URTICARIA

(LOCAL ANAPHYLACTIC REACTION)

IMMUNOLOGIC REACTION
NON IMMUNOLOGIC REACTION
CLINICAL SIGNS

* SKIN INDURATION
* ERYTHEMA
* PRURITUS
WHEAL AND FLARE MANIFESTATIONS
EPIDEMIOLOGY
ALL AGE
20% OF POPULATION
URTICARIA + ANGIOEDEMA: 49%
URTICARIA ONLY: 40%
ANGIOEDEMA ONLY: 11%


PATHOGENESIS
IMMUNOLOGICAL REACTION
NONIMMUNOLOGICAL REACTION
IMMUNOLOGICAL REACTION
HYPERSENSITIVITY I Rx (anaphylaxis)
HYPERSENSITIVITY II Rx (cytotoxic)
HYPERSENSITIVITY III Rx (immune complex)
HYPERSENSITIVITY IV Rx (cellular)


NONIMMUNOLOGICAL REACTION
IDIOPATHIC
ANAPHYLACTOID
HYPERSENSITIVITY Rx type I

SPESIFIC IgE FIXATION ON MAST CELL
ALLERGEN-ANTIBODI (SPESIFIC IgE)
MAST CELL DEGRANULATION
MEDIATOR RELEASE AND ACTIVATION
VASODILATATION, VASCULAR HYPERPERMEABILITY
LOCAL ERYTHEMA, ERYTHEMA, ITCHING
EARLY AND LATE PHASE ALLERGIC REACTION

LOCAL ANAPHYLAXIS REACTION

HYPERSENSITIVITY type I (IgE)
MOST FREQUENT MECHANISME
CAN BE THE PART OF SYSTEMIC ANAPHYLAXIS
LOCAL VASODILATATION AND HYPERPERMEABILITY

PATHOLOGY
DERMIS EDEMATOUS
SMALL VESSEL DILATATION,
PERIVASCULAR INFILTRATES OF
EOSINOPHILS
NON NECROTIC VASCULITIS
NECROTIC VASCULITIS
PERIVASCULITIS
VARIETY OF INFLAMMATION Rx

ETIOLOGY FACTORS

DRUGS
FOODS and FOODS ADDITIVES
INFECTION
INSECT BITES AND STINGS
CONTACT URTICARIA
PSYCHOGENIC URTICARIA
INHALANT URTICARIA
UNDERLYING SYSTEMIC DISEASE

CLASSIFICATION

* ACUTE URTICARIA
* CHRONIC URTICARIA
* PHYSICAL URTICARIA
ACUTE URTICARIA

MOST FREQUENT TYPE AMONG ATOPIC
POPULATION
SINGLE EPISODE,EXTENSIVE EVALUATION
CHRONIC URTICARIA

PERSISTENT/RECURRENT > 6 WEEKS
SPECIFIC CUASE ONLY IN 20% CASES
EPISODES MAY LAST FROM MONTHS TO YEARS
FEMALE S > MALES
MIDDLE - AGED
NO ASSOCIATION WITH ATOPIC DISEASE
INVOLVING OTHER SYSTEMS:
NAUSEA,VOMITING,CRAMPS,DIARRHEA,
DYSPNEA, MYALGIA


PHYSICAL URTICARIA (1)

* APLICATION OF PHYSICAL STIMULI
* CONFINED TO THE AREA
PRESSURE
EXERCISE
EXTREMES OF TEMPERATURE
PHYSICAL URTICARIA (2)

DERMOGRAPHISM
COLD/HEAT URTICARIA
CHOLINERGIC URTICARIA
SOLAR URTICARIA
AQUAGENIC URTICARIA
DIAGNOSIS

ATOPY IN THE FAMILY
ANTECEDENT ATOPIC DISEASES
ATOPIC MARK
CLINICAL ATOPIC SIGNS and
SYMPTOMS
LABORATORY TEST
ELIMINATION-PROVOCATION TEST
ATOPY IN THE FAMILY

ATOPIC DERMATITIS
BRONCHIAL ASTHMA
ALLERGIC RHINITIS
PARENTS, GRANDPARENTS, SIBLINGS
ANTECEDENT ATOPIC DISEASES

COWS MILK ALLERGY
DIARHEA
ATOPIC DERMATITIS
BRONCHIAL ASTHMA
ALLERGIC RHINITIS
ATOPIC MARK
GEOGRAPHIC TONGUE
DENNIE-MORGAN LINE
SALUTE SIGN
HYPERPIGMENTATION
NASAL CREASE
SUBORBITAL HYPERPIGMENTATION
LABORATORY EXAMINATION

TOTAL IgE LEVEL
IgE SPECIFIC
SERUM EOSINOPHIL COUNT
SKIN PRICK TEST (SPT)
DIFFERENTIAL DIAGNOSIS

PAPULAR URTICARIA
MULTIFORM ERYTHEMA
SCABIES
CELLULITIS
HEREDITERY ANGIONEUROTIC OEDEMA
OTHER FORM OF OEDEMA
PRURIGO
TREATMENT

MILD:
SPONTANEOUS HEALING,+ ANTIHISTAMINE
EXTENSIVE/SEVERE:
ANAPHYILAXIS TREATMENT PROCEDURE
DEPENDS ON THE SEVERITY OF THE DISEASE
MEDICATION FOR CHRONIC URTICARIA
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DRUG DOSAGE
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ANTIHISTAMINE
H1 Hydroxyzin < 6 yr: until 50 mg/day
> 6 yr: 50-100 mg/day
Cyproheptadine 0,25 mg/kgBW/day
H2 Cimetidine 20 mg/kgBW/day

SYMPATHOMIMETIC
Ephedrine 1 mg/yr/time
Salbutamol 0,075 mg/kgBW/day
Terbutaline 0,075 mg/kgBW/day
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