DEFINITION
Sheet1
DEFINITION
UrticariaAngioedema
(nettle-rash, hives)(giant urticaria, angioneuroticedema /
Quinckes edema)
lesionPapules/wheals; circumscribedswelling
Lightly erythematous
>>central clearing/blanched
blanched with pressure
locationupper corium ofdeep dermis
the dermissubcutaneous / submucosa layer
sensationprurituspainful, burning
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DEFINITION
UrticariaAngioedema
(nettle-rash, hives)(giant urticaria, angioneuroticedema /
Quinckes edema)
lesionPapules/wheals; circumscribedswelling
Lightly erythematous
>>central clearing/blanched
blanched with pressure
locationupper corium ofdeep dermis
the dermissubcutaneous / submucosa layer
sensationprurituspainful, burning
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Sheet1
DEFINITION
UrticariaAngioedema
(nettle-rash, hives)(giant urticaria, angioneuroticedema /
Quinckes edema)
lesionPapules/wheals; circumscribedswelling
Lightly erythematous
>>central clearing/blanched
blanched with pressure
locationupper corium ofdeep dermis
the dermissubcutaneous / submucosa layer
sensationprurituspainful, burning
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Sheet1
DEFINITION
UrticariaAngioedema
(nettle-rash, hives)(giant urticaria, angioneuroticedema /
Quinckes edema)
lesionPapules/wheals; circumscribedswelling
Lightly erythematous
>>central clearing/blanched
blanched with pressure
locationupper corium ofdeep dermis
the dermissubcutaneous / submucosa layer
sensationprurituspainful, burning
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PATHOPHYSIOLOGY
CLASSIFICATION
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CLASSIFICATION
I.Duration
Acute: < 6 weeks
Chronic: > 6 weeks
II.Ethiology & pathophysiologic mechanism
A.Immunologic
Hypersensitive reaction
B.Anaphylactoic
1.Hereditary Angioedema
2.Histamine liberators
3.Aspirin
C.Physical:
1.Dermatographia ("writing on the skin")
2.Cold urticaria
3.Cholinergic urticaria
4.Heat urticaria
5.Solar urticaria
6.Pressure urticaria & angioedema
7.Vibratory angioedema
8.Aquagenic urticaria
D.Miscellaneous
1.Papular urticaria
2.Urticaria pigmentosa
3.Systemic mastocytosis
4.Infection + urticaria
5.Urticaria with underlying systemic disease
a. Collagen vascular diseases
b. Malignancies
c. Endocrine hormone imbalance
6.Psychogenic factors
7.Idiopathics urticaria & angioedema
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CLASSIFICATION
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CLASSIFICATION
I.Duration
Acute: < 6 weeks
Chronic: > 6 weeks
II.Ethiology & pathophysiologic mechanism
A.Immunologic
Hypersensitive reaction
B.Anaphylactoic
1.Hereditary Angioedema
2.Histamine liberators
3.Aspirin
C.Physical:
1.Dermatographia ("writing on the skin")
2.Cold urticaria
3.Cholinergic urticaria
4.Heat urticaria
5.Solar urticaria
6.Pressure urticaria & angioedema
7.Vibratory angioedema
8.Aquagenic urticaria
D.Miscellaneous
1.Papular urticaria
2.Urticaria pigmentosa
3.Systemic mastocytosis
4.Infection + urticaria
5.Urticaria with underlying systemic disease
a. Collagen vascular diseases
b. Malignancies
c. Endocrine hormone imbalance
6.Psychogenic factors
7.Idiopathics urticaria & angioedema
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CLASSIFICATION
Sheet1
CLASSIFICATION
I.Duration
Acute: < 6 weeks
Chronic: > 6 weeks
II.Ethiology & pathophysiologic mechanism
A.Immunologic
Hypersensitive reaction
B.Anaphylactoic
1.Hereditary Angioedema
2.Histamine liberators
3.Aspirin
C.Physical:
1.Dermatographia ("writing on the skin")
2.Cold urticaria
3.Cholinergic urticaria
4.Heat urticaria
5.Solar urticaria
6.Pressure urticaria & angioedema
7.Vibratory angioedema
8.Aquagenic urticaria
D.Miscellaneous
1.Papular urticaria
2.Urticaria pigmentosa
3.Systemic mastocytosis
4.Infection + urticaria
5.Urticaria with underlying systemic disease
