Urticaria and Angioedema Flashcards
Define urticaria and angioedema?
U - superficial swelling of the skin (epidermis and mucous membranes) that results in a red, raised, itchy rash
AO - a deeper swelling within in the dermis and submucosal or subcutaneous tissues
Urticaria:
What is also known as?
Describe how they look?
Symptoms?
What mediator cause urticaria?
Lasts 30 mins -24 hrs
Hives
Nettle rash
Red/PALE centre
Raised rash
Wheals - surrounding erythema - varies in size
ITCHY + BURNING
Histamine
Angioedema:
Where can it effect?
Not itchy but what may the patient complain of?
Mediator responsible?
Can last up to 3 days!
Face, oropharynx, genitals, gastrointestinal tract
Painful due to swelling
Bradykinin
Types of urticaria:
What does the following mean?
CSU?
cold urticaria
delayed pressure urticaria
solar urticaria
vibratory urticaria
cholinergic urticaria
contact urticaria
aquagenic urticaria
Spontaneous appearance of wheals/angioedema or both for > 6 weeks due to unknown causes
Inducible urticaria:
cold urticaria - to cold – ice cube test
delayed pressure urticaria - to pressure – dermagraphism
solar urticaria – to sun
vibratory urticaria
cholinergic urticaria – raised body temperature = exercise test
contact urticaria - touch
aquagenic urticaria – exposure to water – water test
Triggers for Urticaria:
Stress and infection,
What medication can trigger urticaria?
What environmental factors?
NSAIDs/opiates
Hot, cold, pressure
REST ON PREVIOUS CARD
thyroid dysfunction electrolyte abnormalities Vit B12, folate, ferritin, VitD H.pylori infection urticarial vasculitis
Investigations:
Clinical history and appearance of rash.
Bloods:
- FBC, U&E’s & LFT’s - baseline
- Why do TFT’s?
- Why do B12 and folate?
Ferritin and iron also cause urticaria!
What blood tests can be done for angioedema?
Provoking Tests:
- What can be done to induce dermatographism?
- What can be done for other types of urticaria?
Patients would be referred for allergy testing - but it is unlikely for CSU.
Hypothyroidism can induce urticaria
B12 and folate deficiency can cause urticaria
C4 and C1 inhibitor levels
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Scratch with wooden spoon/spatula
Ice cube - for cold induced urticaria
Exercise ……
Pressure …..
Water……
Prognosis:
Acute urticaria - respond well to treatment - shortlived/self-limiting
Chronic urticaria:
- Relapsing and remitting
Prognosis:
Acute urticaria - respond well to treatment - shortlived/self-limiting
Chronic urticaria:
- Relapsing and remitting
Treatment:
Avoid triggers!
(1) A non-sedating H1 antihistamine is used - given an example?
(2) Increase dose or add 2nd antihistamine
(3) Leukotriene receptor antagonists:
- Give an example?
(4) Immunosuppression!
What can be given if there is angioedema only?
What should be started if symptoms are very severe?
Cetirizine
Loratadine
2nd gen antihistamines
Tranexamic acid
Corticosteroids
Immunosuppression:
Cyclosporine - how does this work?
Anti-IgE therapy can be started as well - what is the drug called?
Inhibits mast cells and basophil degranulation
Omalizumab
Omalizumab:
Monoclonal antibodies against IgE. How?
Used in CSU and SEVERE asthma
Route?
How long for?
It is expensive so you need to know whether the patient is lilt to benefit from it.
It can also be used at home but comes with pros and cons.
Blocks ability for allergens to bind to IgE on mast cells
SC monthly
6 months
Assessing severity of urticaria:
UAS7 - what does it stand for?
Allows clinicians to determine whether Omatlizumab therapy is needed.
Urticaria Activity Score(UAS7)
