This document provides an overview of urticaria and skin allergy tests. It discusses:
1. The goals of understanding the clinical approach to evaluating and treating urticaria, including distinguishing between types of urticaria and treatments.
2. Details on the morphology, pathophysiology, clinical features, diagnosis, and treatment of different types of urticaria such as acute vs chronic urticaria.
3. Descriptions of prick and patch tests used to diagnose allergies, including how they work, what positive and negative results look like, and the testing process.
This document provides information on urticaria (hives), including definitions, epidemiology, pathogenesis, classification, and specific types. Some key points:
- Wheals are central swellings surrounded by erythema that itch or burn and resolve within 24 hours. Angioedema causes swelling below the skin that takes longer to resolve.
- Urticaria prevalence is 15-25% lifetime and chronic urticaria affects 1% annually, more common in adults and women.
- Pathogenesis involves skin mast cell degranulation in response to triggers like allergens, autoantibodies, neuropeptides.
- Classification includes acute (<6 weeks), chronic (>6 weeks),
This document discusses adverse drug reactions and drug hypersensitivities. It begins by noting that adverse drug reactions are commonly found in clinical practice and should be considered for all patients undergoing treatment. It then describes the Gell and Coombs classification of hypersensitivities, which distinguishes four types - Type I involves IgE antibodies and causes rapid reactions, Type II involves cytotoxicity, Type III involves immune complex formation, and Type IV involves T cells and causes delayed reactions. The document provides examples of drugs that can cause each type of reaction and cutaneous conditions that may present, such as urticaria, angioedema, and various maculopapular eruptions.
This case involves a 25-year-old woman who presented to the emergency department with shortness of breath and an expanding rash. She has a history of asthma and allergies to aspirin and shellfish. On exam, she was tachypnic, hypertensive, and had periorbital edema and scattered wheals. Her symptoms and history are concerning for anaphylaxis.
This document provides information on different types of allergy tests, including skin prick tests, intradermal tests, serum IgE assays, nasal provocation tests, and bronchial provocation tests. It describes how each test is performed, interpreted, and its advantages and disadvantages. Allergy tests are used to identify specific allergens that may be causing a person's symptoms in order to guide allergen avoidance and immunotherapy treatments. Precautions must be taken with allergy challenge tests due to the risk of systemic allergic reactions.
Allergic disorders are common in children, affecting 15-30% globally. Allergies are caused by an inappropriate immune response to substances called allergens. Common allergic disorders in children include allergic rhinitis, atopic dermatitis, urticaria, insect bites, food allergy, and anaphylaxis. Allergic reactions involve the release of mediators like histamine from immune cells. Treatment focuses on avoidance of triggers, antihistamines, and management of symptoms.
Type 1 2 3 and 4 hypersensitivity reactions
Their mechanism of actions and advantages and disadvantages
Introduction
Categories
Causes
Diagnosis
Signs and symptoms
Urticaria, Angioedema, and Anaphylaxis.pptxJwan AlSofi
This document provides an overview of urticaria, angioedema, and anaphylaxis. It defines the conditions, describes their pathophysiology as being related to mast cell degranulation and mediator release, and classifies them as acute, chronic, physical, or hereditary. Epidemiology, clinical manifestations, diagnostic approach, differential diagnosis, treatment involving antihistamines and epinephrine, and prevention are discussed. Anaphylaxis is emphasized as a medical emergency requiring immediate epinephrine injection and supportive care.
The document discusses urticaria (hives), including its definition, classification as acute or chronic, pathophysiology involving histamine release from mast cells, causes such as allergies, infections, and physical stimuli, associated conditions like angioedema, evaluation through patient history and physical exam, and treatment focusing on identification and avoidance of triggers as well as antihistamines.
This document provides information on urticaria (hives), including definitions, epidemiology, pathogenesis, classification, and specific types. Some key points:
- Wheals are central swellings surrounded by erythema that itch or burn and resolve within 24 hours. Angioedema causes swelling below the skin that takes longer to resolve.
- Urticaria prevalence is 15-25% lifetime and chronic urticaria affects 1% annually, more common in adults and women.
- Pathogenesis involves skin mast cell degranulation in response to triggers like allergens, autoantibodies, neuropeptides.
