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Dermatology > Anaphylaxis, Angioedema and Urticaria > Flashcards

Anaphylaxis, Angioedema and Urticaria Flashcards

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Dermatology Board Prep flashcards
1
Q

What is urticaria?

A

Swelling involving the superficial dermis, raising the epidermis.
Itchy wheals

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2
Q

What is another term used for urticaria?

A

Hives

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3
Q

What causes urticaria?

A

A local increase in permeability of capillaries and small venules. Due to a number of inflammatory mediators, especially histamine released from mast cells (also prostaglandins, leukotrienes).

Mediator release can be due to immunological or non-immunological mechanisms.

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4
Q

What do urticaria wheals look like?

A

They can be a few millimetres or several centimetres in diameter, coloured red or white, with or without a surrounding ref flare.

Each wheal may last a few minutes or several hours.

The shape may be round, form rings, map like or giant patches.

Can affect any site of the body.

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5
Q

Is urticaria itchy?

A

Yes and can have a burning like sensation.

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6
Q

What causes urticaria?

A

Acute viral infection - URTI, viral hepatitis
Acute bacterial infection - dental abscess, sinusitis
Food allergy (IgE mediated) - milk, eggs, peanut, shellfish
Drug allergy (IgE mediated) - often an antibiotic, contrast medium, opiates, NSAIDS
Insect bites
Vaccination
Contact - latex
Hereditary

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7
Q

What is angioedema?

A

Swelling involving the dermis and subcutaneous tissues.

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8
Q

Where does angioedema most commonly occur?

A

Eyes
Lips and tongue

In severe cases can occur in the internal lining of upper respiratory tract and intestines

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9
Q

Urticaria only affects the skin, but angioedema can also affect what?

A

Mucosa

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10
Q

What is the mechanism behind the swelling in angioedema?

A

Small blood vessels in the subcutaneous and/ or submucosal tissues leak watery liquid through their walls and cause swelling. (The dame thing happens in urticaria but closer to the skin surface).

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11
Q

What makes up the subcutaneous tissue?

A

Fat, connective tissue, vessels

(Also called adipose tissue)

Connects the dermis to underlying structures

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12
Q

What are the physical signs of angioedema?

A

Red or skin coloured swellings occurring below the surface of the skin.

May or may not be itchy.
Often accompanied by pain and tenderness.

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13
Q

What are the 4 main types of angioedema?

A

Acute allergic
Non-allergic drug reactions
Idiopathic
Hereditary

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14
Q

Why can angioedema be dangerous?

A

In severe cases swelling of the throat or tongue may make it difficult to breath

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15
Q

Does ACE inhibitor angioedema occur with or without urticaria?

A

Without

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16
Q

Acute allergic angioedema occurs almost always with urticaria. True or false?

A

True

17
Q

What is anaphylaxis?

A

Also known as anaphylactic shock- a serious reaction that can come on rapidly and lead to death. It typically includes: bronchospasm, facial and laryngeal oedema, hypotension.

It can present initially with urticaria and angioedema.

18
Q

In anaphylaxis what symptoms can occur associated with the CVS?

A

Chest pains
Rapid or irregular heartbeat
Hypotension

19
Q

In anaphylaxis what symptoms can occur associated with the GI tract?

A

Cramps
Nausea
Vomiting
Diarrhoea

20
Q

What systemic symptoms are associated with anaphylaxis?

A

Confusion
Dizziness
Tremor
Collapse

21
Q

At least how many organ systems should show symptoms of anaphylaxis to make a diagnosis?

A

2

22
Q

How is anaphylaxis treated?

A

Stabilise the airway
IM adrenaline
Corticosteroids
Antihistamines

23
Q

What is Stevens-Johnson syndrome?

A

A rare, serious disorder of the skin and mucous membranes. At least 2 mucosal sites are involved. Skin involvement may be limited or extensive.

Often it begins with flu like symptoms, followed by a painful red or purple rash that spreads and blisters. The top layer of skin dies, sheds then heals.

24
Q

What typically causes Stevens-Johnson syndrome?

A

Reaction to a medication or infection.

25
Q

What distinguishes SJS from erythema multiforme?

A

The extensive necrosis

26
Q

What is death often due to in SJS and TEN?

A

Sepsis
Electrolyte imbalance
Multi system organ failure

27
Q

What drugs can cause SJS?

A

Anti - gout medication e.g allopurinol
Anticonvulsants
Antipsychotics

28
Q

What risk factors are associated with SJS?

A

HIV

SLE

29
Q

SJS usually begins with what symptoms?

A

Fever
Sore throat
Fatigue
Burning eyes

30
Q

What mucosal sites are usually affected in SJS?

A

Mouth and lips almost always.

Genital area and anal region

31
Q

What type of hypersensitivity reaction is SJS?

A

Type IV

32
Q

What is toxic epidermal necrolysis?

A

A potentially life threatening skin disorder. The skin develops a scalded appearance over an extensive area. Some consider TEN to be the severe end of a spectrum of skin disorders which includes SJS

33
Q

What is the most common cause of TEN?

A

A drug reaction - phenytoin, sulphonamides, allopurinol, penicillins, carbamazepine, NSAIDS

34
Q

How is SJS and TEN managed?

A

Stop precipitating factor

Supportive care often in ICU - fluids to rehydrate, pain relief, sterile would dressings

For hypersensitivity immune response: 
IV immunoglobulins
Corticosteroids 
Antihistamines 
Immunosuppressive agents
35
Q

What is erythema multiforme?

A

An acute self limiting inflammatory condition. Mucosal involvement is absent or limited to only one mucosal surface.

36
Q

What is the main precipitating factor or erythema multiforme?

A

Herpes simplex virus

Other infections and drugs can cause it

37
Q

What do erythema multiforme lesions typically look like?

A

Target shape

38
Q

What does a type IV hypersensitivity reaction mean (in the case of SJS and TEN)

A

Cytotoxic T cells attack and kill epithelial cells in the skin epidermis and mucosa

Dermatology (35 decks)

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