a. Collagen vascular diseases
b. Malignancies
c. Endocrine hormone imbalance
6.Psychogenic factors
7.Idiopathics urticaria & angioedema
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CLASSIFICATION
Sheet1
CLASSIFICATION
I.Duration
Acute: < 6 weeks
Chronic: > 6 weeks
II.Ethiology & pathophysiologic mechanism
A.Immunologic
Hypersensitive reaction
B.Anaphylactoic
1.Hereditary Angioedema
2.Histamine liberators
3.Aspirin
C.Physical:
1.Dermatographia ("writing on the skin")
2.Cold urticaria
3.Cholinergic urticaria
4.Heat urticaria
5.Solar urticaria
6.Pressure urticaria & angioedema
7.Vibratory angioedema
8.Aquagenic urticaria
D.Miscellaneous
1.Papular urticaria
2.Urticaria pigmentosa
3.Systemic mastocytosis
4.Infection + urticaria
5.Urticaria with underlying systemic disease
a. Collagen vascular diseases
b. Malignancies
c. Endocrine hormone imbalance
6.Psychogenic factors
7.Idiopathics urticaria & angioedema
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HYPERSENSITIVITY
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TYPE I
- Ig-E mediated mediator release
- E/ : fish, berries, nut, egg, chocolate, drugs, bee-sting, animal danders/saliva
- Ig-E passive transfer -----> Prausnitz-Kustner rct
- D/ : avoidance-challenge test
skin prich / scratch / intradermal test
serum Ig-E total/specific
Eosinophyl count
TYPE II
Tranfusion Reaction Cytotoxic Ig-G & Ig-M >< isoantigen
Complement activation
C3a & C5a
Mediator release
( Histamine )
TYPE III
Serum sickness : urticaria, arthralgia fever
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TYPE I
- Ig-E mediated mediator release
- E/ : fish, berries, nutch, egg, chocolate, drugs, bee-sting, animal danders/saliva
- Ig-E passive transfer -----> Prausnitz-Kustner rct
- D/ : avoidance-challenge test
skin prich / scratch / intradermal test
serum Ig-E total/specific
Eosinophil count
TYPE II
Tranfusion Reaction Cytotoxic Ig-G & Ig-M >< isoantigen
Complement activation
C3a & C5a
Mediator release
( Histamine )
TYPE III
Serum sickness : urticaria, arthralgia fever
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TYPE I
- Ig-E mediated mediator release
- E/ : fish, berries, nutch, egg, chocolate, drugs, bee-sting, animal danders/saliva
- Ig-E passive transfer -----> Prausnitz-Kustner rct
- D/ : avoidance-challenge test
skin prich / scratch / intradermal test
serum Ig-E total/specific
Eosinophil count
TYPE II
Tranfusion Reaction Cytotoxic Ig-G & Ig-M >< isoantigen
Complement activation
C3a & C5a
Mediator release
( Histamine )
TYPE III
Serum sickness : urticaria, arthralgia, fever
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PATHOPHYSIOLOGY
HEREDITARY ANGIOEDEMA
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HEREDITARY ANGIOEDEMA
1Relative frequency-
2PrecipitantMinor trauma, emotional disorders, infection
sudden temperature change
3Onset-
4Duration2 - 4 days
5Symptomes
a. localrecurrent, angioedema, urticaria (-), non pruritic
b. systemicheadeache, recurrent abdominal pain,
laryngeal edema,
6TestsAsymptomatic : C4 , C2
Attack : C4 (-), C2
CH30 C1 - INH
7MechanismC1-INH deficiency/malfunction
8TreatmentInfusion : C1 - esterase inhibitor concentrate
Analgesics
Endotracheal incubation
shock ---> Intravenous solution
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HEREDITARY ANGIOEDEMA
1Relative frequency-
2PrecipitantMinor trauma, emotional disorders, infection
sudden temperature change
3Onset-
4Duration2 - 4 days
5Symptomes
a. localrecurrent, angioedema, urticaria (-), non pruritic
b. systemicheadeache, recurrent abdominal pain,
laryngeal edema,
6TestsAsymptomatic : C4 , C2
Attack : C4 (-), C2
CH30 C1 - INH
7MechanismC1-INH deficiency/malfunction
8TreatmentInfusion : C1 - esterase inhibitor concentrate
Analgesics
Endotracheal incubation
shock ---> Intravenous solution
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HEREDITARY ANGIOEDEMA
