345 Urticaria, Angioedema

Question 1

Tendency to manifest asthma, rhinitis, urticaria and atopic dermatitis

Answer 1

Atophy

Question 2

Process that prepares mast cells and basophils for subsequent antigen specific activation

Answer 2

Sensitization

Question 3

Dilation of vascular structures in the superficial dermis

Answer 3

Urticaria

Question 4

Dilation from deeper dermis and subcutaneous tissues

Answer 4

Angioedema

Question 5

Acute vs chronic angioedema

Answer 5

Acute occurs less than 6 weeks

Chronic persisting for more than 6 weeks

Question 6

Lifespan most common for chronic urticaria/angioedema

Answer 6

3rd to 5th decade

Question 7

Most common cause of chronic urticaria

Answer 7

Idiopathic

Question 8

Acute Urticaria most often result from what?

Answer 8

Exposure to food, environmental or drug allergen or viral infection

Question 9

Appearance of linear wheal with surrounding erythema at the site of a brisk stroke with a firm object

Answer 9

Dermographism

Question 10

Lifespan commonly affected by dermographism

Answer 10

2nd to 3rd decade

Question 11

Presents in response to a sustained stimulus such as shoulder strap or belt, running, or manual labor

Answer 11

Pressure urticaria

Question 12

Time with greatest propensity to develop atopic allergy

Answer 12

Childhood and early adolescence

Question 13

Modulates T cell phenotype

Answer 13

IL 4

Question 14

When can angioedema without urticaria develop

Answer 14

C1 inhibitor deficiency

Question 15

Most common site of angioedema

Answer 15

Periorbital and perioral

Question 16

True or false: no residual scarring occur in Urticaria and angioedema unless there is an underlying Vasculitic process

Answer 16

True

Question 17

Pruritic wheals are of small size 1-2 mm and surrounded by a large area of erythema; attacks precipitated by fever, hot bath, or shower or exercise attributed to rice in body temperature

Answer 17

Cholinergic Urticaria

Question 18

Precipitated by exertion

Answer 18

Exercise induced anaphylaxis

Question 19

True or false: there is an association with presence of IgE specific for alpha 5 gliadin in wheat

Answer 19

True

Question 20

Best evidence for IgE and mast cell involvement in Urticaria and angioedema

Answer 20

Cold urticaria

Question 21

True or false: 15% of patient with chronic urticaria have an autoimmune cause for their disease

Answer 21

False. 45%

Question 22

Full penetrant autosomal dominant disease due to mutation in SERPING1 gene leading to a deficiency in C1INH type 1

Answer 22

Hereditary angioedema

Question 23

Third less common type of HAE has normal C1INH but mutant form of what leading to excessive bradykinins

Answer 23

Factor XII

Question 24

Suggested by lack of pruritus and of urticaria lesions and prominent recurrebt gastrointestinal attacks of colic and episodes of laryngeal edema

Answer 24

Hereditary angioedema (HAE)

Question 25

Concomitant flushing and hyperpigmented papules that urticate with stroking in the absence of angioedema raise the question of mastocytosis

Answer 25

Mastocytosis

Question 26

Types of HAE. Deficiency of C1INH

Answer 26

Type 1

Question 27

Types of HAE. Nonfunctional protein by a catalytic inhibition assay

Answer 27

Type 2

Question 28

Type of HAE. Normal levels of complement proteins and a factor XII gene mutation

Answer 28

Type 3

Question 29

Used first in the treatment of urticaria

Answer 29

H1 antihistamines like: diphenhydramine, loratadine, desloratidine, fexifenadine, cetirizine, Levocetirizine

Question 30

Added when H1 antihistamines are Inadequate

Answer 30

H2 antihistamines: ranitidine, cimetidine, famotidine

Question 31

Important add on therapy in treatment of urticaria and angioedema

Answer 31

CysLT1 receptor antagonist: Montelukast and zafirlukast

Question 32

Given when long acting antihistamines and CysLT receptor antagonist fail

Answer 32

Monoclonal anti IgE antibodies: omalizumab

Question 33

When are systemic glucocorticoids useful?

Answer 33

Pressure urticaria Vasculitic urticaria Idiopathic angioedema Chronic urticaria

Question 34

Given to patient with chronic urticaria that is severe and poorly responsive to other modalities

Answer 34

Cyclosporine

Question 35

May be used in acute attack of HAE

Answer 35

Bradykinin 2 receptor antagonist: Icatibant | Kallikrein inhibitor: Ecallantide

Question 36

How many patient with allergic rhinitis manifest asthma?

Answer 36

50%

Question 37

How many percent of individuals with asthma and chronic bilateral sinusitis have allergic rhinitis

Answer 37

70-80%

Question 38

Hallmarks of allergic rhinitis

Answer 38

Episodic rhinorrhea, sneezing, obstruction of the nasal passages with lacrimarion, pruritus of the conjunctiva, nasal mucosa and oropharynx

Question 39

Seasonal allergic rhinitis characterized by oropharyngeal pruritus and or mild swelling following the ingestion of raw plant-based foods which contain cross- reacting pollen- related allergens

Answer 39

Pollen associated food allergen syndrome

Question 40

Occurs in middle decades of life and is characterized by nasal obstruction, anosmia, chronic sinusitisand prominent eosinophilic nasal discharge in the absence of allergen sensitization

Answer 40

Perennial nonallergic rhinitis with eosinophilia syndrome (NARES)

Question 41

Most cost effective means of managing allergic rhinitis

Answer 41

Allergen avoidance

Question 42

Most potent drugs available for relief of established rhinitis, seasonal or perennial and effective in relieving nasal congestion as well as ocular symptoms

Answer 42

Intranasal glucocorticoids

Question 43

Most frequent side effect of intranasal glucocorticoids

Answer 43

Local irritation

Question 44

Examples of intranasal glucocorticoids

Answer 44

Beclomethasone, flunisolide, triamcinolone, budesonide, fluticasone propionate, fluticasone furoate, cicloswnide and mometasobe furoate

Question 45

Nasal spray that may benefit nonallergic rhinitis but with dysgeusia adverse effect

Answer 45

Azelastine

Question 46

Duration of alpha adrenergic agents is limite due to what?

Answer 46

Rebound rhinitis | 7-14 days use can lead to rhinitis medicamentosa

Question 47

Approved for treament for both seasonal and perennial rhinitis and it reduced both nasal and ocular symptoms by 20%

Answer 47

CysLT1 blocker: Montelukast

Question 48

Nasal spray that inhibits mast cell degranulation and can be used prophylactically on a continuous basis during the season

Answer 48

Cromolyn sodium nasal spray

Question 49

Anticholinergic agent effective in reducing rhinorrhea including patients with perennial non allergic symptoms

Answer 49

Topical ipatropium

Question 50

Consisted of repeated exposure to gradually increasing concentration of the allergens considered specifically responsible for the symptom complex. What are the two types?

Answer 50

Immunotherapy: subcutaneous and sublingual