- Classification includes acute (<6 weeks), chronic (>6 weeks),
This document discusses adverse drug reactions and drug hypersensitivities. It begins by noting that adverse drug reactions are commonly found in clinical practice and should be considered for all patients undergoing treatment. It then describes the Gell and Coombs classification of hypersensitivities, which distinguishes four types - Type I involves IgE antibodies and causes rapid reactions, Type II involves cytotoxicity, Type III involves immune complex formation, and Type IV involves T cells and causes delayed reactions. The document provides examples of drugs that can cause each type of reaction and cutaneous conditions that may present, such as urticaria, angioedema, and various maculopapular eruptions.
This case involves a 25-year-old woman who presented to the emergency department with shortness of breath and an expanding rash. She has a history of asthma and allergies to aspirin and shellfish. On exam, she was tachypnic, hypertensive, and had periorbital edema and scattered wheals. Her symptoms and history are concerning for anaphylaxis.
This document provides information on different types of allergy tests, including skin prick tests, intradermal tests, serum IgE assays, nasal provocation tests, and bronchial provocation tests. It describes how each test is performed, interpreted, and its advantages and disadvantages. Allergy tests are used to identify specific allergens that may be causing a person's symptoms in order to guide allergen avoidance and immunotherapy treatments. Precautions must be taken with allergy challenge tests due to the risk of systemic allergic reactions.
Allergic disorders are common in children, affecting 15-30% globally. Allergies are caused by an inappropriate immune response to substances called allergens. Common allergic disorders in children include allergic rhinitis, atopic dermatitis, urticaria, insect bites, food allergy, and anaphylaxis. Allergic reactions involve the release of mediators like histamine from immune cells. Treatment focuses on avoidance of triggers, antihistamines, and management of symptoms.
Type 1 2 3 and 4 hypersensitivity reactions
Their mechanism of actions and advantages and disadvantages
Introduction
Categories
Causes
Diagnosis
Signs and symptoms
Urticaria, Angioedema, and Anaphylaxis.pptxJwan AlSofi
This document provides an overview of urticaria, angioedema, and anaphylaxis. It defines the conditions, describes their pathophysiology as being related to mast cell degranulation and mediator release, and classifies them as acute, chronic, physical, or hereditary. Epidemiology, clinical manifestations, diagnostic approach, differential diagnosis, treatment involving antihistamines and epinephrine, and prevention are discussed. Anaphylaxis is emphasized as a medical emergency requiring immediate epinephrine injection and supportive care.
The document discusses urticaria (hives), including its definition, classification as acute or chronic, pathophysiology involving histamine release from mast cells, causes such as allergies, infections, and physical stimuli, associated conditions like angioedema, evaluation through patient history and physical exam, and treatment focusing on identification and avoidance of triggers as well as antihistamines.
1. Urticaria and angioedema can be caused by allergic triggers like foods, drugs, infections, insect bites, or physical factors. Chronic urticaria lasts longer than 6 weeks.
2. Chronic urticaria is difficult to determine the cause of and may last for years. Physical urticarias are triggered by environmental stimuli and are often resistant to corticosteroids.
3. Angioedema causes swelling in the deep layers of the skin and tissues. It can be caused by allergic, pseudoallergic, or nonallergic mechanisms. Treatment depends on the mechanism but may include antihistamines, corticosteroids, or epinephrine to prevent air
HYPERSENSITIVITY REACTIONS path and micropptxtejaswi71117
Hypersensitivity reactions occur when the immune system responds inappropriately or excessively to antigens. Coombs and Gell classified hypersensitivities into four types based on their pathogenic mechanisms: Type I involves IgE antibodies and is responsible for immediate hypersensitivity reactions like anaphylaxis; Type II involves cytotoxic antibodies damaging cells; Type III occurs via immune complex deposition; Type IV involves T cell-mediated delayed hypersensitivity seen in contact dermatitis. These classifications systematized the understanding of hypersensitivity reactions.
This document provides an overview of allergic diseases, including their clinical features, investigation, diagnosis and management. It discusses the most common allergic diseases such as urticaria, angioedema, allergic rhinitis, asthma, and anaphylaxis. For each condition, it describes the clinical presentation, pathology, and recommended treatment approaches. It also addresses topics such as the prevalence of allergic diseases, the hygiene hypothesis, allergy testing methods, and general management strategies.
This document provides information on urticaria (hives), including:
- Urticaria is characterized by itchy pink swellings (wheals) that appear on the skin and do not last more than 24 hours. It is classified as acute (<6 weeks) or chronic (>6 weeks).
- Urticaria is caused by mast cell degranulation releasing histamine, causing increased capillary permeability and fluid leakage leading to wheal formation.
- There are different types of physical urticarias triggered by factors like cold, heat, sunlight, pressure, water, etc. Investigation and treatment depends on the identified cause.