1Relative frequency-
2PrecipitantMinor trauma, emotional disorders, infection
sudden temperature change
3Onset-
4Duration2 - 4 days
5Symptomes
a. localrecurrent, angioedema, urticaria (-), non pruritic
b. systemicheadeache, recurrent abdominal pain,
laryngeal edema,
6TestsAsymptomatic : C4 , C2
Attack : C4 (-), C2
CH30 C1 - INH
7MechanismC1-INH deficiency/malfunction
8TreatmentInfusion : C1 - esterase inhibitor concentrate
Analgesics
Endotracheal incubation
shock ---> Intravenous solution
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HEREDITARY ANGIOEDEMA
1Relative frequency-
2PrecipitantMinor trauma, emotional disorders, infection
sudden temperature change
3Onset-
4Duration2 - 4 days
5Symptomes
a. localrecurrent, angioedema, urticaria (-), non pruritic
b. systemicheadeache, recurrent abdominal pain,
laryngeal edema,
6TestsAsymptomatic : C4 , C2
Attack : C4 (-), C2
CH30 C1 - INH
7MechanismC1-INH deficiency/malfunction
8TreatmentInfusion : C1 - esterase inhibitor concentrate
Analgesics
Endotracheal incubation
shock ---> Intravenous solution
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HEREDITARY ANGIOEDEMA
1Relative frequency-
2PrecipitantMinor trauma, emotional disorders, infection
sudden temperature change
3Onset-
4Duration2 - 4 days
5Symptomes
a. localrecurrent, angioedema, urticaria (-), non pruritic
b. systemicheadeache, recurrent abdominal pain,
laryngeal edema,
6TestsAsymptomatic : C4 , C2
Attack : C4 (-), C2
CH30 C1 - INH
7MechanismC1-INH deficiency/malfunction
8TreatmentInfusion : C1 - esterase inhibitor concentrate
Analgesics
Endotracheal incubation
shock ---> Intravenous solution
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Sheet1
HEREDITARY ANGIOEDEMA
1Relative frequency-
2PrecipitantMinor trauma, emotional disorders, infection
sudden temperature change
3Onset-
4Duration2 - 4 days
5Symptomes
a. localrecurrent, angioedema, urticaria (-), non pruritic
b. systemicheadeache, recurrent abdominal pain,
laryngeal edema,
6TestsAsymptomatic : C4 , C2
Attack : C4 (-), C2
CH30 C1 - INH
7MechanismC1-INH deficiency/malfunction
8TreatmentInfusion : C1 - esterase inhibitor concentrate
Analgesics
Endotracheal incubation
shock ---> Intravenous solution
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Sheet1
HEREDITARY ANGIOEDEMA
1Relative frequency-
2PrecipitantMinor trauma, emotional disorders, infection
sudden temperature change
3Onset-
4Duration2 - 4 days
5Symptomes
a. localrecurrent, angioedema, urticaria (-), non pruritic
b. systemicheadeache, recurrent abdominal pain,
laryngeal edema,
6TestsAsymptomatic : C4 , C2
Attack : C4 (-), C2
CH30 C1 - INH
7MechanismC1-INH deficiency/malfunction
8TreatmentInfusion : C1 - esterase inhibitor concentrate
Analgesics
Endotracheal incubation
shock ---> Intravenous solution
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Sheet1
HEREDITARY ANGIOEDEMA
1Relative frequency-
2PrecipitantMinor trauma, emotional disorders, infection
sudden temperature change
3Onset-
4Duration2 - 4 days
5Symptomes
a. localrecurrent, angioedema, urticaria (-), non pruritic
b. systemicheadeache, recurrent abdominal pain,
laryngeal edema,
6TestsAsymptomatic : C4 , C2
Attack : C4 (-), C2
CH30 C1 - INH
7MechanismC1-INH deficiency/malfunction
8TreatmentInfusion : C1 - INH concentrate
Analgesics
Endotracheal incubation
shock ---> Intravenous solution
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PHYSICAL URTICARIA
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PHYSICAL URTICARIA
1Relative frequencyMost frequent
2PrecipifantStroking skin
3Onsetimmediate minutes
delayed: 3-8 hours
4Durationimmediate: 2-3 hours
delayed: 24-48 hours
5Symptomes
a. localimmediate: erythema, wheal, pruritus +/-
delayed: erythema, wheal, pruritus +/-,
nodule
b. systemicnone
6Testsscratch skin
7Mechanismimmediate: histamine
delayed: ?
