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Vibratory urticaria

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Description

Vibratory urticaria is a condition in which exposing the skin to vibration, repetitive stretching, or friction results in allergy symptoms such as hives (urticaria), swelling (angioedema), redness (erythema), and itching (pruritus) in the affected area. The reaction can be brought on by towel drying, hand clapping, running, a bumpy ride in a vehicle, or other repetitive stimulation. Headaches, fatigue, faintness, blurry vision, a metallic taste in the mouth, facial flushing, and more widespread swelling (especially of the face) can also occur during these episodes, especially if the stimulation is extreme or prolonged. The reaction occurs within a few minutes of the stimulation and generally lasts up to an hour. Affected individuals can have several episodes per day.

Frequency

Vibratory urticaria is a rare disorder; its prevalence is unknown. It belongs to a class of disorders called physical urticarias in which allergy symptoms are brought on by direct exposure to factors such as pressure, heat, cold, or sunlight. Physical urticarias have been estimated to occur in up to 5 per 1,000 people.

Causes

Vibratory urticaria can be caused by a mutation in the ADGRE2 gene. This gene provides instructions for making a protein found in several types of immune system cells, including mast cells. Mast cells, which are found in many body tissues including the skin, are important for the normal protective functions of the immune system. They also play a role in allergic reactions, which occur when the immune system overreacts to stimuli that are not harmful. The specific role of the ADGRE2 protein in mast cells is not well understood.

The ADGRE2 protein consists of two parts (subunits) that interact with each other: an alpha subunit that lies on the outside surface of the cell and a beta subunit that crosses the cell membrane and extends into the cell. The ADGRE2 gene mutation that causes vibratory urticaria changes a single protein building block (amino acid) in the alpha subunit, altering the protein structure and leading to a less stable interaction between the two subunits. This fragile connection can be more easily broken; vibration, friction, or stretching of the skin can disrupt the association between subunits in mast cells. Researchers suggest that once the subunits are disconnected, the beta subunit signals the mast cells to react and produce the allergy symptoms in the skin that occur in vibratory urticaria.

Some people with vibratory urticaria do not have a mutation in the ADGRE2 gene. In these affected individuals, the cause of the disorder is unknown.

Inheritance

This condition is inherited in an autosomal dominant pattern, which means one copy of the altered gene in each cell is sufficient to cause the disorder.

In most cases, an affected person has one parent with the condition.

Other Names for This Condition

  • DDU
  • dermodistortive urticaria
  • VBU
  • vibratory angioedema

Additional Information & Resources

Genetic and Rare Diseases Information Center

Catalog of Genes and Diseases from OMIM

Scientific Articles on PubMed

References

  • Abajian M, Młynek A, Maurer M. Physical urticaria. Curr Allergy Asthma Rep. 2012 Aug;12(4):281-7. doi: 10.1007/s11882-012-0269-0. Review. Citation on PubMed
  • Abajian M, Schoepke N, Altrichter S, Zuberbier T, Maurer M. Physical urticarias and cholinergic urticaria. Immunol Allergy Clin North Am. 2014 Feb;34(1):73-88. doi: 10.1016/j.iac.2013.09.010. Epub 2013 Oct 28. Review. Erratum in: Immunol Allergy Clin North Am. 2014 May;34(2):xix. Zuberbier, H C Torsten [corrected to Zuberbier, Torsten]. Citation on PubMed
  • Aloyouny A, Stoopler ET. Vibrational angioedema: considerations for oral health care providers. Spec Care Dentist. 2016 Nov;36(6):335-338. doi: 10.1111/scd.12185. Epub 2016 Apr 26. Citation on PubMed
  • Boyden SE, Desai A, Cruse G, Young ML, Bolan HC, Scott LM, Eisch AR, Long RD, Lee CC, Satorius CL, Pakstis AJ, Olivera A, Mullikin JC, Chouery E, Mégarbané A, Medlej-Hashim M, Kidd KK, Kastner DL, Metcalfe DD, Komarow HD. Vibratory Urticaria Associated with a Missense Variant in ADGRE2. N Engl J Med. 2016 Feb 18;374(7):656-63. doi: 10.1056/NEJMoa1500611. Epub 2016 Feb 3. Citation on PubMed or Free article on PubMed Central
  • Dice JP. Physical urticaria. Immunol Allergy Clin North Am. 2004 May;24(2):225-46, vi. Review. Citation on PubMed
  • Kalathoor I. Snoring-Induced Vibratory Angioedema. Am J Case Rep. 2015 Oct 1;16:700-2. doi: 10.12659/AJCR.894636. Citation on PubMed or Free article on PubMed Central
  • Lang DM, Hsieh FH, Bernstein JA. Contemporary approaches to the diagnosis and management of physical urticaria. Ann Allergy Asthma Immunol. 2013 Oct;111(4):235-41. doi: 10.1016/j.anai.2013.07.031. Epub 2013 Aug 20. Citation on PubMed
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