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  1. 1. Dr. Angelo Smith M.D WHPL URTICARIA
  2. 2. • Urticaria (from the  urtica, "nettle" from urere, "to burn“) commonly  referred  to  as hives,  is  a  kind of skin rash notable for pale red, raised, itchy  bumps.
  3. 3. Urticaria Angioedema
  4. 4. Urticaria, is characterized by transient, itchy, elevated edematous wheals or red papules.
  5. 5. Wheal # A central swelling, surrounded by erythema. # Itching or burning sensations # The wheal disappear usually within 1-24 h.
  6. 6. # Pronounced swelling of the lower  dermis and subcutis. # Most often found in the lips, eyelids or  genitalia. # Itching and sometimes pain. # Resolution can take up to 72h. # It is associated with urticaria in about  40% of cases. Angioedema
  7. 7. CLASSIFICATION • Ordinary urticaria- acute , chronic, episodic. • Physical urticaria • Angioedema • Contact urticaria • Urticarial vasculitis
  8. 8. ALLERGIC TRIGGERS • Acute Urticaria • Drugs - β-lactam antibiotics, sulfonamides, aspirin • Foods - milk, eggs, peanuts, sesame, soy wheat, shellfish, fish • Food additives • Infections • Insect bites and stings • Contactants and inhalants (includes animal dander and latex) Chronic Urticaria Physical factors –cold –heat –dermatographic –pressure –solar Idiopathic
  11. 11. INFECTIONS • viral : herpes simplex, hepatitis B, coxsackie A and B, upper respiratory infections. • Bacterial - associated with certain infectious foci: dental caries/abscesses, pharyngitis /tonsillitis, otitis media, occult abscesses, UTI. • Parasitic : ascaris, strongyloides, echinococcus, toxocara, fasciola, filaria, schistosoma. • Fungal? : candida
  12. 12. PHYSICAL URTICARIA The physical urticarias are characterized by the development of wealing and itching promptly after application of the appropriate physical stimulus. Weals typically fade within 30-60 minutes. The exception is delayed pressure urticaria when the weals take several hours to appear after sustained pressure and can last up to 48 hours.
  13. 13. Itchy, monomorphic pale or pink wheals on trunk, neck, and limbs – after exercise or a hot shower, spicy food, under too many covers. Anything that raises internal body temperature Physical urticaria – cholinergic (STRESS) Prevalence of 11% in the age group of 16-35 years.
  14. 14. Physical urticaria-pressure Large painful or itchy red swelling at sites of pressure (soles, palms, or waist) lasting 24 hours or more - application of pressure perpendicular to skin produces red swelling after a latent period of 1 to 4 hours.
  15. 15. Physical urticaria - Dermographic urticaria Itchy, linear wheals with surrounding bright-red flare at sites of scratching or rubbing. # The most frequent form of physical urticaria. # Affecting mainly young adults # Mean duration 6.5 years
  16. 16. Physical urticaria - Heat • A rare form of urticaria. •Induced by direct contact of the skin with warm objects or warm air. •The eliciting temperature ranges from 38º C to more than 50 º C .
  17. 17. PHYSICAL URTICARIA- COLD Itchy pale or red swelling at sites of contact with cold surfaces or fluids- ten minutes application of an ice pack causes a wheal within five minutes of the removal of ice. ICE CUBE TEST
  18. 18. •More frequent in women than men. •Majority is idiopathic, some can also occur as a result of infections, neoplasia or autoimmune diseases. •Infectious: syphilis, measles hepatitis ,mononucleosis, HIV.
  19. 19. Lukewarm water immersion of forearm for Aquagenic urticaria urtication in aquagenic urticaria; should not be performed in patients with a history of aquagenic angioedema or anaphylaxis
  20. 20. CONTACT URTICARIA Contact urticaria is an important manifestation of natural rubber latex allergy.
  21. 21. Urticarial Vasculitis
  22. 22. LABORATORY ASSESSMENT  Possible tests for selected patients  Stool examination for ova and parasites  Blood chemistry profile  Antinuclear antibody titer (ANA)  Hepatitis B and C  Skin tests for IgE-mediated reactions Initial tests CBC with differential Erythrocyte sedimentation rate Urinalysis RAST for specific IgE Complement studies: CH50 Cryoproteins Thyroid microsomal antibody Antithyroglobulin Thyroid stimulating hormone (TSH)
  23. 23. Skin Prick Test (SPT)
  24. 24. Positive reaction
  25. 25. THERAPY FOR URTICARIA • Search for triggers • treat the treatable causes • Anti-histamines • Short-acting (Benadryl, Atarax) • Long-acting (Claritin, Reactine) • Corticosteroids • start around 1 mg/kg/day (single or divided doses)
  26. 26. ASSOCIATED WITH OTHER CONDITIONS • Collagen vascular disease (eg, systemic lupus erythematosus) • Complement deficiency, viral infections (including hepatitis B and C), serum sickness, and allergic drug eruptions • Chronic tinea pedis • Pruritic urticarial papules and plaques of pregnancy (PUPPP) • Schnitzler’s syndrome