Urticaria And Angioedema

Question 1

What is urticaria also known as?

Answer 1

Hives

Question 2

How do you described urticaria?

Answer 2

Transient, red pruritic well demarcated wheals

Question 3

How long does each individual lesion last for hives?

Answer 3

Less than 24 hours

Question 4

What causes urticaria?

Answer 4

Release of histamine from mast cells in dermis
Also from physical contact with allergen

Question 5

What is angioedema?

Answer 5

Deeper swelling of the skin involving subcutaneous tissues, often involves eyes, lips and tongue
May or may not accompany urticaria

Question 6

What are the different types of andioedema?

Answer 6

Hereditary (does not occur with urticaria)
Acquired forms

Question 7

Describe the lesion in urticaria

Answer 7

Erythematous, usually pruritic papule or plaque that appears and disappears over a relatively short period

Question 8

What is the actual disease, urticaria defined as?

Answer 8

Many hives

Question 9

What are the 2 classifications of urticaria?

Answer 9

Acute (<6 weeks)
Chronic (>6 weeks)

Question 10

What are the causes of acute urticaria?

Answer 10

Immunological reaction to medications, foods, contact allergens and insect venoms, viral infection and idiopathic

Question 11

What are the causes of chronic urticaria?

Answer 11

Idiopathic
Autoimmune
Drug induced
Complement mediated
Secondary to a systemic disorder
Foods - rare
Environmental triggers - rare

Question 12

What is the treatment for acute urticaria?

Answer 12

Symptom control with antihistamine

Question 13

What is the treatment for chronic urticaria?

Answer 13

Symptom control with antihistamines
Addition of second line treatment eg leukotrine modifier, cyclosporine or hydroxychloroquine for severe refractiory urticaria

Question 14

What are the clinical findings for urticaria?

Answer 14

Hive is pruritic, raised and often flat topped lesion that’s firm and has a sharp border
Most hives are surrounded by a variably wide, patchy erythema that is mediated by the axon reflex

Question 15

How quickly do hooves develop?

Answer 15

Very quickly, over minutes

Question 16

What are the clinical findings for extensive urticaria?

Answer 16

Hives develop rapidly and scan disappears almost as fast
Most hives disappear over 3-8 hours
Pruritis is usually extreme
Lesions are rubbed, not scratched
Problems become more extreme in the evening

Question 17

Triggers of acute urticaria?

Answer 17

Allergens eg foods, medications
Analgesics or antipyretic agents sometimes also
NSAID
Respiratory or GI infections

Question 18

Clinical findings of acute urticaria?

Answer 18

Hives - extremely pruritic more than chronic form
Flushing
Angioedema
Anaphylaxis
Arthalgias
Fever
Lymphadenopathy

Question 19

What is the diagnostic approach for acute urticaria?

Answer 19

Patient history mainly

Question 20

Prick testing and IgE testing should be used when for urticaria?

Answer 20

Only when and allergic reaction is suspected

Question 21

What is the treatment for acute urticaria?

Answer 21

Nonsedating antihistamine - loratadine 10mg, Bilastine 20mg, Cetirizine 10mg

Sedating antihistamines - clemastinum 10mg

Systemic corticosteroids - prednisolone 50mg daily for 3-5 days

Question 22

What is the definition of chronic urticaria?§

Answer 22

> 6 weeks with new wheals or occasional hive free periods

Question 23

What is a trigger for chronic urticaria?

Answer 23

A substance the patient is occasionally exposed to eg foods like shellfish, peanuts etc

Question 24

What are some causes of chronic urticaria?

Answer 24

• Allergic reactions
• Infections (chronic tonsillitis, sinusitis, and dental abscesses, hepatitis,
Helicobacter pylori infection)
• Autoimmune Diseases (thyroiditis, SLE, rheumatic fever, acute
rheumatoid arthritis)
• Psychoneurologic Factors (stress or depression)
• Pseudoallergies
• Enzyme defects

Question 25

What is a pseudo allergy?

Answer 25

A substance that can elicit an urticaria reactor ion built no specific IgE can be identified

Question 26

What are the types of physical urticaria?

Answer 26

• Dermatographism
• Pressure Urticaria
• Vibratory Angioedema
• Acquired Cold Urticaria
• Heat Urticaria
• Solar Urticaria
• Radiation Urticaria
• Cholinergic Urticaria
• Adrenergic Urticaria
• Contact Urticaria
• Aquagenic Urticaria