Urticaria (Hives) Flashcards
Urticaria is the medical name for hives, which is a skin reaction that causes itchy welts, also called wheals. What are wheals (or welts)?
1 - dry itchy cysts
2 - oedematous papules due to dermal swelling
3 - allergic reaction causing a systemic eczema reaction
4 - can be any of the above
2 - oedematous papules due to dermal swelling
- papules are raised skin <0.5cm
Urticaria is the medical name for hives, which is a skin reaction that causes itchy welts, also called wheals. Which of the following is NOT a common symptom patients with urticaria present with?
1 - transient itchy skin (very itchy)
2 - mucosal swelling
3 - present in all layers of the skin superficial dermis
3 - present in all layers of the skin
- typically confined to superficial dermis
- Wheals can be single, multiple, small or large
Urticaria is the medical name for hives, which is a skin reaction that causes itchy welts, also called wheals. Which of the following is NOT a typical cause of urticaria?
1 - allergy
2 - burns
3 - autoimmunity
4 - drugs
5 - diet
6 - infections
2 - burns
Which of the following has been identified as the most common cause of Urticaria?
1 - allergy
2 - autoimmunity
3 - drugs
4 - diet
5 - infections
1 - allergy
Angioedema relates to swelling of the skin. Is this confined to the superficial or deep layers of the skin?
- affects deep layers of the skin
Angioedema relates to swelling of the deep layers of the skin. Does this cause pain?
- yes
- often associated with pain
What had been identified as a key component causing recurrent angioedema?
1 - cytotoxic T cell inhibitor deficiency
2 - B cell inhibitor deficiency
3 - mast cell inhibitor deficiency
4 - C1 esterase inhibitor deficiency
4 - C1 esterase inhibitor deficiency
- only known inhibitor of the complement pathway
All of the following can be used to diagnose patients with angioedema and urticaria, except which one?
1 - history and clinical findings
2 - blood tests
3 - urine analysis
4 - physical and dietary challenges
5 - skin tests and biopsy
3 - urine analysis
- if a patient presents with just angioedema, need to check C1 esterase inhibitor levels
Patients with urticaria typically present to primary care, emergency rooms, dermatologists or allergists. However, typically how long to the wheals/hives lasts for?
1 - <1h
2 - <6h
3 - <12h
4 - <24h
4 - <24h
- episodes can be prolonged though
Patients with urticaria typically present to primary care, emergency rooms, dermatologists or allergists and typically only last up to 24h. Are wheals/hives always accompanied by angiodema?
- no
- urticaria can be alone
- urticaria can include angioedema
- urticaria can include angioedema and anaphylaxis
What is the term given to urticaria when the wheals/hives last >24h?
1 - urticarial vasculitis
2 - angioedemitis
3 - urticarialitis
4 - systemic urticarial
1 - urticarial vasculitis
Although the exact cause of urticaria remains unknown, the following have been identified in the potential pathophysiolohy:
- Mast cell stimulation
- Mast cell independent urticaria
- Prostaglandins
- Cyropyrins (node like receptors, involved in inflammatory pathways)
All of the following have been identified in the aetiology urticaria:
- Immunologic - autoimmune
- IgE dependent (type I)
- Immuno complex (type III)
- Kinin and complement dependant
- Non immunologic –direct mast cell activation(opiates) , vasoactive stimuli (wasp), aspirin, dietary pseudoallergens, ACEI
- Idiopathic
Which of the following is NOT a real classification of urticaria?
1 - hand and foot urticaria
2 - spontaneous urticaria
3 - physical (inducible)
4 - urticarial vasculitis (>24h)
5 - contact urticaria
6 - angioedema without urticaria
7 - distinctive urticarial syndromes
1 - hand and foot urticaria
Which of the following is the definition of chronic urticaria?
1 - lasting >6 weeks
2 - lasting >6 weeks at least twice a week
3 - lasting >12 weeks
4 - lasting >12 weeks at least once a week
2 - lasting >6 weeks at least twice a week
- <6 weeks it is called episodic /recurrent urticaria
Ordinary/spontaneous urticaria can be acute and is commonly seen in which age group with atopic dermatitis (eczema)?
1 - babies
2 - young children
3 - teenagers
4 - adults
2 - young children
Ordinary/spontaneous urticaria can be chronic and typically peaks at what age?
1 - 2nd decade
2 - 3rd decade
3 - 4th decade
4 - 5th decade
3 - 4th decade
Urticaria can occur any time, but is it more common during the day or evening?
- evening
Urticaria can be associated with all of the following, EXCEPT which one?
1 - pre-menstrual exacerbations
2 - fatigue
3 - osteoporosis
4 - chills
5 - arthralgia
3 - osteoporosis
Which of the following conditions are associated with urticaria?
1 - Thyroid disease
2 - Vitiligo
3 - Insulin dependent diabetes
4 - Rheumatoid arthritis
5 - Pernicious anaemia
6 - Helicobacter pylori
7 - Strongyloidiasis
8 - all of the above
8 - all of the above
- strong autoimmune component
Physical/inducible urticaria can be caused by exogenous stimuli. This can include which of the following?
