GA(2) LEN/EDF/UNEV), la cuantificación de la inflamación puede efectuarse midiendo la circunferencia del antebrazo a tres alturas (hueco antecubital, muñeca y punto medio entre los dos anteriores). Esta medición debe realizarse previamente a la aplicación del estímulo vibratorio y 5<span class="elsevierStyleHsp" style=""></span>min después de la finalización con una cinta métrica. Se pueden usar indistintamente los términos vórtice en castellano o <span class="elsevierStyleItalic">vortex</span> en latín, pero no «vórtex», término incorrecto derivado de una mala traducción del inglés «vortex».</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M.A. Pastor-Nieto, L. Vergara-de-la-Campa, M.E. Gatica-Ortega, A. 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Gatica-Ortega, A. Giménez-Arnau" "autores" => array:4 [ 0 => array:4 [ "nombre" => "M.A." "apellidos" => "Pastor-Nieto" "email" => array:1 [ 0 => "mapastornieto@gmail.com" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "L." "apellidos" => "Vergara-de-la-Campa" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 2 => array:3 [ "nombre" => "M.E." "apellidos" => "Gatica-Ortega" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "A." "apellidos" => "Giménez-Arnau" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Universitario de Guadalajara, Guadalajara, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Departamento de Medicina y Especialidades Médicas, Facultad de Medicina y Ciencias de la Salud, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Dermatología, Complejo Hospitalario de Toledo, Toledo, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital del Mar, IMIM, Universitat Autònoma, Barcelona, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Angioedema vibratorio adquirido (no familiar)" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 637 "Ancho" => 851 "Tamanyo" => 57026 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The volar surface of the forearm should be exposed to the vibration for 5<span class="elsevierStyleHsp" style=""></span>minutes. This should be induced by a laboratory vortex mixer (780–1380<span class="elsevierStyleHsp" style=""></span>rpm), with readings taken at 10<span class="elsevierStyleHsp" style=""></span>minutes once the stimulus has stopped. The result is considered positive when inflammation resulting the vibratory stimulus induced by the movement of the vortex. According to recommendations from consensus guidelines (EAACI/GA(2)LEN/EDF/UNEV), inflammation can be quantified by measuring the circumference of the forearm at 3 points (cubital fossa, wrist, and midpoint between the two). This measurement should be made with a measuring tape before application of the vibratory stimulus and 5<span class="elsevierStyleHsp" style=""></span>minutes afterwards.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Vibratory angioedema is defined as a pruriginous inflammatory reaction that occurs a few minutes after exposure to vibration.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">1</span></a> An autosomal dominant variant, hereditary type of vibratory angioedema has been reported, manifesting as prolonged angioedema (hours to days) resulting from exposure to a vibratory stimulus.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">2</span></a> The more frequent sporadic form, acquired (nonfamilial) vibratory angioedema, is characterized by similar symptoms.<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">3–13</span></a> Boyden et al.<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">14,15</span></a> reported another autosomal dominant variant, which is characterized by mutations in adhesion G protein-coupled receptor E2 (ADGRE-2) and wheals instead of angioedema. This form is known as ADGRE-2-linked hereditary vibratory urticaria.<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">2,16</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Diagnosis is based on the clinical history and the vortex provocation test (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Dermographism should be ruled out. Elevated serum histamine and mast cell degranulation mediators have been reported during episodes.<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">3–5,14,17,18</span></a> Treatment involves avoiding exposure to vibratory stimuli or, if this is not feasible (e.g., owing to occupational settings), administration of antihistamines (anti-H1) (level of evidence C).<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">1</span></a></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">We performed a literature review on acquired (nonfamilial) vibratory angioedema in September 2020. The search terms applied were “vibratory” or “vibrational” or “vibration-induced” and “angioedema” or “urticaria”. We searched for articles in English, French, and Spanish, without time restrictions, in MEDLINE, Cochrane Central Register of Controlled Trials, and Web of Science.</p><p id="par0020" class="elsevierStylePara elsevierViewall">We identified 21 articles between 1982 and 2016. Ten were ruled out owing to insufficient information and/or hereditary cases. We recorded 12 cases of acquired disease (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>), including 7 males (58%), and 6 occupational cases (50%). The mean age at diagnosis was 35 (16–70) years, and the mean age at onset of symptoms was 31<span class="elsevierStyleHsp" style=""></span>years. The latency period between onset of symptoms and consultation ranged from 3<span class="elsevierStyleHsp" style=""></span>months to 20<span class="elsevierStyleHsp" style=""></span>years.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">The most frequent triggers were lawnmowers<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">3,6,10</span></a> and musical instruments.