1. Urticaria

2. URticaria is an extremely common allergic disease of skin and mucosa characterized by evanescent localized edema and severe itching.
Definition

3. Wheal

4. Angioedema

5. Etiologic Factors
Physical and chemical factors such as foods, drugs, inhalants and infections.
Diseases such as endocrine and mental factors.
Heredity.
Others.

6. Foods
Fish, shrimp, pea crab,
eggs and milk, etc.

7. Drugs：penicillin, furoxone,
blood serum and vaccine, etc.
Histamine liberators: aspirin, morphine, atropine and vitamine B1, etc.

8. Physical and Chemical Factors
Cold, heat, sunlight, scrape, pressure, mechanical irritation, etc.

9. 1．TypeⅠhypersensitivity(most of urticaria)
Pathomechanism
1．TypeⅠhypersensitivity(most of urticaria)
IgE
Mast cell
Basophile granulocyte
Degranulate, release chemical mediator
Increased capillary permeability, telangiectasia, smooth muscle spasm,increased secretion of glandular organ.
Symptoms (skin and mucosa)

11. Mechanism
2．Type Ⅲ hypersensibility (antigen antibody complex mode): mainly seen when hypersensitive with serum or drugs.
3．non-allergia: induced by some material which can directly irritate mast cells to release histamine and other substances.

12. Histamine Liberators
some simple chemical materials：such as derivations of amine and amidine.
some drugs：such as morphine, codeine, vitamine B1, quinin, papaverine and polymyxin, etc.
idioblast polymer：such as snake venom, bacteriotoxin and peptone, etc.

13. Clinical Manifestation
The primary lesion of urticaria is wheal which causes severe itching, burning or stinging.
Urticaria can be classified into two groups: acute urticaria (lasting no more than 6 weeks) and chronic urticaria.

14. Other Variants of Urticaria
Factitious urticaria
Cholinergic urticaria
Cold urticaria
Serum disease urticaria
Pressure urticaria
Angioedema
Solar urticaria

15. Wheal

16. Factitious urticaria

17. Factitious
urticaria

18. Acute
urticaria

19. Angioedema

20. Angioedema

21. Cholinergic
urticaria

22. Serum disease urticaria

23. Urticaria
eruption

24. Urticaria eruption

25. Laboratory Examination
1. Dermal test
2. Specific IgE mensuration

26. Diagnosis and Differential Diagnosis
Papular
urticaria

27. Treatment 1．Antihistamine drug H1 antihistamines H2 antihistamines
combinatively or alternatively

28. 2．Sympatheticomimetic：
1:1000 adrenalin 0.5-1ml hypodermic injection
Used in acute urticaria, widespread wheal or larynx edema. When in severe case, inject extra 0.5ml after 20 to 30 minutes. Be careful if the patient is suffered from hypertension or cardiac disease.
Oxygen
Used when dyspnea.
Incision of trachea
When necessary.

29. 3．Adrenocortical Hydrocortisone 100200mg iv.gtt
Used in acute intractable situation such as anaphylactic shock, serum disease urticaria, etc.
Prednisone 30－40mg po.

30. 4．Histaglobin：
2ml per ramus，containing 12mg of HGG and 0.15mg of histamine hydrochloride.
Usage：2－4ml im. Once or twice per week. The course of treatment is 4 to 6 times.
Mechanism：induce antihistamine

31. The combination with corticosteroids and antihistamines is inadvisable.
Contraindiction：It shouldn’t be used in patients who are hypersensitive of HGG. When in patients with streptococcus angina or in menstrual period, it should be used prudently.
Side effect：hypoleukia (partly), facial hyperemia, nausea and vomit (very few) ,etc. When it happens the treatment should be ended.

32. 5．Antibiotics or sulfanilamide group：
Refer to urticaria caused by gastrointestinal tract infection, obviourly or delitescently.

33. 6．Aminophylline： usage: 0.1 tid。
mechanism：increase the amount of adenosine cyclophosphate in cells and decrease the release of histamine.

34.  10ml of 10％ Calcium Gluconate Injection，iv.gtt once or twice one day
7．Suplical：
 10ml of 10％ Calcium Gluconate Injection，iv.gtt once or twice one day
Ca2+ can decrease the permeability of blood capillary.
Contraindication:cardiopath

35. 8．Desensitization treatment：
Treat the hypersensitive patients with foregone anaphylactogen.
Hypodermic injection once per week starting with low concentration and low dose ，then increase to thetherapeutical dose to maintain the treatment.
Induce the body to produce block antibody which can prohibit the anaphylactogen from causing allergic response.

36. 9．Antifibrinolysin： 6-amidocaproic（EACA） Usage： 2.0 tid/qid。
Indication：angiaedema and cold urticaria
 The mechanism includes anticoagulation, anticomplement, antianaphylaxis and antiinflammatory.

37. 10．Others： Hydroxychloroquine：0.2Bid，good for solar urticaria.
Atropine, probanthin, ephedrin and vistaril ,etc. Effective for cholinergic urticaria.

38. 11．External therapy： camphor-brimstone-calamine lotion
Cream.Triamcinolone.Co, etc.

39. 12．Traditional Chinese Medicine：
Fangfeng pill,
garter snake itching-
relieving pill

40. Wheal

41. Factitial urticaria

42. Factitial
urticaria

43. Acute
urticaria

44. Angioedema

45. Angioedema

46. Cholinergic
urticaria

47. Serum disease urticaria

48. Urticaria
eruption

49. Urticaria eruption