Transcript Urticaria.ppt

Urticaria
Definition
URticaria is an extremely common
allergic disease of skin and mucosa
characterized by evanescent
localized edema and severe itching.
Wheal
Angioedema
Etiologic Factors
Physical and chemical factors
such as foods, drugs, inhalants and
infections.
Diseases such as endocrine
and mental factors.
Heredity.
Others.
Foods
Fish, shrimp, pea crab,
eggs and milk, etc.
Drugs：penicillin, furoxone,
blood serum and vaccine, etc.
Histamine liberators: aspirin,
morphine, atropine and vitamine
B1, etc.
Physical and Chemical
Factors
Cold, heat, sunlight,
scrape, pressure,
mechanical irritation, etc.
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)
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.
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.
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.
Other Variants of Urticaria
Factitious urticaria
Cholinergic urticaria
Cold urticaria
Serum disease urticaria
Pressure urticaria
Angioedema
Solar urticaria
Wheal
Factitious urticaria
Factitious
urticaria
Acute
urticaria
Angioedema
Angioedema
Cholinergic
urticaria
Serum disease urticaria
Urticaria
eruption
Urticaria eruption
Laboratory Examination
1. Dermal test
2. Specific IgE mensuration
Diagnosis and
Differential Diagnosis
Papular
urticaria
Treatment
1．Antihistamine drug
H1 antihistamines
H2 antihistamines
combinatively or
alternatively
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.
3．Adrenocortical
Hydrocortisone 100200mg iv.gtt
Used in acute intractable
situation such as anaphylactic
shock, serum disease urticaria,
etc.
Prednisone 30－40mg po.
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
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.
5．Antibiotics or sulfanilamide
group：
Refer to urticaria caused by
gastrointestinal tract infection,
obviourly or delitescently.
6．Aminophylline：
usage: 0.1 tid。
mechanism：increase the
amount of adenosine
cyclophosphate in cells and
decrease the release of histamine.
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
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.
9．Antifibrinolysin：
6-amidocaproic（EACA）
Usage： 2.0 tid/qid。
Indication：angiaedema and cold
urticaria
 The mechanism includes anticoagulation,
anticomplement, antianaphylaxis and
antiinflammatory.
10．Others：
Hydroxychloroquine：0.2Bid，
good for solar urticaria.
Atropine, probanthin,
ephedrin and vistaril ,etc.
Effective for cholinergic
urticaria.
11．External therapy：
camphor-brimstone-calamine lotion
Cream.Triamcinolone.Co, etc.
12．Traditional Chinese Medicine：
Fangfeng pill,
garter snake itching-
relieving pill
Wheal
Factitial urticaria
Factitial
urticaria
Acute
urticaria
Angioedema
Angioedema
Cholinergic
urticaria
Serum disease urticaria
Urticaria
eruption
Urticaria eruption