1 - mechanical (dermographism, delayed pressure urticaria, vibratory)
2 - Temperature – heat, cold
3 - Sweat, stress- cholinergic, adrenergic, exercise induced
4 - Solar urticaria (heat)
5 - Aquagenic urticaria (water)
6 - all of the above
6 - all of the above
Dermographism can be:
- Simple or symptomatic
- Whealing occurs in response to gentle skin stroking
- Resolves in an hour
- No association with atopy
- Delayed dermographism
Delayed pressure urticaria is another form of urticaria. Which of the following is NOT correct about this form of urticaria?
1 - deep erythematous swellings at sites of sustained pressure
2 - 30 seconds to 12 minutes
3 - pruritic/painful or both
4 - tight clothing , soles – after walking
5 - flu like symptoms, arthralgia
6 - vibratory angioedema
2 - 30 seconds to 12 minutes
- typically occurs between 30 minutes to 12 hours
Urticaria due to temperature changes is another form of urticaria. Does heat urticaria typically occur quickly or slowly?
- quickly
- within minutes, can last hours
Cholinergic urticaria is a form of urticaria caused by the sweat and are typically associated with stress. Which of the following occur?
1 - transient, papular 2-3 mm wheals with surrounding flare
2 - 15 minutes of sweat inducing stimuli
3 - common in young adults
4 - exercise induced anaphylaxis
5 - ood and exercise induced anaphylaxis - gliadin
6 - all of the above
6 - all of the above
- cholinergic urticaria is typically much smaller than standard urticaria
Urticarial vasculitis is a form of urticaria. Which of the following are true about urticarial vasculitis?
1 - lasts for more than 24 hours
2 - can show bruise like skin changes
3 - burning than itching
4 - arthralgia, renal, ocular changes
5 - aistology – vasculitis
6 - all of the above
6 - all of the above
All of the following can be used to diagnose acute urticaria, EXCEPT which one?
1 - IgE test
2 - IgG test
3 - RAST screen
4 - skin prick test
2 - IgG test
Rast = Radioallergosorbent test, a laboratory test performed on blood. It tests for the amount of specific IgE antibodies in the blood which are present if there is a “true” allergic reaction.
All of the following can be used to diagnose chronic urticaria, EXCEPT which one?
1 - skin prick test
2 - ESR
3 - CRP
4 - thyroid autoantibodies
1 - skin prick test
- often autoimmune so can use this to diagnose patients
How is physical urticaria diagnosed?
1 - skin prick test
2 - ESR
3 - CRP
4 - challenged with potential agent they came into contact with
4 - challenged with potential agent they came into contact with
How is Urticarial vasculitis diagnosed?
1 - skin prick test
2 - ESR
3 - CRP
4 - skin biopsy
4 - skin biopsy
How is angioedema without wheals diagnosed?
1 - low C4 level and/or C1 inhibitor levels
2 - ESR
3 - CRP
4 - skin biopsy
1 - low C4 level and/or C1 inhibitor levels
What is typically the 1st line treatment for urticaria?
1 - prednisolone
2 - cyclosporine
3 - methotrexate
4 - antihistamines
4 - antihistamines
- fexofenadine is 1st line
- Classic antihistamines –sedation
- Second generation antihistamines, preferred choice as no sedation
- H1 and H2 antihistamines
Which of the following is typically NOT a 2nd line treatment for urticaria?
1 - prednisolone
2 - Epinephrine (if anaphylaxis)
3 - Montelukast
4 - Antihistamines
4 - Antihistamines
- prednisolone only in short courses, but is 1st out of the 3
Which of the following is NOT a non-drug therapy that can be used to treat urticaria?
1 - Exclusion of food additives, salicylates
2 - Tolerance by repeated exposure
3 - Ultraviolet light
4 - Exercise
4 - Exercise
Which of the following is NOT a 3rd line therapy for urticaria?
1 - Cyclosporine
2 - Flumazenil
3 - Methotrexate
4 - Mycophenolate mofetil
5 - Omalizumab – anti IGE monoclonal antibody
2 - Flumazenil
- benzodiazepine antagonist
If a patient is diagnosed with C1 esterase inhibitor deficiency, which of the following can be used to treat them?
1 - C1 concentrate for emergency use
2 - Fresh frozen plasma
3 - given as prophylaxis 1 hr before surgery
4 - oral tranexamic acid
5 - avoid oestrogen –OCP/HRT
6 - all of the above
5 - all of the above
If a patient has been diagnosed with angioedema, which of the following should be used in their management?
1 - ABCDE
2 - Stop any trigger
3 - Antihistamines
4 - Steroids
5 - all of the above
5 - all of the above
- can lead to anaphylaxis, asphyxia, cardiac arrest and death
Once treated, typically how long before angioedema resolves?
1 - 1-3h
2 - 1-3 days
3 - 1-3 weeks
4 - 1-3 months
2 - 1-3 days
