Urticaria Flashcards

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1
Q

What is the duration of acute?

A
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2
Q

What is the duration of acute?

A
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3
Q

What is duration of chronic?

A

> 6 wks, 50% resolve in 6 mo, 20% in 12-36 mo, small amount >36 mo

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4
Q

What is the recurrance rate of chronic urticaria?

A

25-40%

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5
Q

What is the etiology of urticaria?

A
Idiopathic
Food/Food additives
Drugs
Physical contact
Insect bites
Hypersensitivity
Infectious diseases
Systemic disease
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6
Q

What are the physical causes of urticaria?

A
Dermatographism
Cold
Pressure
Vibration
Heat 
Sunlight (solar)
Emotional stress
Exercise
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7
Q

What are acute causes of urticaria?

A

Infection (40%)
Drug (10%)
Food (≤ 1%)
Idiopathic (50%)

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8
Q

What is the chronic cause of urticaria?

A

Autoimmune (40-50%)
Chronic Infection (≤5%)
Idiopathic (50%)

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9
Q

Who gets acute urticaria?

A

common in children

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10
Q

Who gets chronic urticaria?

A

4th to 5th decades, women

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11
Q

What labs do you want for urticaria?

A

CBC; Sed rate; Thyroid panel; ANA; RF; serology- Hep B

Parasitology

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12
Q

What skin testing do you do?

A

allergic extracts, screening for dermatographism

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13
Q

When do you get skin biopsy?

A

urticaria vasculitis

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14
Q

What is the tx for life threatening urticaria?

A

ED for resuscitation

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15
Q

What are the meds for urticaria?

A
Oral Histamines
H1 blocker 1st generation 
Hydroxyzine 25 mg Po q 6 hrs
Diphenhydramine 25-50 mg PO q 6-8 hrs
H1 blocker 2nd generation 
Loratadine 10 mg qd
Cetirizine 10 mg qd
Fexofenadine 180 mg
H2 blockers
Cimetidine (Tagamet) 300 mg 4 x a day (or 800 mg qd)
Famotidine (Pepcid) 40 mg qd
Ranitidine (Zantac) 150 mg BID (or 300 mg qd)
Tricyclic antidepressant/ antihistamine
Doxepin (Sinequan)10-25 mg q 3-4 times a day (or 25-50 mg qd)
Glucocorticoids
Prednisone 40-60 mg daily x 5 days
Not indicated for long term use
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16
Q

What is the treatment for chronic urticaria?

A

Omalizumab (Xolair)
Monoclonal antibody that binds to IgE and inhibits binding to cell receptors
Doxepin Cream (Zonalon) 5%
Capsaicin

17
Q

When do you give dermatology referral?

A

chronic urticaria and urticarial vasculitis

18
Q

What is the prognosis?

A

acute - excellent - resolves 1-4 days

chronic - variable

19
Q

What is duration of chronic?

A

> 6 wks, 50% resolve in 6 mo, 20% in 12-36 mo, small amount >36 mo

20
Q

What is the recurrance rate of chronic urticaria?

A

25-40%

21
Q

What is the etiology of urticaria?

A
Idiopathic
Food/Food additives
Drugs
Physical contact
Insect bites
Hypersensitivity
Infectious diseases
Systemic disease
22
Q

What are the physical causes of urticaria?

A
Dermatographism
Cold
Pressure
Vibration
Heat 
Sunlight (solar)
Emotional stress
Exercise
23
Q

What are acute causes of urticaria?

A

Infection (40%)
Drug (10%)
Food (≤ 1%)
Idiopathic (50%)

24
Q

What is the chronic cause of urticaria?

A

Autoimmune (40-50%)
Chronic Infection (≤5%)
Idiopathic (50%)

25
Q

Who gets acute urticaria?

A

common in children

26
Q

Who gets chronic urticaria?

A

4th to 5th decades, women

27
Q

What labs do you want for urticaria?

A

CBC; Sed rate; Thyroid panel; ANA; RF; serology- Hep B

Parasitology

28
Q

What skin testing do you do?

A

allergic extracts, screening for dermatographism

29
Q

When do you get skin biopsy?

A

urticaria vasculitis

30
Q

What is the tx for life threatening urticaria?

A

ED for resuscitation

31
Q

What are the meds for urticaria?

A
Oral Histamines
H1 blocker 1st generation 
Hydroxyzine 25 mg Po q 6 hrs
Diphenhydramine 25-50 mg PO q 6-8 hrs
H1 blocker 2nd generation 
Loratadine 10 mg qd
Cetirizine 10 mg qd
Fexofenadine 180 mg
H2 blockers
Cimetidine (Tagamet) 300 mg 4 x a day (or 800 mg qd)
Famotidine (Pepcid) 40 mg qd
Ranitidine (Zantac) 150 mg BID (or 300 mg qd)
Tricyclic antidepressant/ antihistamine
Doxepin (Sinequan)10-25 mg q 3-4 times a day (or 25-50 mg qd)
Glucocorticoids
Prednisone 40-60 mg daily x 5 days
Not indicated for long term use
32
Q

What is the treatment for chronic urticaria?

A

Omalizumab (Xolair)
Monoclonal antibody that binds to IgE and inhibits binding to cell receptors
Doxepin Cream (Zonalon) 5%
Capsaicin

33
Q

When do you give dermatology referral?

A

chronic urticaria and urticarial vasculitis

34
Q

What is the prognosis?

A

acute - excellent - resolves 1-4 days

chronic - variable