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Allergic diseases – anaphylaxis a nd anaphylactoid reactions, urticaria, angioedema, eczema. Małgorzata Sokołowska-Wojdyło MD, MSc, PhD Department of Dermatology, Venereology, Allergology, Medical University of Gdansk, Poland. Anaphylaxis - definition.
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Allergic diseases – anaphylaxis and anaphylactoid reactions, urticaria, angioedema, eczema Małgorzata Sokołowska-Wojdyło MD, MSc, PhD Department of Dermatology, Venereology, Allergology, Medical University of Gdansk, Poland
Anaphylaxis - definition • the maximal variant of the immediate IgE-mediated allergic reaction that affects the entire body • the antigen is either injected or ingested and then spreads via the blood • contact can happened through the mucosal surfaces or the skin also
Etiology • medications • preservatives • dyes • foods • occupational exposure • insect toxins
Etiology • aeroallergens • seminal fluid • echinococcal cysts • cold • warmth • light
Etiology • contact urticaria • C1 INH deficiency • systemic mastocytosis • many of the above factors together • idiopathic (cause unknown)
Anaphylaxis - diagnostic criteria I.Pruritus, flushing, urticaria, angioedema II.Pruritus, flushing, urticaria, angioedema; nausea, cramps; rhinorrhea, hoarseness, dyspnea; tachycardia, hypotension, arrythmias III.Pruritus, flushing, urticaria, angioedema; vomiting, defecation; laryngeal edema, bronchospasm, cyanosis, shock IV.Pruritus, flushing, urticaria, angioedema; vomiting, defecation;respiratory arrest, cardiac arrest
Caution!! In addition to the classic signs of acute urticaria and angioedema, an early clue may be tingling of the tongue, palms, soles and tip of the nose.
Anaphylaxis - investigations • anamnesis (history) and the observation • prick an patch tests • C1 INH blood level test
Anaphylaxis - treatment • standard medications and equipment necessaryto the resuscitation • avoiding the causing factor
An anaphylactoid reaction - refers to the same clinical reaction pattern, but in the absence of an acute type I reaction - differentiation between anaphylaxis and an anaphylactoidreaction - general examination, lab tests, observation - the patient is treated in the same manner
Urticaria - definition • common reaction pattern in which pink,itchy or “burning” swellings can occurr anywhere on the body • individual wheals lasting not longer than 24 h, but new ones continuing to appear for days, months or even years. Urticaria that persists for more than 6 weeks is classified as chronic.
Urticaria - epidemiology • Appearance - 20-30% of individuals have at least one attack of acute urticaria in their lifetime (urticaria is one of the most common skin disorders). • Occasionaly urticaria is combined with angioedema.
Urticaria - cause the signs and symptoms of urticaria are caused by mast cell degranulation, with release of histamine
Urticaria - classification • Physical urticaria: - Cold urticaria - Solar urticaria - Heat urticaria - Cholinergic urticaria - Immediate pressure urticaria - dermographism - Delayed pressure urticaria
Urticaria - classification 2. Hypersensitivity urticaria 3. Autoimmune urticaria 4. Pharmacological urticaria 5. Contact urticaria
Urticaria spectrum Friedman P.S.: Assessment of urticaria and angio-oedema. Clinical an Experimental Allergy, 1998, 29, 109-112
Clinical features and course • Most types of urticaria share the sudden appearance of pink itchy wheals, which can come up anywhere on the skin surface. • The course of an urticarial reaction depends on its triggering factor.
Cold induced urticaria - Ice Cube Test Result Caution! - the linear urticaria along the "running drip", lower right.
What can cause the cholinergic urticaria? • Exercise • Hot baths/showers • Fever • Occlusive dressings • Spicy food • Emotional stress
The reasons of acute urticaria • Medications • Penicillins • NSAIDs • ASA • Cephalosporins • Sulfonamides • Isoniazid • Barbituranes • Carbamazepine 2. Insectantigens ( bee, wasporhornettoxinsfollowingsensitization) 3. Infections and infestations ( parasites, hepatitis B, infectiousmononucleosis, bacterialtoxins)
The reasons of acute urticaria 5. Food - fish, shellfish - coca, chocolate - tonik water - some spices - cheese especially with mould - fruits: strawberries, walnuts, citrus fruits, kiwi - vegetables: peanuts, beans and peas, tomatoes, celery root, dill 5. Animals
Complications • interference with daily activities • sleep disturbances • depression • asthma • asphyxiaction
The investigations • anamnesis, history (especially: prescribed drugs) • general medicalexamination - the physical test • laboratory tests • prick tests • RAST
The differential diagnosis • insect bites or stings • infestations • erythema multiforme • urticarial vasculitis • dermatitis herpetiformis
Urticaria - diagnostics Zuberbier T.: EAACI/GA/LEN/EDF quideline: definition, classification and diagnosois of urticaria. Allergy, 2006,61,316-320
The treatment • to eliminate a cause / triggeringfactors • theantihistaminica (medicaments) • the diet ex. onlyrice, potatoes and water 7 days • themastcellstabilizers ( ketotifen, cromylonsodium) • thedistracters and antipruriticointents and creams • „ theblindtherapy” ( antibiotics, anticandidaldrugs, antifungalagents, antimalarialagents) • systemic steroids, cyclosporine(in case of autologicalurticaria)
Angioedema definition acute subcutaneous edema causing circumsribed irregular cutaneous swelling
Etiology • medications • preservatives • dyes • food • occupational exposure • insect toxins • aeroallergens • seminal fluid