Urticaria & Angioedema

A Diagnostic and

Therapeutic Approach

Sumadiono

Pediatric Department Faculty of Medicine

Gadjah Mada University Yogyakarta

20% population have urticaria and/or angioedema 50% of these patients have urticaria and

angioedema 40% have only urticaria 10% have only angioedema

Epidemiology

Urticaria vs. Angioedema Urticaria

Elevated, erythematous, oedema of the superficial dermis

Often pruritic wheals Caused by fluid leakage into the

superficial dermis

Angioedema Fluid leakage in the deep dermis

and subcutaneous tissues Nonpitting Often painful or burning

Clinical Classification

Ordinary UrticariaAcute (up to 6 week)Chronic (6 Week or more)Episodic (Intermitten)

Physical UrticariaAquagenic urticariaCholinergic urticariaCold urticaria Delayed pressure urticariaLocalised heat urticariaDermographismeSolar urticariaVibratory angioedema

AngioedemaContact UrticariaUrticarial Vasculitis

Ordinary chronic urticaria

Dermatographism

6

Cholinergic urticaria

Cold urticaria

8

Autoimmune urticaria

9

10

Angioedema

Urticarial vasculitis

Etiology of Urticarial Reactions

• Acute UrticariaDrugs

Foods

Food additives

Viral infections–hepatitis A, B, C

–Epstein-Barr virus

Insect bites and stings

Contactants and inhalants (includes animal dander and latex)

Chronic Urticaria

Physical factors–cold–heat–dermatographi

c–pressure–solar

Idiopathic

16

Allergen Detection

SKIN PRICK TEST

o Most commono Conveniento Safeo Widely accepted

Algorithm Treatment of Chronic Urticaria/Angioedema

Elimination & 2nd H1 antihistamine

Adequate control2nd H1 am + 1st H1 pm

Adequate control 2nd H1 am + 1st H1 pm + H2

Adequate control2nd H1 am + antileukotriene

+/- 1st H1 pm

Reevaluate Dx/Vasculitis, corticosteroid/alternative

Adequate control

Summary-1

• The most common type of swelling in children is acute urticaria/angioedema

• Cause of acute urticaria: IgE-mediated, infections, bites/sting

• Cause of chronic urticaria/angioedema: idiophatic. physical, must be distinguished from urticarial vasculitis

• Recurrent angioedema without urticaria suggest heridatary angioedema

Summary-2:Treatment of Urticaria/Angioedema

• Avoidance of known provoking stimuli

• H1 antihistmanines are the mainstay of treatment

• Difficult cases: combination of 2nd H1 antihistamine, 1st H1 antihistamine, H2 antihistamine, antileukotriene, corticosteroid if needed

• Not responsive/oropharyngeal attacks of hereditary angioedema: must be treated as a medical emergency