Urticaria & Angioedema

Urticaria: Very common Skin disease affected 20% of population at certain time in their life characterized by appearance of wheals or hives with or without angioedema.

Pathogenesis: Histamine is the main mediator that is responsible for wheal production… Degranulation of mast cell… Immunologic Mechanism Type I HSR Type III HSR Non Immunologic Mechanism

Classification of Urticaria: Ordinary urticaria….. Acute urticaria: that disappear in less than 6week. Chronic urticaria: when the lesions recur daily for more than 6 week. Provoking factors: 50% idiopathic Other causes (food & food items, drugs, psych. Upset, chronic d. & chronic infections…..etc)

Ordinary Urticaria

Ordinary Urticaria

ANGIOEDEMA A variant of urticaria that may appear alone or as a part of generalized urticaria. It involve deep dermal tissue & subcutaneous tissue occur at any site mostly periorbital, perioral or genital sometimes to larynx cause hoarseness of the voice, or Asphyxia in severe cases. The lesion of angiooedema usually less demarcated than wheal, less erythematous less itchy or not itchy. Hereditary Angioedema:

ANGIOEDEMA

II. Physical urticaria: Cholinergic urticaria Dermographism Pressure urticaria Solar urticaria Cold urticaria Heat urticaria. Aquagenic urticaria Vibratory urticaria

Dermographisim

III. Urticarial Vasculitis: IV. Papular urticaria: Immune complex disease….urticarial lesions > 24 hr. IV. Papular urticaria: A specific type occurs most com. in children & represent excessive allergic reaction to insect bite..(age 1.5—2 yr) V. Contact urticaria: Application of certain substances to skin as chemical, food, drug, or animal saliva or plants like tomato or potato. VI. Urticaria Pigmentosa (Mastocytosis): Benign proliferation of mast cells present mainly in child, rarely in adult… generalized erythematous or more com. brownish maculopapular or nodular lesion with intermittent mild or sever itching.

Papular Urticaria

Investigations: General: CBP , GSE , ESR , urine & blood sugar, liver & renal function tests. Skin test: commonly used in pt. with chronic urticaria. We must exclude certain disease commonly associated with chronic urticaria as: Chronic suppurative infection esp. sinus infection, UTI, tooth inf., Cholecystitis or Compylobacter. Connective Tissue Diseases. Hyperthyroidism. Intestinal warms. Internal malignancy. Lymphoma. D.M. Pregnancy and Chronic exposure to external allergen.

Treatment: Trivial (disappear spontaneously) Avoid provoking factor which known by good History and examination and by aid of Investigation. Oral antihistamine {main step in Treatment} dose & duration depend on age, weight, severity of the condition & response to the treatment.

H1 BLOCKER: which include Sedative antihistamines: DIPHENHYDRAMINE, HYDROXYZIN, PROMITHAZINE, TRIPROLIDIN, CERIZOLE. Low sedative antihistamine: ASTEMIZOLE,TERFINADIN, LORATIDIN, CETRIZIN. H2 BLOCKER:

3. Acute sever urticaria……. IM antihistamine, I 3. Acute sever urticaria……. IM antihistamine, I.V steroid (hydrocortisone) & S.C. adrenaline. 4. Systemic steroids…. 5. Immunosuppressive….. CYCLOSPORINE, AZATHIOPRIM, METHOTREXATE. 6. Leukotrein receptor antagonist: ZAFILUKAST, MONTELUKAST. 7. Topical Treatment…. topical steroid….. CALAMIN lotion.

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