<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">8,10,11</span></a> All of the affected patients had localized lesions, although none had generalized wheals. One patient reported chronic spontaneous urticaria<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">5</span></a> and another, carpal tunnel syndrome caused by severe edema of the wrist after occupational exposure to vibration.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">4</span></a> Three patients (25%) had systemic symptoms (flushing, chest tightness, generalized heat, dizziness, tachycardia, and hypertension), and 1 fulfilled the criteria for anaphylaxis.<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">6,9,13</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The vortex test was used in 9/12 cases (75%), with the type and frequency (rpm) reported in 5/9. The frequency recommended in guidelines (780–1380<span class="elsevierStyleHsp" style=""></span>rpm) was applied in 3 cases.<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">5,6</span></a> The forearm circumference (before and after testing) was specified in only 2 patients (increases of 4 and 12<span class="elsevierStyleHsp" style=""></span>mm, respectively).<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">4,6</span></a> Symptoms triggered by the vortex appeared between 0.5 and 10<span class="elsevierStyleHsp" style=""></span>minutes once the oscillation had stopped. Only 1 patient developed wheals with the vortex (i.e., the patient with concomitant spontaneous urticaria). Median nerve conduction velocity slowed after the vortex was applied in the patient with carpal tunnel syndrome.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">4</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Controls were included in 6 articles. Ting et al.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">3</span></a> studied 17 controls; of these, 4/7 relatives of the patient with acquired vibratory angioedema and 5/10 healthy volunteers developed edema that extended beyond the area in contact with the vortex.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Provocation tests for other types of inducible urticaria were carried out in 9 patients. These were positive in only 1 patient, who had delayed pressure urticaria and dermographism.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">6</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">There have also been 2 reports of acquired vibratory urticaria secondary to identifiable causes: a patient with <span class="elsevierStyleItalic">Candida glabrata</span> infection who experienced urticaria on the fingers when using a typewriter,<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">19</span></a> and another with anaphylaxis after using a sewing machine 17<span class="elsevierStyleHsp" style=""></span>hours after being stung by a wasp.<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">20</span></a> These cases were not included in the present review owing to the fact that the clinical findings differed from those of acquired angioedema (wheals and no angioedema), the need for a previous condition that triggered symptoms when co-occurring with the vibration, and the subacute course that resolved after control of the previous condition.</p><p id="par0050" class="elsevierStylePara elsevierViewall">The factors involved in acquired vibratory angioedema are unclear. While serum levels of histamine and other mast cell degranulation mediators are elevated during episodes, we do not know why patients present with angioedema and no wheals, generally no systemic symptoms, and no association with spontaneous urticaria.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Similarly, there is considerable heterogeneity in the practice, methodology, and interpretation of the vortex test, thus making it difficult to define response patterns or ranges of intensity and revealing the need for the method to be standardized.</p><p id="par0060" class="elsevierStylePara elsevierViewall">A high percentage of the general population experiences symptoms when exposed to a vibratory stimulus (7%–41.3%),<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">18,21</span></a> thus suggesting that some cases could involve physiological responses. In order to distinguish between physiological and pathological responses, it would be interesting to set a threshold, as is the case in other types of inducible urticaria (e.g., simple dermographism and symptomatic dermographism). In our opinion, considering this phenomenon as pathological should also be based on functional compromise and on impairment of quality of life owing to the individual's obligation to be exposed to vibratory stimuli in both professional and nonprofessional settings.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0065" class="elsevierStylePara elsevierViewall">The present study was not supported by funding from the public sector, commercial sector, or not-for-profit entities.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflicts of Interest</span><p id="par0070" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflicts of Interest" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 637 "Ancho" => 851 "Tamanyo" => 57026 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The volar surface of the forearm should be exposed to the vibration for 5<span class="elsevierStyleHsp" style=""></span>minutes. This should be induced by a laboratory vortex mixer (780–1380<span class="elsevierStyleHsp" style=""></span>rpm), with readings taken at 10<span class="elsevierStyleHsp" style=""></span>minutes once the stimulus has stopped. The result is considered positive when inflammation resulting the vibratory stimulus induced by the movement of the vortex. According to recommendations from consensus guidelines (EAACI/GA(2)LEN/EDF/UNEV), inflammation can be quantified by measuring the circumference of the forearm at 3 points (cubital fossa, wrist, and midpoint between the two). This measurement should be made with a measuring tape before application of the vibratory stimulus and 5<span class="elsevierStyleHsp" style=""></span>minutes afterwards.