8Treatmentantihistamine continuous
1st + 2nd generation
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PHYSICAL URTICARIA
1Relative frequencyMost frequent
2PrecipitantStroking skin
3Onsetimmediate minutes
delayed: 3-8 hours
4Durationimmediate: 2-3 hours
delayed: 24-48 hours
5Symptomes
a. localimmediate: erythema, wheal, pruritus +/-
delayed: erythema, wheal, pruritus +/-,
nodule
b. systemicnone
6Testsscratch skin
7Mechanismimmediate: histamine
delayed: ?
8Treatmentantihistamine continuous
1st + 2nd generation
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PHYSICAL URTICARIA
1Relative frequencyMost frequent
2PrecipifantStroking skin
3Onsetimmediate minutes
delayed: 3-8 hours
4Durationimmediate: 2-3 hours
delayed: 24-48 hours
5Symptomes
a. localimmediate: erythema, wheal, pruritus +/-
delayed: erythema, wheal, pruritus +/-,
nodule
b. systemicnone
6Testsscratch skin
7Mechanismimmediate: histamine
delayed: ?
8Treatmentantihistamine continuous
1st + 2nd generation
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PHYSICAL URTICARIA
1Relative frequencyMost frequent
2PrecipifantStroking skin
3Onsetimmediate minutes
delayed: 3-8 hours
4Durationimmediate: 2-3 hours
delayed: 24-48 hours
5Symptomes
a. localimmediate: erythema, wheal, pruritus +/-
delayed: erythema, wheal, pruritus +/-,
nodule
b. systemicnone
6Testsscratch skin
7Mechanismimmediate: histamine
delayed: ?
8Treatmentantihistamine continuous
1st + 2nd generation
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PHYSICAL URTICARIA
1Relative frequencyMost frequent
2PrecipifantStroking skin
3Onsetimmediate minutes
delayed: 3-8 hours
4Durationimmediate: 2-3 hours
delayed: 24-48 hours
5Symptomes
a. localimmediate: erythema, wheal, pruritus +/-
delayed: erythema, wheal, pruritus +/-,
nodule
b. systemicnone
6Testsscratch skin
7Mechanismimmediate: histamine
delayed: ?
8Treatmentantihistamine continuous
1st + 2nd generation
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PHYSICAL URTICARIA
1Relative frequencyMost frequent
2PrecipifantStroking skin
3Onsetimmediate minutes
delayed: 3-8 hours
4Durationimmediate: 2-3 hours
delayed: 24-48 hours
5Symptomes
a. localimmediate: erythema, wheal, pruritus +/-
delayed: erythema, wheal, pruritus +/-,
nodule
b. systemicnone
6Testsscratch skin
7Mechanismimmediate: histamine
delayed: ?
8Treatmentantihistamine continuous
1st + 2nd generation
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Sheet1
PHYSICAL URTICARIA
1Relative frequencyMost frequent
2PrecipifantStroking skin
3Onsetimmediate minutes
delayed: 3-8 hours
4Durationimmediate: 2-3 hours
delayed: 24-48 hours
5Symptomes
a. localimmediate: erythema, wheal, pruritus +/-
delayed: erythema, wheal, pruritus +/-,
nodule
b. systemicnone
6Testsscratch skin
7Mechanismimmediate: histamine
delayed: ?
8Treatmentantihistamine continuous
1st + 2nd generation
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Sheet1
PHYSICAL URTICARIA
1Relative frequencyMost frequent
2PrecipifantStroking skin
3Onsetimmediate minutes
delayed: 3-8 hours
4Durationimmediate: 2-3 hours
delayed: 24-48 hours
5Symptomes
a. localimmediate: erythema, wheal, pruritus +/-
delayed: erythema, wheal, pruritus +/-,
nodule
b. systemicnone
6Testsscratch skin
7Mechanismimmediate: histamine
delayed: ?
8Treatmentantihistamine continuous
1st + 2nd generation
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PHYSICAL URTICARIA
Dermo / Dermato
Graphism
Writing on the skin
1Relative frequencyMost frequent
2PrecipitantStroking skin
3Onsetimmediate minutes
delayed: 3-8 hours
4Durationimmediate: 2-3 hours
delayed: 24-48 hours
5Symptomes
a. localimmediate: erythema, wheal, pruritus +/-
delayed: erythema, wheal, pruritus +/-,
nodule
b. systemicnone
6Testsscratch skin
7Mechanismimmediate: histamine
delayed: ?
