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Habif 6: Urticaria, Angioedema, and Pruritus > Urticaria > Flashcards

Urticaria Flashcards

1
Q

Urticaria vs angioedema

A

Urticaria has edema in the superficial dermis and is well demarcated. Angioedema has edema in the deep dermis or subq and is poorly demarcated

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2
Q

Ddx of urticaria

A 
BP
DH
Drug eruption
Erythema marginatum
Erythema multiforme
Papular urticaria
Pruritic urticaria papules and plaques of pregnancy
Stills disease
Urticaria pigmentosa 
Urticaria vasculitis
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3
Q

Time duration of ordinary and delayed pressure urticaria

A

4-36 hours

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4
Q

Time duration of physical urticaria

A

30 minutes to 2 hr

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5
Q

Time duration of contact urticaria

A

1-2 hrs

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6
Q

Time duration of urticarial vasculitis

A

1-7 days

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7
Q

Chronic vs. acute urticaria

A

6 weeks

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8
Q

What are the three mechanisms for histamine release leading to acute urticaria

A

IgE often due to foods/drugs/inhalants
Complement/immune complex mediated often due to blood products
Nonimmunologic via drugs like aspirin and NSAIDs or histamine containing foods

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9
Q

What medications exacerbate chronic urticaria

A

Aspirin/NSAIDs, penicillin, ACE-I, opiates, EtOH, febrille illness, and stress

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10
Q

What systemic illness should you screen for in chronic urticaria

A

Thyroid autoimmunity, especially in females (can treat even if hypo or euthyroid)

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11
Q

DDx of chronic urticaria

A

Cutaneous lupus, urticarial vasculitis, urticaria pigmentosa, Sweets, Fixed drug eruption, BP, Muckle-Wells (urticaria, deafness, amyloidosis), Schnitzler syndrome (nonpruritic urticaria, IgM gammopathy)

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12
Q

MOA of antihistamines

A

Do not block the release of histamine, but inhibit its vasodilation and vessel fluid loss

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13
Q

Tx options in chronic urticaria

A

Anti-histamines, Doxepin, steroids, Leukotriene modifiers

3rd line agents: IVIG, methotrexate, and omalizumab

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14
Q

Physical urticaria subtypes

A
  1. Aquagenic
  2. Cholinergic
  3. Cold
  4. Delayed pressure
  5. Dermatographism
  6. Exercise induced
  7. Solar
  8. Vibratory
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15
Q

Timeframe of most physical urticarias

A

Brief. attacks lasting 30-120 minutes

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16
Q

Dariers sign

A

Exaggerated triple response seen in dermatographism

  • red line w/in 15 sec
  • broadening erythema
  • wheel with surrounding erythema replaces red line
17
Q

Pressure urticaria tx

A

Usually required prednisone, antihistamines not as effective

18
Q

Presentation of cholinergic urticaria

A

round papular wheels that appear after exercise

19
Q

How to differentiate cholinergic urticaria from exercise induced anaphylaxis

A

Hot water bath with induce the urticaria without the anaphylaxis

20
Q

Two types of cold urticaria

A

Primary (children and young adults) and secondary acquired (people with previous primary cold urticaria who develop persistent wheels with vasculitis on bx)

21
Q

Solar urticaria classification

A

Based on wavelength that induces the urticaria

Those reacting to >400gm wavelength will get hives even through glass

22
Q

Aquagenic pruritus skin findings

A

None, just severe prickling skin discomfort
Tx with topical capsacin
Need to r/o polycythemia rubra vera

23
Q

Syndromes of Angioedema

A
  1. Idiopathic recurrent
  2. Allergic
  3. Medication induced
  4. Hereditary (Type I,II, and III)
  5. Acquired (Types I and II)
  6. Episodic angioedema with eosinophilia (benign)
  7. Thyroid autoimmune
24
Q

Hereditary antioedema substypes

A

Type I: C1 INH protein deficiency
Type II: C1 INH protein dysfunction
Type III: coagulation factor XII gene mutation

25
Q

Acquired angioedema subtypes

A

Type I: lymphoproliferative dz consume C1 INH
Type II: auto-immune (anti C1 INH antibody)
Look for anti-C1q autoantibodies

26
Q

Clinical presentation of hereditary angioedema

A

Late childhood or adolescence, family hx as it is autosomal dominant
Recurrent non-pitting, non-pruritic, non urticarial edema

27
Q

W/u of suspected hereditary angioedema

A

measure serum complement 4, C1-INH (inhibitor)

28
Q

Treatment of hereditary angioedema

A

Attenuated androgens: Danazol, Stanozolol, and oxandrolone

29
Q

Contact urticaria syndrome types

A

Immmunologic (IgE mediated, can see associated rhinitis, laryngeal edema, and GI upset, can confirm dx via RAST)
Nonimmunologic (more common and benign, does not require pre-sensatization)

30
Q

Pemphigoid Gestationis

A

self-limited, autoimmune usually presenting in late pregnancy to immediate post-partum
Tx with steroids and antihistamines
Associated with prematurity and small for age babies

31
Q

PUPPP (pruritic urticarial papules and plaques of pregnancy)

A

Most common in 1st pregnancy
begins in late 3rd trimester or immedicately postpartum
Begins on abdomen and may spread symmetrically to extremities (initial lesions may be confined to striae)
No complciations

32
Q

Atopic eruption of pregnancy

A 
pts with atopic background 
variable morphology (eczematous patches, prurigo nodules, etc)
33
Q

Intrahepatic cholestasis

A

Itchy without rash (skin changes may be due to scratching)
Associated with increased bile acids
May recur with subsequent pregnancies
Increased risk of fetal demise, prematurity, fetal distress
Tx: ursodeoxycholic acid

34
Q

Urticarial vasculitis clinical features

A

Urticaria last 1-7 days (rather than <24hrs)

Not itchy but complain of burning pain

35
Q

Two subtypes of urticarial vasculitis

A

Normocomplement (idiopathic, benign, self-limited) and hypocomplement (more likely to have systemic sx/dz)

36
Q

Serum sickness etiology

A

Following exposure to medication, monocloncal antibody, blood products, or animal derived vaccines
Type III hypersensitivity (immune complex) reaction where these complexes get trapped in vessel walls and activate complement

37
Q

Serum sickness clinical presentation

A

Symptoms appear 8-13 days post exposure and last for 4 days

Morbilliform rash/urticaria are classically seen with fever, malaise, arthralgias, etc

38
Q

Commonly implicated drugs in serum sickness

A

Penicillin, sulfas, Thiouracils, aminosalicylic acid, streptomycin, hydantoins, and cholecystographic dyes

Habif 6: Urticaria, Angioedema, and Pruritus (3 decks)

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