- Antihistamines are the main treatment for symptom
This document summarizes different types of urticaria (hives). It describes urticaria as pink, itchy swellings (wheals) that can occur anywhere on the body and last less than 24 hours. It divides urticaria into acute (<6 weeks) and chronic (>6 weeks) forms. It discusses physical urticarias like cold, solar, heat, cholinergic, aquagenic, dermographism, and delayed pressure urticaria. It also covers hypersensitivity, autoimmune, pharmacological, contact, and latex allergy urticaria. The document provides details on presentation, course, complications, differential diagnosis, investigations, and management of different types of urticaria.
This document provides an overview of allergies and hypersensitivity reactions. It defines allergies as conditions caused by an exaggerated immune response, classified them into 4 main types (Type I-IV). Common allergens that cause reactions are discussed, along with risk factors like heredity and environmental exposures. The pathophysiology of allergic reactions is described, involving the release of histamine from mast cells leading to symptoms. Diagnosis involves clinical evaluation, skin testing, and serum testing. Management focuses on medications that block mediators or prevent activation of immune cells, including antihistamines, epinephrine, and corticosteroids.
The document provides information about anaphylaxis including its definition, triggers, risk factors, types of reactions, pathophysiology, signs and symptoms, and diagnostic criteria. Anaphylaxis is a severe, life-threatening allergic reaction that requires prompt medical treatment. Common triggers include foods, medications, insect stings, and latex. Reactions can be uni-phasic, protracted, or bi-phasic. The pathophysiology involves the release of inflammatory mediators from mast cells and basophils via IgE-mediated or non-IgE mediated mechanisms. Signs and symptoms affect multiple organ systems and can include skin issues, respiratory distress, gastrointestinal symptoms and cardiovascular or neurological problems.
Haya is a 47-year-old woman presenting with a 3-day history of widespread, pruritic skin rash with individual lesions lasting around 8 hours. Khalid is a 28-year-old man with a 6-month history of periodic swelling on his body accompanied by itching and raised lesions that disappear within minutes to hours and are worse with exercise or embarrassment. Urticaria is characterized by transient skin or mucosal swellings due to plasma leakage and can be caused by allergies, autoimmunity, drugs, dietary factors, or infections. Treatment involves antihistamines as first-line and corticosteroids, epinephrine, or monoclonal antibodies as later options for severe or
The document discusses hypersensitivity reactions, which occur when the immune system overreacts to substances that are normally harmless. It defines four main types of hypersensitivity reactions:
Type I are immediate reactions mediated by IgE antibodies. Type II involve cytotoxic antibodies against self-cells. Type III occur when antigen-antibody complexes activate the complement system. Type IV are delayed hypersensitivity reactions.
The document provides examples like allergies, transfusion reactions, and serum sickness. It explains the underlying immunology and describes associated symptoms, laboratory tests, and management approaches for different hypersensitivity reactions like rhinitis, asthma, and anaphylaxis.
This document summarizes the five types of hypersensitivity reactions: Type I (immediate/anaphylaxis), Type II (antibody-mediated/cytotoxic), Type III (immune complex-mediated), Type IV (cell-mediated/delayed), and Type V (stimulatory reactions). It provides examples for each type, including allergic reactions like hay fever and hives (Type I), hemolytic disease of the newborn and autoimmune hemolytic anemia (Type II), Arthus reaction and serum sickness (Type III), tuberculin skin test and contact dermatitis (Type IV), and Graves' disease (Type V).
hypersensitivityreactionscld-130203182150-phpapp01.pptxSanskriti Shah
This document provides an overview of hypersensitivity reactions, including their classification and the pathophysiology, etiology, signs/symptoms, diagnosis, and management of different types. It discusses Type I-IV hypersensitivity reactions in detail. Type I reactions involve IgE antibodies and mast cells/basophils, causing immediate allergic reactions. Types II-IV are immune complex-mediated or cell-mediated reactions that occur hours to days after exposure. Diagnostic tests and treatments aim to identify triggers and control inflammation/symptoms through avoidance, medications, immunotherapy, and management of anaphylaxis if needed.