8Treatmentantihistamine continuous
1st + 2nd generation
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COLD URTICARIA/ANGIOEDEMA
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COLD URTICARIA/ANGIOEDEMA
FamilialAcquired
IdiopathicUnderlying disease *
1Relativeraremore commonrare
frequency
2Precipifantcold
3Onsetimmediate: 0-4 hoursfew minutes-
delayed: 9-18 hours
4Duration1-2 hours
5Symptomeserythematous
a. localimmediate: patches/urticaria/angioedemaurticaria/angioedema
papules - nonpruritic,
burning
delayed: deep swelling
b. systemicFever, arthralgias, chills,headache, hypotension,~ underlying desease
headache, myalgias,syncope, wheezing
lekositosis
6Testsapply cold material on skinapply cold material on skinVDRL, abnormal cold-
(-)(+)dependent proteins,
malignant, blood cells
7Mechanismautosomal dominantpassive transfer IgE (IgM)vasculitis ?
in heritancehistamine
delayed: ?
8Treatmentprecipitant avoidance antihistamine desensitization
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COLD URTICARIA/ANGIOEDEMA
FamilialAcquired
IdiopathicUnderlying disease *
1Relativeraremore commonrare
frequency
2Precipifantcold
3Onsetimmediate: 0-4 hoursfew minutes-
delayed: 9-18 hours
4Duration1-2 hours
5Symptomeserythematous
a. localimmediate: patches/urticaria/angioedemaurticaria/angioedema
papules - nonpruritic,
burning
delayed: deep swelling
b. systemicFever, arthralgias, chills,headache, hypotension,~ underlying desease
headache, myalgias,syncope, wheezing
lekositosis
6Testsapply cold material on skinapply cold material on skinVDRL, abnormal cold-
(-)(+)dependent proteins,
malignant, blood cells
7Mechanismautosomal dominantpassive transfer IgE (IgM)vasculitis ?
in heritancehistamine
delayed: ?
8Treatmentprecipitant avoidance antihistamine desensitization
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Sheet1
COLD URTICARIA/ANGIOEDEMA
FamilialAcquired
IdiopathicUnderlying disease *
1Relativeraremore commonrare
frequency
2Precipitantcold
3Onsetimmediate: 0-4 hoursfew minutes-
delayed: 9-18 hours
4Duration1-2 hours
5Symptomeserythematous
a. localimmediate: patches/urticaria/angioedemaurticaria/angioedema
papules - nonpruritic,
burning
delayed: deep swelling
b. systemicFever, arthralgias, chills,headache, hypotension,~ underlying desease
headache, myalgias,syncope, wheezing
lekositosis
6Testsapply cold material on skinapply cold material on skinVDRL, abnormal cold-
(-)(+)dependent proteins,
malignant, blood cells
7Mechanismautosomal dominantpassive transfer IgE (IgM)vasculitis ?
in heritancehistamine
delayed: ?
8Treatmentprecipitant avoidance antihistamine desensitization
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Sheet1
COLD URTICARIA/ANGIOEDEMA
FamilialAcquired
IdiopathicUnderlying disease *
1Relativeraremore commonrare
frequency
2Precipifantcold
3Onsetimmediate: 30' - 4 hoursfew minutes-
delayed: 9 -18 hours
4Duration1-2 hours
5Symptomeserythematous
a. localimmediate: patches/urticaria/angioedemaurticaria/angioedema
papules - nonpruritic,
burning
delayed: deep swelling
b. systemicFever, arthralgias, chills,headache, hypotension,~ underlying desease
headache, myalgias,syncope, wheezing
lekositosis
6Testsapply cold material on skinapply cold material on skinVDRL, abnormal cold-
(-)(+)dependent proteins,
malignant, blood cells
7Mechanismautosomal dominantpassive transfer IgE (IgM)vasculitis ?
in heritancehistamine
delayed: ?
8Treatmentprecipitant avoidance antihistamine desensitization
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Sheet1
COLD URTICARIA/ANGIOEDEMA
FamilialAcquired
IdiopathicUnderlying disease *
1Relativeraremore commonrare
frequency
2Precipifantcold
3Onsetimmediate: 0-4 hoursfew minutes-
delayed: 9-18 hours
4Duration1-2 hours
5Symptomeserythematous
a. localimmediate: patches/urticaria/angioedemaurticaria/angioedema
papules - nonpruritic,
burning
delayed: deep swelling
b. systemicFever, arthralgias, chills,headache, hypotension,~ underlying desease
headache, myalgias,syncope, wheezing
lekositosis
6Testsapply cold material on skinapply cold material on skinVDRL, abnormal cold-
(-)(+)dependent proteins,
malignant, blood cells
7Mechanismautosomal dominantpassive transfer IgE (IgM)vasculitis ?
in heritancehistamine
delayed: ?