</p>" ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Abbreviations</span>: CPAP, continuous positive airway pressure; CIndU, chronic inducible urticaria; CholU, cholinergic urticaria; DPU, delayed pressure urticaria; F, female; M, male; NS, not specified; SCU, spontaneous chronic urticaria; SD, symptomatic dermographism.</p>" "tablatextoimagen" => array:1 [ 0 => array:1 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Author/year of publication \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sex/age, y \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Triggers: findings, symptoms, and duration \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Systemic symptoms \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Vortex test performed/oscillation frequency \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Measurement of forearm circumference/results \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Symptoms and latency (time to onset after initiation of the vortex test) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Diagnostic tests for other CIndU/results \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Treatment \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Alpern et al.<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">13</span></a>/2016 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">F/53 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Massage bed: onset in the form of anaphylaxis; 2 additional episodes of edema affecting hands and feet, pruritus, and mild dizziness. No further episodes of anaphylaxis in the following 3<span class="elsevierStyleHsp" style=""></span>y \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Anaphylaxis (generalized pruritus, flushing, nausea, vomiting, hypotension, presyncope) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Avoidance of vibratory stimulus \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Kalathoor<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">12</span></a>/2015 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">F/70 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Snoring: lingual and pharyngeal edema with difficulty swallowing (every 3<span class="elsevierStyleHsp" style=""></span>mo for 3<span class="elsevierStyleHsp" style=""></span>y); driving; some episodes of pruritus and hand edema \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CPAP \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Guarneri et al.<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">11</span></a>/2014 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">M/20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Horn: labial angioedema (for 5<span class="elsevierStyleHsp" style=""></span>months, although he had been playing it for 6<span class="elsevierStyleHsp" style=""></span>y) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Sarmast et al.<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">10</span></a>/2014 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">M/38 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Trumpet: pain, edema, and erythema affecting the upper lip (3<span class="elsevierStyleHsp" style=""></span>y); lawnmower: hand edema \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes/NS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Burning sensation, edema, erythema, and mild pain in forearm (5<span class="elsevierStyleHsp" style=""></span>min after test) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Negative (DPU) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Prednisone \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pressler et al.<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">9</span></a>/2012 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">F/36 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Exercise (running, walking quickly, cycling over rough ground, skiing): angioedema (20<span class="elsevierStyleHsp" style=""></span>y with worsening of systemic symptoms during recent months) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Dizziness, tachycardia, and hypotension \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes/2400<span class="elsevierStyleHsp" style=""></span>rpm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Angioedema affecting the area of contact (5–10<span class="elsevierStyleHsp" style=""></span>min after test) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Negative (heat, cold, DPU, SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ketotifen \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Patruno et al.<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">8</span></a>/2009 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">M/28 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Saxophone: lower lip edema (6<span class="elsevierStyleHsp" style=""></span>mo) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes/NS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Angioedema (5<span class="elsevierStyleHsp" style=""></span>min after test) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Negative (heat, cold, DPU, CholU, SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Prednisone \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mathelier-Fusade et al.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">7</span></a>/2001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">F/34 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mountain bike for 10<span class="elsevierStyleHsp" style=""></span>min: forearm edema (4<span class="elsevierStyleHsp" style=""></span>y) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes/NS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Erythema, pruritus, and circumferential edema (5<span class="elsevierStyleHsp" style=""></span>min after test) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Negative (DPU, CholU, SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Lawlor et al.