The document discusses allergies and anaphylaxis. It defines allergies as hypersensitive reactions to allergens that come into contact with the skin, nose, eyes, or respiratory/gastrointestinal tracts. Anaphylaxis is a severe allergic reaction that can be life-threatening. The immune system normally produces antibodies to defend against harmful substances, but in allergies it overreacts to harmless substances. Allergic reactions are classified based on their mechanisms and time courses. Type 1 reactions are immediate and IgE-mediated, like anaphylaxis. Skin prick and serum IgE tests can help identify allergens and prevent severe allergic reactions. Proper medical history is important
This document discusses eczema and impetigo. It begins by defining eczema as a common form of skin inflammation that can affect people of any age. Family history and environmental factors can increase risk. The causes of eczema involve dry, sensitive skin and immune system issues. Treatment includes moisturizers, corticosteroids, immunosuppressants, and lifestyle changes. Impetigo is a superficial skin infection most common in children, caused by Staphylococcus or Streptococcus bacteria. It presents as fluid-filled vesicles or crusty yellow lesions. Treatment involves antibiotics like penicillin for 7-10 days.
Allergic rhinitis is a type I hypersensitivity reaction mediated by IgE antibodies. It has a prevalence of 10-20% in the US and is characterized by symptoms like sneezing, rhinorrhea, nasal congestion and pruritus. Risk factors include family history of atopy, environmental exposures, and lifestyle factors. Treatment involves allergen avoidance, pharmacotherapy with antihistamines, intranasal corticosteroids, leukotriene receptor antagonists and immunotherapy for selected patients.
This document provides information on allergies and hypersensitivity reactions. It discusses the four types of hypersensitivity reactions including type I (allergic) reactions mediated by IgE antibodies. Common diseases caused by type I reactions include anaphylaxis, allergic rhinitis, asthma, food allergies, and urticaria. Skin prick tests are described as a technique for diagnosing allergies. Treatment options discussed include symptomatic treatments and immunotherapy/desensitization. Drug allergies and anaphylaxis are also summarized, including symptoms, management, and common triggers.
This document discusses atopic dermatitis (eczema), including its pathophysiology, epidemiology, treatment recommendations, and evidence. Key points:
1. Atopic dermatitis is a chronic, relapsing inflammatory skin disease caused by genetic and immune mechanisms resulting in dry, itchy skin.
2. Treatment recommendations include topical corticosteroids and calcineurin inhibitors based on severity, with more potent topical/oral steroids, phototherapy, immunosuppressants for refractory cases.
3. Evidence suggests ultra-potent topical steroids should not be used continuously for more than 3 weeks to avoid side effects like skin atrophy.
Chronic urticaria lasts longer than 6 weeks and presents as recurrent hives and angioedema occurring more than 3 days a week. It can be classified as inducible or spontaneous. Inducible types are triggered by specific physical stimuli like pressure, cold, heat, or vibration. Chronic urticaria is considered after ruling out look-alike conditions such as urticarial vasculitis and other autoinflammatory syndromes. Its evaluation involves considering potential systemic triggers or underlying causes.
This presentation includes basic of PCOS their pathology and treatment and also Ayurveda correlation of PCOS and Ayurvedic line of treatment mentioned in classics.
1. Urticaria and angioedema can be caused by allergic triggers like foods, drugs, infections, insect bites, or physical factors. Chronic urticaria lasts longer than 6 weeks.
2. Chronic urticaria is difficult to determine the cause of and may last for years. Physical urticarias are triggered by environmental stimuli and are often resistant to corticosteroids.
3. Angioedema causes swelling in the deep layers of the skin and tissues. It can be caused by allergic, pseudoallergic, or nonallergic mechanisms. Treatment depends on the mechanism but may include antihistamines, corticosteroids, or epinephrine to prevent air
HYPERSENSITIVITY REACTIONS path and micropptxtejaswi71117
Hypersensitivity reactions occur when the immune system responds inappropriately or excessively to antigens. Coombs and Gell classified hypersensitivities into four types based on their pathogenic mechanisms: Type I involves IgE antibodies and is responsible for immediate hypersensitivity reactions like anaphylaxis; Type II involves cytotoxic antibodies damaging cells; Type III occurs via immune complex deposition; Type IV involves T cell-mediated delayed hypersensitivity seen in contact dermatitis. These classifications systematized the understanding of hypersensitivity reactions.
This document provides an overview of allergic diseases, including their clinical features, investigation, diagnosis and management. It discusses the most common allergic diseases such as urticaria, angioedema, allergic rhinitis, asthma, and anaphylaxis. For each condition, it describes the clinical presentation, pathology, and recommended treatment approaches. It also addresses topics such as the prevalence of allergic diseases, the hygiene hypothesis, allergy testing methods, and general management strategies.
This document provides information on urticaria (hives), including:
- Urticaria is characterized by itchy pink swellings (wheals) that appear on the skin and do not last more than 24 hours. It is classified as acute (<6 weeks) or chronic (>6 weeks).
