Presentation on theme: "Urticaria. URticaria is an extremely common allergic disease of skin and mucosa characterized by evanescent localized edema and severe itching. Definition."— Presentation transcript:
URticaria is an extremely common allergic disease of skin and mucosa characterized by evanescent localized edema and severe itching. Definition
Etiologic Factors Physical and chemical factors such as foods, drugs, inhalants and infections. Diseases such as endocrine and mental factors. Heredity. Others.
Foods Fish, shrimp, pea crab, eggs and milk, etc.
Drugs ： penicillin, furoxone, blood serum and vaccine, etc. Histamine liberators: aspirin, morphine, atropine and vitamine B 1, etc.
Physical and Chemical Factors Cold, heat, sunlight, scrape, pressure, mechanical irritation, etc.
Pathomechanism 1 ． Type Ⅰ hypersensitivity(most of urticaria) IgE Mast cellBasophile granulocyte Degranulate, release chemical mediator Increased capillary permeability, telangiectasia, smooth muscle spasm,increased secretion of glandular organ. Symptoms (skin and mucosa)
Mechanism 2 ． Type Ⅲ hypersensibility (antigen antibody complex mode): mainly seen when hypersensitive with serum or drugs. 3 ． non-allergia: induced by some material which can directly irritate mast cells to release histamine and other substances.
Histamine Liberators some simple chemical materials ： such as derivations of amine and amidine. some drugs ： such as morphine, codeine, vitamine B 1, quinin, papaverine and polymyxin, etc. idioblast polymer ： such as snake venom, bacteriotoxin and peptone, etc.
The primary lesion of urticaria is wheal which causes severe itching, burning or stinging. Urticaria can be classified into two groups: acute urticaria (lasting no more than 6 weeks) and chronic urticaria. Clinical Manifestation
Other Variants of Urticaria Factitious urticaria Cholinergic urticaria Cold urticaria Serum disease urticaria Pressure urticaria Angioedema Solar urticaria
Serum disease urticaria
1. Dermal test 2. Specific IgE mensuration Laboratory Examination
Papular urticaria Diagnosis and Differential Diagnosis
1 ． Antihistamine drug H 1 antihistamines H 2 antihistamines combinatively or alternatively Treatment
2 ． Sympatheticomimetic ： 1 :1000 adrenalin 0.5-1ml hypodermic injection Used in acute urticaria, widespread wheal or larynx edema. When in severe case, inject extra 0.5ml after 20 to 30 minutes. Be careful if the patient is suffered from hypertension or cardiac disease. Oxygen Used when dyspnea. Incision of trachea When necessary.
3 ． Adrenocortical Hydrocortisone 100 200mg iv.gtt Used in acute intractable situation such as anaphylactic shock, serum disease urticaria, etc. Prednisone 30 － 40mg po.
4 ． Histaglobin ： 2ml per ramus ， containing 12mg of HGG and 0.15mg of histamine hydrochloride. Usage ： 2 － 4ml im. Once or twice per week. The course of treatment is 4 to 6 times. Mechanism ： induce antihistamine
The combination with corticosteroids and antihistamines is inadvisable. Contraindiction ： It shouldn’t be used in patients who are hypersensitive of HGG. When in patients with streptococcus angina or in menstrual period, it should be used prudently. Side effect ： hypoleukia (partly), facial hyperemia, nausea and vomit (very few),etc. When it happens the treatment should be ended.
5 ． Antibiotics or sulfanilamide group ： Refer to urticaria caused by gastrointestinal tract infection, obviourly or delitescently.
6 ． Aminophylline ： usage: 0.1 tid 。 mechanism ： increase the amount of adenosine cyclophosphate in cells and decrease the release of histamine.
7 ． Suplical ： 10ml of 10 ％ Calcium Gluconate Injection ， iv.gtt once or twice one day Ca 2+ can decrease the permeability of blood capillary. Contraindication:cardiopath
8 ． Desensitization treatment ： Treat the hypersensitive patients with foregone anaphylactogen. Hypodermic injection once per week starting with low concentration and low dose ， then increase to thetherapeutical dose to maintain the treatment. Induce the body to produce block antibody which can prohibit the anaphylactogen from causing allergic response.
9 ． Antifibrinolysin ： 6-amidocaproic （ EACA ） Usage ： 2.0 tid/qid 。 Indication ： angiaedema and cold urticaria The mechanism includes anticoagulation, anticomplement, antianaphylaxis and antiinflammatory.
10 ． Others ： Hydroxychloroquine ： 0.2Bid ， good for solar urticaria. Atropine, probanthin, ephedrin and vistaril,etc. Effective for cholinergic urticaria.
11 ． External therapy ： camphor-brimstone-calamine lotion Cream.Triamcinolone.Co, etc.
12 ． Traditional Chinese Medicine ： Fangfeng pill, garter snake itching- relieving pill