8Treatmentprecipitant avoidance antihistamine desensitization
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Sheet1
COLD URTICARIA/ANGIOEDEMA
FamilialAcquired
IdiopathicUnderlying disease *
1Relativeraremore commonrare
frequency
2Precipifantcold
3Onsetimmediate: 0-4 hoursfew minutes-
delayed: 9-18 hours
4Duration1-2 hours
5Symptomeserythematous
a. localimmediate:urticaria/angioedemaurticaria/angioedema
papules, nonpruritic,
burning
delayed: deep swelling
b. systemicFever, arthralgias, chills,headache, hypotension,~ underlying disease
headache, myalgias,syncope, wheezing
lekositosis
6Testsapply cold material on skinapply cold material on skinVDRL, abnormal cold-
(-)(+)dependent proteins,
malignant, blood cells
7Mechanismautosomal dominantpassive transfer IgE (IgM)vasculitis ?
in heritancehistamine
delayed: ?
8Treatmentprecipitant avoidance antihistamine desensitization
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Sheet1
COLD URTICARIA/ANGIOEDEMA
FamilialAcquired
IdiopathicUnderlying disease *
1Relativeraremore commonrare
frequency
2Precipifantcold
3Onsetimmediate: 0-4 hoursfew minutes-
delayed: 9-18 hours
4Duration1-2 hours
5Symptomeserythematous
a. localimmediate: patches/urticaria/angioedemaurticaria/angioedema
papules - nonpruritic,
burning
delayed: deep swelling
b. systemicFever, arthralgias, chills,headache, hypotension,~ underlying desease
headache, myalgias,syncope, wheezing
lekositosis
6Testsapply cold material on skinapply cold material on skinVDRL, abnormal cold-
(-)(+)dependent proteins,
malignant, blood cells
7Mechanismautosomal dominantpassive transfer IgE (IgM)vasculitis ?
in heritancehistamine
delayed: ?
8Treatmentprecipitant avoidance antihistamine desensitization
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Sheet1
COLD URTICARIA/ANGIOEDEMA
FamilialAcquired
IdiopathicUnderlying disease *
1Relativeraremore commonrare
frequency
2Precipifantcold
3Onsetimmediate: 0-4 hoursfew minutes-
delayed: 9-18 hours
4Duration1-2 hours
5Symptomeserythematous
a. localimmediate: patches/urticaria/angioedemaurticaria/angioedema
papules - nonpruritic,
burning
delayed: deep swelling
b. systemicFever, arthralgias, chills,headache, hypotension,~ underlying desease
headache, myalgias,syncope, wheezing
lekositosis
6Testsapply cold material on skinapply cold material on skinVDRL, abnormal cold-
(-)(+)dependent proteins,
malignant, blood cells
7Mechanismautosomal dominantpassive transfer IgE (IgM)vasculitis ?
in heritancehistamine
delayed: ?
8Treatmentprecipitant avoidance antihistamine desensitization
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Sheet1
COLD URTICARIA/ANGIOEDEMA
FamilialAcquired
IdiopathicUnderlying disease *
1Relativeraremore commonrare
frequency
2Precipifantcold
3Onsetimmediate: 0-4 hoursfew minutes-
delayed: 9-18 hours
4Duration1-2 hours
5Symptomeserythematous
a. localimmediate: patches/urticaria/angioedemaurticaria/angioedema
papules - nonpruritic,
burning
delayed: deep swelling
b. systemicFever, arthralgias, chills,headache, hypotension,~ underlying desease
headache, myalgias,syncope, wheezing
lekositosis
6Testsapply cold material on skinapply cold material on skinVDRL, abnormal cold-
(-)(+)dependent proteins,
malignant, blood cells
7Mechanismautosomal dominantpassive transfer IgE (IgM)vasculitis ?
in heritancehistamine
delayed: ?