- Urticaria is caused by mast cell degranulation releasing histamine, causing increased capillary permeability and fluid leakage leading to wheal formation.
- There are different types of physical urticarias triggered by factors like cold, heat, sunlight, pressure, water, etc. Investigation and treatment depends on the identified cause.
- Antihistamines are the main treatment for symptom
This document summarizes different types of urticaria (hives). It describes urticaria as pink, itchy swellings (wheals) that can occur anywhere on the body and last less than 24 hours. It divides urticaria into acute (<6 weeks) and chronic (>6 weeks) forms. It discusses physical urticarias like cold, solar, heat, cholinergic, aquagenic, dermographism, and delayed pressure urticaria. It also covers hypersensitivity, autoimmune, pharmacological, contact, and latex allergy urticaria. The document provides details on presentation, course, complications, differential diagnosis, investigations, and management of different types of urticaria.
This document provides an overview of allergies and hypersensitivity reactions. It defines allergies as conditions caused by an exaggerated immune response, classified them into 4 main types (Type I-IV). Common allergens that cause reactions are discussed, along with risk factors like heredity and environmental exposures. The pathophysiology of allergic reactions is described, involving the release of histamine from mast cells leading to symptoms. Diagnosis involves clinical evaluation, skin testing, and serum testing. Management focuses on medications that block mediators or prevent activation of immune cells, including antihistamines, epinephrine, and corticosteroids.
The document provides information about anaphylaxis including its definition, triggers, risk factors, types of reactions, pathophysiology, signs and symptoms, and diagnostic criteria. Anaphylaxis is a severe, life-threatening allergic reaction that requires prompt medical treatment. Common triggers include foods, medications, insect stings, and latex. Reactions can be uni-phasic, protracted, or bi-phasic. The pathophysiology involves the release of inflammatory mediators from mast cells and basophils via IgE-mediated or non-IgE mediated mechanisms. Signs and symptoms affect multiple organ systems and can include skin issues, respiratory distress, gastrointestinal symptoms and cardiovascular or neurological problems.
Haya is a 47-year-old woman presenting with a 3-day history of widespread, pruritic skin rash with individual lesions lasting around 8 hours. Khalid is a 28-year-old man with a 6-month history of periodic swelling on his body accompanied by itching and raised lesions that disappear within minutes to hours and are worse with exercise or embarrassment. Urticaria is characterized by transient skin or mucosal swellings due to plasma leakage and can be caused by allergies, autoimmunity, drugs, dietary factors, or infections. Treatment involves antihistamines as first-line and corticosteroids, epinephrine, or monoclonal antibodies as later options for severe or
The document discusses hypersensitivity reactions, which occur when the immune system overreacts to substances that are normally harmless. It defines four main types of hypersensitivity reactions:
Type I are immediate reactions mediated by IgE antibodies. Type II involve cytotoxic antibodies against self-cells. Type III occur when antigen-antibody complexes activate the complement system. Type IV are delayed hypersensitivity reactions.
The document provides examples like allergies, transfusion reactions, and serum sickness. It explains the underlying immunology and describes associated symptoms, laboratory tests, and management approaches for different hypersensitivity reactions like rhinitis, asthma, and anaphylaxis.
This document summarizes the five types of hypersensitivity reactions: Type I (immediate/anaphylaxis), Type II (antibody-mediated/cytotoxic), Type III (immune complex-mediated), Type IV (cell-mediated/delayed), and Type V (stimulatory reactions). It provides examples for each type, including allergic reactions like hay fever and hives (Type I), hemolytic disease of the newborn and autoimmune hemolytic anemia (Type II), Arthus reaction and serum sickness (Type III), tuberculin skin test and contact dermatitis (Type IV), and Graves' disease (Type V).
hypersensitivityreactionscld-130203182150-phpapp01.pptxSanskriti Shah
This document provides an overview of hypersensitivity reactions, including their classification and the pathophysiology, etiology, signs/symptoms, diagnosis, and management of different types. It discusses Type I-IV hypersensitivity reactions in detail. Type I reactions involve IgE antibodies and mast cells/basophils, causing immediate allergic reactions. Types II-IV are immune complex-mediated or cell-mediated reactions that occur hours to days after exposure. Diagnostic tests and treatments aim to identify triggers and control inflammation/symptoms through avoidance, medications, immunotherapy, and management of anaphylaxis if needed.
