URTICARIA

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URTICARIA, WHEALS, ALLERGIC RASHES,

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URTICARIA:

Dr. Angelo Smith M.D WHPL URTICARIA

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Urticaria  (from the    urtica , "nettle" from  urere , "to burn “ ) commonly referred to as  hives , is a kind of skin rash notable for pale red, raised, itchy bumps.

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Urticaria Angioedema

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Urticaria , is characterized by transient, itchy, elevated edematous wheals or red papules.

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Wheal # A central swelling, surrounded by erythema. # Itching or burning sensations # The wheal disappear usually within 1-24 h.

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# Pronounced swelling of the lower dermis and subcutis . # Most often found in the lips, eyelids or genitalia. # Itching and sometimes pain. # Resolution can take up to 72h. # It is associated with urticaria in about 40% of cases. Angioedema

classification:

classification Ordinary urticaria- acute , chronic, episodic. Physical urticaria Angioedema Contact urticaria Urticarial vasculitis

Allergic Triggers:

Allergic Triggers Acute Urticaria Drugs - β - lactam antibiotics, sulfonamides, aspirin Foods - milk, eggs, peanuts, sesame, soy wheat, shellfish, fish Food additives Infections Insect bites and stings Contactants and inhalants (includes animal dander and latex) Chronic Urticaria Physical factors cold heat dermatographic pressure solar Idiopathic

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CHRONIC URTICARIA – COMMON CAUSES

Histamine as a Mast Cell Mediator:

Histamine as a Mast Cell Mediator

INFECTIONS:

INFECTIONS viral : herpes simplex, hepatitis B, coxsackie A and B, upper respiratory infections. Bacterial - associated with certain infectious foci: dental caries/abscesses, pharyngitis /tonsillitis, otitis media, occult abscesses, UTI. Parasitic : ascaris , strongyloides , echinococcus , toxocara , fasciola , filaria , schistosoma. Fungal? : candida

Physical urticaria:

Physical urticaria The physical urticarias are characterized by the development of wealing and itching promptly after application of the appropriate physical stimulus. Weals typically fade within 30-60 minutes. The exception is delayed pressure urticaria when the weals take several hours to appear after sustained pressure and can last up to 48 hours.

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Itchy, monomorphic pale or pink wheals on trunk, neck, and limbs – after exercise or a hot shower, spicy food, under too many covers. Anything that raises internal body temperature Physical urticaria – cholinergic (STRESS) Prevalence of 11% in the age group of 16-35 years.

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Physical urticaria-pressure Large painful or itchy red swelling at sites of pressure (soles, palms, or waist) lasting 24 hours or more - application of pressure perpendicular to skin produces red swelling after a latent period of 1 to 4 hours.

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Physical urticaria - Dermographic urticaria Itchy, linear wheals with surrounding bright-red flare at sites of scratching or rubbing. # The most frequent form of physical urticaria. # Affecting mainly young adults # Mean duration 6.5 years

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Physical urticaria - Heat A rare form of urticaria. Induced by direct contact of the skin with warm objects or warm air. The eliciting temperature ranges from 38º C to more than 50 º C .

Physical urticaria- cold:

Physical urticaria- cold Itchy pale or red swelling at sites of contact with cold surfaces or fluids- ten minutes application of an ice pack causes a wheal within five minutes of the removal of ice. ICE CUBE TEST

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More frequent in women than men. Majority is idiopathic, some can also occur as a result of infections, neoplasia or autoimmune diseases. Infectious: syphilis, measles hepatitis ,mononucleosis, HIV.

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Lukewarm water immersion of forearm for Aquagenic urticaria urtication in aquagenic urticaria; should not be performed in patients with a history of aquagenic angioedema or anaphylaxis

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CONTACT URTICARIA Contact urticaria is an important manifestation of natural rubber latex allergy.

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Urticarial Vasculitis

Laboratory Assessment:

Laboratory Assessment Possible tests for selected patients Stool examination for ova and parasites Blood chemistry profile Antinuclear antibody titer (ANA) Hepatitis B and C Skin tests for IgE -mediated reactions Initial tests CBC with differential Erythrocyte sedimentation rate Urinalysis RAST for specific IgE Complement studies: CH 50 Cryoproteins Thyroid microsomal antibody Antithyroglobulin Thyroid stimulating hormone (TSH)

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Skin Prick Test (SPT)

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Positive reaction

Therapy for Urticaria:

Therapy for Urticaria Search for triggers treat the treatable causes Anti-histamines Short-acting (Benadryl, Atarax ) Long-acting (Claritin, Reactine ) Corticosteroids start around 1 mg/kg/day (single or divided doses)

Associated With Other Conditions:

Associated With Other Conditions Collagen vascular disease ( eg , systemic lupus erythematosus ) Complement deficiency, viral infections (including hepatitis B and C), serum sickness, and allergic drug eruptions Chronic tinea pedis Pruritic urticarial papules and plaques of pregnancy (PUPPP) Schnitzler’s syndrome

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