8Treatmentprecipitant avoidance antihistamine desensitization
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Sheet1
COLD URTICARIA/ANGIOEDEMA
FamilialAcquired
IdiopathicUnderlying disease *
1Relativeraremore commonrare
frequency
2Precipitantcold
3Onsetimmediate: 0-4 hoursfew minutes-
delayed: 9-18 hours
4Duration1-2 hours
5Symptomeserythematous
a. localimmediate: patches/urticaria/angioedemaurticaria/angioedema
papules - nonpruritic,
burning
delayed: deep swelling
b. systemicFever, arthralgias, chills,headache, hypotension,~ underlying disease
headache, myalgias,syncope, wheezing
lekositosis
6Testsapply cold material on skinapply cold material on skinVDRL, abnormal cold-
(-)(+)dependent proteins,
malignant, blood cells
7Mechanismautosomal dominantpassive transfer IgE (IgM)vasculitis ?
in heritancehistamine
delayed: ?
8Treatmentprecipitant avoidance antihistamine desensitization
*Infection,syphilitic paroxysmal cold hemoglobinuria, infectious mononucleosis cryofibrinogenemia,
cryoglobulinenemia, cold agglutinine diseases, connective tissue vasculer disease, hematopoetic malignancies
Sheet2
Sheet3
CHOLINERGIC
Sheet1
CHOLINERGIC
1Relative frequencyvery frequent
2Precipitantgeneral overheating/pyrexia
stress
vigorous exercise
spicy food
3Onsetminutes
4Duration30' - 1 hour
5Symptomes
a. localerythematous, multiple distinctive wheals
1 - 3 mm
b. systemicdizziness, headeache, nausea, vomiting, syncope
pulmonary function, BHR, wheezing
6Tests- exercise challenge
- hot water bath
- metacholine skin test
7Mechanismpassive transfer parasympathetic
stimulating (achethylcholine)
8Treatmentprecipitant avoidance
rapid cooling
antihistamine
refractory: anticholinergic
Sheet2
Sheet3
Sheet1
CHOLINERGIC
1Relative frequencyvery frequent
2Precipitantgeneral overheating/pyrexia
stress
vigorous exercise
spicy food
3Onsetminutes
4Duration30' - 1 hour
5Symptomes
a. localerythematous, multiple distinctive wheals
1 - 3 mm
b. systemicdizziness, headeache, nausea, vomiting, syncope
pulmonary function, BHR, wheezing
6Tests- exercise challenge
- hot water bath
- metacholine skin test
7Mechanismpassive transfer parasympathetic
stimulating (achethylcholine)
8Treatmentprecipitant avoidance
rapid cooling
antihistamine
refractory: anticholinergic
Sheet2
Sheet3
Sheet1
CHOLINERGIC
1Relative frequencyvery frequent
2Precipitantgeneral overheating/pyrexia
stress
vigorous exercise
spicy food
3Onsetminutes
4Duration30' - 1 hour
5Symptomes
a. localerythematous, multiple distinctive wheals
1 - 3 mm
b. systemicdizziness, headeache, nausea, vomiting, syncope
pulmonary function, BHR, wheezing
6Tests- exercise challenge
- hot water bath
- metacholine skin test
7Mechanismpassive transfer parasympathetic
stimulating (achethylcholine)
8Treatmentprecipitant avoidance
rapid cooling
antihistamine
refractory: anticholinergic
Sheet2
Sheet3
Sheet1
CHOLINERGIC
1Relative frequencyvery frequent
2Precipitantgeneral overheating/pyrexia
stress
vigorous exercise
spicy food
3Onsetminutes
4Duration30' - 1 hour
5Symptomes
a. localerythematous, multiple distinctive wheals
1 - 3 mm
b. systemicdizziness, headeache, nausea, vomiting, syncope
pulmonary function, BHR, wheezing
6Tests- exercise challenge
- hot water bath
- metacholine skin test
7Mechanismpassive transfer parasympathetic
stimulating (achethylcholine)
8Treatmentprecipitant avoidance
rapid cooling
antihistamine
refractory: anticholinergic
Sheet2
Sheet3
Sheet1
CHOLINERGIC
1Relative frequencyvery frequent
2Precipitantgeneral overheating/pyrexia
stress
vigorous exercise
spicy food
3Onsetminutes
4Duration30' - 1 hour
5Symptomes
a. localerythematous, multiple distinctive wheals
1 - 3 mm
b. systemicdizziness, headeache, nausea, vomiting, syncope