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">6</span></a>/1989 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">F/28 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Applauding for 5<span class="elsevierStyleHsp" style=""></span>min, and/or electric lawnmower or garden shears: tingling, pruritus, and erythema on wrists and forearms lasting minutes; walking for <<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleHsp" style=""></span>min: pruritus followed by erythema on the anterior aspect of the thighs (10<span class="elsevierStyleHsp" style=""></span>y) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Facial flushing, chest tightness, and generalized sensation of heat \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes/780<span class="elsevierStyleHsp" style=""></span>rpm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes/4-mm increase in circumference at the mid forearm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Tingling (2<span class="elsevierStyleHsp" style=""></span>min after test) and pruritus (4<span class="elsevierStyleHsp" style=""></span>min after test) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Positive (DPU, SD)Negative (CholU, cold) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Terfenadine \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Keahey<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">5</span></a>/1987 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">M/37 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Machinist (pressure and/or friction): pruriginous and painful lesions (3<span class="elsevierStyleHsp" style=""></span>y) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes/1380<span class="elsevierStyleHsp" style=""></span>rpm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pruritus and erythema (immediate); localized angioedema (4 to 6<span class="elsevierStyleHsp" style=""></span>h after the test) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Negative (SD, DPU: several occasions) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">M/28 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Carpenter (pressure and/or friction): pruriginous and painful lesions (5<span class="elsevierStyleHsp" style=""></span>y) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes/1380<span class="elsevierStyleHsp" style=""></span>rpm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Urticarial reaction (minutes after the test); localized angioedema (4 to 6<span class="elsevierStyleHsp" style=""></span>h after test) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Negative (SD, DPU: several occasions)SCU \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Wener<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">4</span></a>/1983 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">M/32 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Grinding machine: erythema and edema affecting the left hand, and wrist affected by secondary carpal tunnel syndrome (1<span class="elsevierStyleHsp" style=""></span>y) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes/NS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes/12-mm increase in wrist circumference \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Edema, pruritus, paresthesia, and pain affecting the wrist, hand, forearm, and arm (1<span class="elsevierStyleHsp" style=""></span>min after test); inability to flex fingers (4<span class="elsevierStyleHsp" style=""></span>min after test); slowed nerve conduction velocity (5<span class="elsevierStyleHsp" style=""></span>min after test) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Negative (cold, SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Surgery (carpal tunnel release) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ting<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">3</span></a>/1982 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">M/16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Motorcycle or lawnmower: hand edema (3<span class="elsevierStyleHsp" style=""></span>mo) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes/6000<span class="elsevierStyleHsp" style=""></span>rpm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Prolonged angioedema at various sites (arm, leg, and trunk) lasting 12<span class="elsevierStyleHsp" style=""></span>h (onset seconds after test) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Negative (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Desensitization to vibration \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Review of the Literature on Acquired Vibratory Angioedema.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:21 [ 0 => array:3 [ "identificador" => "bib0110" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The definition, diagnostic testing, and management of chronic inducible urticarias – the EAACI/GA(2) LEN/EDF/UNEV consensus recommendations 2016 update and revision" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 24 | 11 | 35 |
| 2024 October | 133 | 66 | 199 |
| 2024 September | 145 | 58 | 203 |
| 2024 August | 139 | 72 | 211 |
| 2024 July | 87 | 68 | 155 |
| 2024 June | 95 | 66 | 161 |
| 2024 May | 112 | 60 | 172 |
| 2024 April | 111 | 49 | 160 |
| 2024 March | 94 | 44 | 138 |
| 2024 February | 80 | 40 | 120 |
| 2024 January | 162 | 52 | 214 |
| 2023 December | 159 | 61 | 220 |
| 2023 November | 108 | 44 | 152 |
| 2023 October | 162 | 64 | 226 |
| 2023 September | 89 | 35 | 124 |
| 2023 August | 88 | 28 | 116 |
| 2023 July | 132 | 76 | 208 |
| 2023 June | 118 | 68 | 186 |
| 2023 May | 104 | 42 | 146 |
| 2023 April | 59 | 13 | 72 |
| 2023 March | 95 | 36 | 131 |
| 2023 February | 53 | 36 | 89 |
| 2023 January | 91 | 70 | 161 |
| 2022 December | 79 | 58 | 137 |
| 2022 November | 123 | 65 | 188 |
| 2022 October | 164 | 59 | 223 |
| 2022 September | 114 | 75 | 189 |
| 2022 August | 93 | 116 | 209 |
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