7 Drugs：penicillin, furoxone, blood serum and vaccine, etc.Histamine liberators: aspirin, morphine, atropine and vitamine B1, etc.
8 Physical and Chemical Factors Cold, heat, sunlight, scrape, pressure, mechanical irritation, etc.
9 1．TypeⅠhypersensitivity(most of urticaria) Pathomechanism1．TypeⅠhypersensitivity(most of urticaria)IgEMast cellBasophile granulocyteDegranulate, release chemical mediatorIncreased capillary permeability, telangiectasia, smooth muscle spasm,increased secretion of glandular organ.Symptoms (skin and mucosa)
11 Mechanism2．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.
12 Histamine Liberatorssome simple chemical materials：such as derivations of amine and amidine.some drugs：such as morphine, codeine, vitamine B1, quinin, papaverine and polymyxin, etc.idioblast polymer：such as snake venom, bacteriotoxin and peptone, etc.
13 Clinical Manifestation 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.
14 Other Variants of Urticaria Factitious urticariaCholinergic urticariaCold urticariaSerum disease urticariaPressure urticariaAngioedemaSolar urticaria
25 Laboratory Examination 1. Dermal test2. Specific IgE mensuration
26 Diagnosis and Differential Diagnosis Papularurticaria
27 Treatment 1．Antihistamine drug H1 antihistamines H2 antihistamines combinatively or alternatively
28 2．Sympatheticomimetic： 1:1000 adrenalin 0.5-1ml hypodermic injectionUsed 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.OxygenUsed when dyspnea.Incision of tracheaWhen necessary.
29 3．Adrenocortical Hydrocortisone 100200mg iv.gtt Used in acute intractable situation such as anaphylactic shock, serum disease urticaria, etc.Prednisone 30－40mg po.
30 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
31 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.
32 5．Antibiotics or sulfanilamide group： Refer to urticaria caused by gastrointestinal tract infection, obviourly or delitescently.
33 6．Aminophylline： usage: 0.1 tid。 mechanism：increase the amount of adenosine cyclophosphate in cells and decrease the release of histamine.
34 10ml of 10％ Calcium Gluconate Injection，iv.gtt once or twice one day 7．Suplical： 10ml of 10％ Calcium Gluconate Injection，iv.gtt once or twice one dayCa2+ can decrease the permeability of blood capillary.Contraindication:cardiopath
35 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.
36 9．Antifibrinolysin： 6-amidocaproic（EACA） Usage： 2.0 tid/qid。 Indication：angiaedema and cold urticaria The mechanism includes anticoagulation, anticomplement, antianaphylaxis and antiinflammatory.
37 10．Others： Hydroxychloroquine：0.2Bid，good for solar urticaria. Atropine, probanthin, ephedrin and vistaril ,etc. Effective for cholinergic urticaria.
38 11．External therapy： camphor-brimstone-calamine lotion Cream.Triamcinolone.Co, etc.
39 12．Traditional Chinese Medicine： Fangfeng pill,garter snake itching-relieving pill