The document discusses allergies and anaphylaxis. It defines allergies as hypersensitive reactions to allergens that come into contact with the skin, nose, eyes, or respiratory/gastrointestinal tracts. Anaphylaxis is a severe allergic reaction that can be life-threatening. The immune system normally produces antibodies to defend against harmful substances, but in allergies it overreacts to harmless substances. Allergic reactions are classified based on their mechanisms and time courses. Type 1 reactions are immediate and IgE-mediated, like anaphylaxis. Skin prick and serum IgE tests can help identify allergens and prevent severe allergic reactions. Proper medical history is important
This document discusses eczema and impetigo. It begins by defining eczema as a common form of skin inflammation that can affect people of any age. Family history and environmental factors can increase risk. The causes of eczema involve dry, sensitive skin and immune system issues. Treatment includes moisturizers, corticosteroids, immunosuppressants, and lifestyle changes. Impetigo is a superficial skin infection most common in children, caused by Staphylococcus or Streptococcus bacteria. It presents as fluid-filled vesicles or crusty yellow lesions. Treatment involves antibiotics like penicillin for 7-10 days.
Allergic rhinitis is a type I hypersensitivity reaction mediated by IgE antibodies. It has a prevalence of 10-20% in the US and is characterized by symptoms like sneezing, rhinorrhea, nasal congestion and pruritus. Risk factors include family history of atopy, environmental exposures, and lifestyle factors. Treatment involves allergen avoidance, pharmacotherapy with antihistamines, intranasal corticosteroids, leukotriene receptor antagonists and immunotherapy for selected patients.
This document provides information on allergies and hypersensitivity reactions. It discusses the four types of hypersensitivity reactions including type I (allergic) reactions mediated by IgE antibodies. Common diseases caused by type I reactions include anaphylaxis, allergic rhinitis, asthma, food allergies, and urticaria. Skin prick tests are described as a technique for diagnosing allergies. Treatment options discussed include symptomatic treatments and immunotherapy/desensitization. Drug allergies and anaphylaxis are also summarized, including symptoms, management, and common triggers.
This document discusses atopic dermatitis (eczema), including its pathophysiology, epidemiology, treatment recommendations, and evidence. Key points:
1. Atopic dermatitis is a chronic, relapsing inflammatory skin disease caused by genetic and immune mechanisms resulting in dry, itchy skin.
2. Treatment recommendations include topical corticosteroids and calcineurin inhibitors based on severity, with more potent topical/oral steroids, phototherapy, immunosuppressants for refractory cases.
3. Evidence suggests ultra-potent topical steroids should not be used continuously for more than 3 weeks to avoid side effects like skin atrophy.
Chronic urticaria lasts longer than 6 weeks and presents as recurrent hives and angioedema occurring more than 3 days a week. It can be classified as inducible or spontaneous. Inducible types are triggered by specific physical stimuli like pressure, cold, heat, or vibration. Chronic urticaria is considered after ruling out look-alike conditions such as urticarial vasculitis and other autoinflammatory syndromes. Its evaluation involves considering potential systemic triggers or underlying causes.
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urticaria and skin allergy tests.pptx
1. Urticaria and skin allergy tests
Dr. Mohammad Alghamdi
Dermatology and Plastic surgery module
2. Goals and Objectives
The purpose of this lecture is to help medical students develop a clinical approach to the initial
evaluation and treatment of patients with urticaria.
After completing this lecture, the medical student will be able to:
Describe the morphology of urticaria and angioedema
Identify the Pathophysiology of urticaria
Distinguish between acute and chronic urticaria
Distinguish between 1st and 2nd generation H1 antihistamines with regard to
sedation.
Recognize the signs and symptoms of anaphylaxis.
Describe Prick and Patch Tests, methods and uses.
3. Introduction
• Urticaria is a descriptive term for recurrent whealing of the skin
• Urticaria is characterized by transient skin or mucosal swellings due to
plasma leakage.
• Superficial dermal swellings are wheals
• Deep swellings of the skin or mucosa are angioedema
• Anaphylaxis is a serious allergic reaction that is rapid in onset and
may cause death
• Prevalence 8-22%
• Any age
• Female>Male (overall)
• Acute & chronic
4. Wheals
• Pruritic
• Pink or pale swellings of the superficial
dermis
• Initial erythematous flare around them
• Hallmark : individual lesions come and go
rapidly, by definition, in general within 24
hours.
5. Angioedema
• Swellings occur deeper in the dermis and in the
subcutaneous or submucosal tissue.
