2. Urticaria- A presentation for patients Provided courtesy of UNEV

3. Urticaria

4. Hives or angioedema

5. Hives and angioedema

6. Men and women

7. Young and elderly

8. Urticaria is common Total population Urticaria

9. Urticaria is common Acute UrticariaChronic Urticaria

10. Urticaria http://www.arianapagerussell.com/work/skin/

11. http://www.facebook.com People and animals

12. What happens in the skin?

18. Triggers http://www.kkr.it/de/referenzen.htm?menID=2433,0&grp=1&p=2 © Rolf Neeser http://vitagate.ch/de/schoenheit/hautpflege/juckreiz

19. Triggers http://wallpaperstock.net http://www.pc- modding.biz

20. …. without triggers Chronic Spontaneous Urticaria

21. Causes Infection 26% Intolerance 38% Auto-reactivity 20% No known cause 30% Other 2%

22. Infection

23. Auto-reactivity Zirkulierende MZ Sekeretagoga = Circulating MZ secretagogues

24. Auto-reactivity

25. Intolerance MZ

26. Intolerance

27. ? Infection 26% Intolerance 38% Auto-reactivity 20% No known cause 30% Other 2%

28. Treatment aus: http://memo-an-mich.de/ complete symptom control

29. Treatment 2nd-generation H1-antihistamine Increase dose (up to 4-fold) If after 2 weeks of continued symptoms Systemic steroids in exacerbations, possibly as a brief therapy Symptoms persist after two weeks Symptoms persist after 2 weeks

30. What doesn‘t help.... Cortisone ointments are rarely effective in urticaria and have long-term side effects. Anti-allergic creams and gels penetrate too slowly into the skin to be effective

31. Summary Urticaria is often incredibly annoying and often disfiguring The most common form is chronic spontaneous urticaria Possible causes are infections, food intolerances or autoimmune processes The treatment of choice is: 1.Antihistamines 2.More antihistamines 3.Mast cell inhibition