• May also affect the oropharynx and rarely
the bowel in hereditary angioedema
• Area of involvement tend to be normal or faint
pink in color, rather than red
• Painful rather than pruritic
• Larger and less well defined than wheals
• Often last for 2 to 3 days
6. Pathophysiology
Mast cell dependent Mast cell independent
The mast cell is the major effector cell in urticaria
Immunological Nonimmunological Immunological Nonimmunological
7. Mast cell dependent
Degranulation of mast cells to release its mediators
A. Immunological:
1. Cross-linking of mast cell bound specific immunoglobulin E (IgE) by
exogenous allergens (mostly in acute spontaneous urticaria)
2. Functional IgG autoantibodies against IgE or the high-affinity IgE
receptor
B. Non-Immunological:
1. Direct mast cell releasing agents (eg. C5a, codeine)
2. Dietary food additives and natural salicylates as well as nonsteroidal
anti-inflammatory drugs (NSAIDS) may cause urticaria via the diversion
of arachidonic acid metabolism from prostaglandin to leukotriene
formation
8. Mast cell independent
1. C1 esterase inhibitor (C1 inh) deficiency (hereditary or acquired) will
lead to increased bradykinins
2. Activating mutation in gene that encodes FXII, leading to increased
formation of bradykinin. (Type III HAE)
3. Angiotensin-converting enzyme (ACE) inhibitor-induced urticaria is
believed to result from the inhibition of endogenous kininase II (also
known as ACE), which leads to increased production of bradykinin via
inhibition of its metabolism
4. Immune complex deposition in urticarial vasculitis
5. Prostaglandins in cases of non immunologic contact urticaria
12. Spontaneous (Ordinary) Urticaria
• All urticarias are acute initially
• The term “chronic urticaria" should only be applied to continuous
urticaria occurring at least twice a week off treatment for more than 6
weeks
• Urticaria occurring less frequently than this over a long period is better
called episodic (or recurrent), because this presentation may be more
likely to have an identifiable environmental cause.
13. Acute spontaneous urticaria
• Common in young children with atopic dermatitis
• Multiple pruritic wheals of different sizes erupt anywhere on the body
and then fade within 2–24 hours without bruising
• Angioedema may last up to 72 hours when severe
• Systemic symptoms of fatigue, lassitude, sweats and chills, indigestion,
myalgia or arthralgia may occur with severe attacks, but the occurrence
of pyrexia or arthritis should alert the clinician to another explanation,
such as urticarial vasculitis, Schnitzler syndrome
14.
15. Chronic Spontaneous Urticaria
• Chronic urticaria peaks in the fourth decade
• Has been associated with autoimmune thyroid disease and other
autoimmune conditions
• Possible association with H pylori
• Parasitic infections, such as intestinal strongyloidiasis, are an
uncommon cause of urticaria in developed countries, but may be a
significant problem where they are endemic
16.
17.
18. Dermographism
• skin writing
• most common type of physical
urticaria
• Sharply localized wheal
• Within seconds after skin has been
stroked
19. Cold urticaria
• Primary
(common , idiopathic)
• Secondary
Due to serum abnormalities e.g.
Cryoglobulins
May have other manifestations as
Raynaud’s phenomenon
20. Cholinergic urticaria
• multiple, transient, papular wheals
• Occur within 15 minutes of sweat-
inducing stimuli, such as any form
of physical exertion, hot baths, or
sudden emotional stress
21. Aquagenic urticaria
• Due contact with water
irrespective its temperature
• May be due to water soluble
antigen in the horny layer which
diffuses into the dermis and active
mast cell
23. Contact Urticaria
• Occur when substance is applied to intact skin
• Non immunologic:
1. No prior sensitization
2. May be due to PGD2 rather than histamine (Blocked by NSAID)
3. Eg: Cosmetics, food additives, occupational exposure
• Immunologic:
1. Less common
2. Type I hypersensitivity reaction
3. Eg: latex
24. Diagnosis
• Urticaria is a clinical diagnosis
• Acute urticaria:
1) with no cause is suggested in the history , investigations rarely
provides an answer
2) To identify environmental allergen as a cause Skin prick test,
specific IgE antibodies.
• Chronic urticaria:
1. Inducible urticaria by appropriate testing(25% os CU)
2. Wheal persist, painful with systemic symptom of fever or arthralgia
urticarial vasculitis
3. If angioedema only suspect HAE (C4 level)
25. Diagnosis
Chronic urticaria:
1. CBC : eosinophilia should prompt a search for parasitic disease
2. ESR: elevated suggest an underlying systemic disease
3. H pyloria antigen in stool
4. Stool analysis for parasitic infestations
5. Thyroid autoantibodies and thyroid function tests
26. Treatment
1. Treat the cause ( treat infection , withdraw offending drug)
2. Recognize and avoid aggravating factors Minimize overheating, stress,
avoid NSAIDs, minimize dietary pseudoallergens
3. Pharmacological:
1st line: antihistamines
2nd line: Steroids, Epinephrine, Montelukast, Colchicine, Sulfasalazine, Dapsone
3rd line: Cyclosporine, Omalizumab, Other immunosuppressives
4. Specific treatment for angioedema without wheals (hereditary)
27. Antihistamines
• H1 antihistamines are the first line treatment of all types of urticaria
They are rapidly absorbed, reaching peak serum concentrations in 1–3
hours
• The second generation of potent specific low-sedation H1
antihistamines is now the treatment of choice. Their main advantage is
low sedation at doses recommended
• Taken on a daily basis, the frequency depending on their half-life. In
other words, they should not be taken only when the patient is
symptomatic (Reassess after 2-3 weeks)
• Increasing the dose of second-generation H1 antihistamines up to
fourfold above license in adults when lower doses do not provide
adequate symptom control
28. Antihistamines
• The addition of H2 antagonists to conventional H1 antihistamines may
be helpful in some patients with chronic urticaria, although the
evidence for combining H1 and H2 antihistamines is poor and not all
authorities recommend this therapeutic approach
• No H1 antihistamine can be advertised as being safe during pregnancy,
but recent urticaria guidelines suggest loratadine and cetirizine
(traditional category B drugs) as preferred medications, especially in
the second and third trimesters
29.
30. Systemic Steroids
• Prednisone or prednisolone is effective for nearly all presentations of
chronic urticaria, but often needs to be used at reasonably high doses
(30–50 mg daily) to achieve good initial control of severe disease
• It should be considered primarily for the short-term management of
“crisis" urticaria and serious angioedema of the throat as a rescue
medication, when, often, a single dose or several daily doses will be
sufficient to re-establish control with regular full- dose antihistamines
• Regular treatment with oral corticosteroids should be avoided
31. Epinephrine
• Subcutaneous or intramuscular injection is the treatment of choice for
anaphylactic shock or severe anaphylactoid reactions, whether due to an
allergy, pseudoallergy, or physical urticaria.
• Epinephrine may also be necessary for angioedema of the oropharynx
in severe acute allergic urticaria and idiopathic angioedema
32. Prick test
• Prick/puncture testing remains one of the most
common and popular methods for allergy testing.
• It is an indirect measure of cutaneous mast cell
reactivity due to the presence of specific IgE.
• Mast cells reside in the subepithelial layer of the
skin and the respiratory, nasolacrimal, and
gastrointestinal tracts.
33. Prick test
• Skin testing detects allergen-specific IgE bound to mast
cells.
• The allergen cross-links specific IgE bound on the mast cell.
• This causes degranulation of preformed mediators,
including histamine and tryptase.
34. Prick test
• Histamine release is the major
mediator that results in a hive at the
prick site and surrounding
erythema, called a wheal and flare.
35. Patch tests
• used in patients with allergic contact dermatitis, to find out whether their skin
condition may be caused or aggravated by a contact allergy.
• Patch tests are not the same as skin prick tests, which are used to diagnose hay
fever allergy (house dust mite, grass pollens and cat dander).
• Skin prick tests have very limited value for patients with skin rashes.
38. Patch testing
• The appointments
• The first appointment will take about half an hour.
• Tiny quantities of 25 to 150 materials in individual square plastic or
round aluminium chambers are applied to the upper back.
• They are kept in place with special hypoallergenic adhesive tape.
• The patches stay in place undisturbed for 48 hours.
39. Patch testing
• At the second appointment, usually two days later, the patches will be
removed. Sometimes further patches are applied.
• The back is marked with an indelible black felt tip pen or other suitable
marker to identify the test sites.
• These marks must still be visible at the third appointment, usually two days
later (4 days after application).
• The back should be checked and if necessary remarked on several
occasions between the 2nd and 3rd appointments.
40. Patch testing
• The results
• Complete a record form at the second and third appointments (usually 48
and 96 hour readings).
• The result for each test site is recorded. The system we use is as follows:
• Negative (-)
• Irritant reaction (IR)
• Equivocal / uncertain (+/-)
• Weak positive (+)
• Strong positive (++)
• Extreme reaction (+++)