pulmonary function, BHR, wheezing
6Tests- exercise challenge
- hot water bath
- metacholine skin test
7Mechanismpassive transfer parasympathetic
stimulating (achethylcholine)
8Treatmentprecipitant avoidance
rapid cooling
antihistamine
refractory: anticholinergic
Sheet2
Sheet3
Sheet1
CHOLINERGIC
1Relative frequencyvery frequent
2Precipitantgeneral overheating/pyrexia
stress
vigorous exercise
spicy food
3Onsetminutes
4Duration30' - 1 hour
5Symptomes
a. localerythematous, multiple distinctive wheals
1 - 3 mm
b. systemicdizziness, headeache, nausea, vomiting, syncope
pulmonary function, BHR, wheezing
6Tests- exercise challenge
- hot water bath
- metacholine skin test
7Mechanismpassive transfer parasympathetic
stimulating (achethylcholine)
8Treatmentprecipitant avoidance
rapid cooling
antihistamine
refractory: anticholinergic
Sheet2
Sheet3
Sheet1
CHOLINERGIC
1Relative frequencyvery frequent
2Precipitantgeneral overheating/pyrexia
stress
vigorous exercise
spicy food
3Onsetminutes
4Duration30' - 1 hour
5Symptomes
a. localerythematous, multiple distinctive wheals
1 - 3 mm
b. systemicdizziness, headeache, nausea, vomiting, syncope
pulmonary function, BHR, wheezing
6Tests- exercise challenge
- hot water bath
- metacholine skin test
7Mechanismpassive transfer parasympathetic
stimulating (achethylcholine)
8Treatmentprecipitant avoidance
rapid cooling
antihistamine
refractory: anticholinergic
Sheet2
Sheet3
Sheet1
CHOLINERGIC
1Relative frequencyvery frequent
2Precipitantgeneral overheating/pyrexia
stress
vigorous exercise
spicy food
3Onsetminutes
4Duration30' - 1 hour
5Symptomes
a. localerythematous, multiple distinctive wheals
1 - 3 mm
b. systemicdizziness, headeache, nausea, vomiting, syncope
pulmonary function, BHR, wheezing
6Tests- exercise challenge
- hot water bath
- metacholine skin test
7Mechanismpassive transfer parasympathetic
stimulating (achethylcholine)
8Treatmentprecipitant avoidance
rapid cooling
antihistamine
refractory: anticholinergic
Sheet2
Sheet3
Sheet1
HEAT, SOLAR, PRESSURE
H e a tS o l a rP r e s s u r e
1Relativerareuncommonfrequent
frequency
2Precipitantheatvarious wave - length (light)pressure
3Onset2 - 5 minutes1 - 5 minutes3 - 12 hours
rarely: few hours
4Duration1 hours15 minutes - 3 hours8 - 48 hours
5Symptomes
a. localpruriticpruriticred
whealsmorbiliform erythemedeep swelling
whealtender
b. systemic-wheezingfever, chills
dizzinessarthralgia
syncopeESR, lekositosis
6Testshot water filled -light exposure --> variableapply weight
cylinder --> skinwave length( 7 - 14 kg); 10 minutes
copro porphyrine
7Mechanismhistamine?passive transfer?
complement?Ig-E
Histamine?
8Treatmentavoidance of precipitantavoidanceavoidance
antihistamineantihistaminesevere:
desensitizationsunscreenantihistamine
corticosteroid
dss alternate
NSAID
Sheet2
Sheet3
Sheet1
HEAT, SOLAR, PRESSURE
H e a tS o l a rP r e s s u r e
1Relativerareuncommonfrequent
frequency
2Precipitantheatvarious wave - length (light)pressure
3Onset2 - 5 minutes1 - 5 minutes3 - 12 hours
rarely: few hours
4Duration1 hours15 minutes - 3 hours8 - 48 hours
5Symptomes
a. localpruriticpruriticred
whealsmorbiliform erythemedeep swelling
whealtender
b. systemic-wheezingfever, chills
dizzinessarthralgia
syncopeESR, lekositosis
6Testshot water filled -light exposure --> variableapply weight
cylinder --> skinwave length( 7 - 14 kg); 10 minutes
copro porphyrine
7Mechanismhistamine?passive transfer?
complement?Ig-E
Histamine?
8Treatmentavoidance of precipitantavoidanceavoidance
antihistamineantihistaminesevere:
desensitizationsunscreenantihistamine
corticosteroid
dss alternate
NSAID
Sheet2
Sheet3
Sheet1
HEAT, SOLAR, PRESSURE
H e a tS o l a rP r e s s u r e
1Relativerareuncommonfrequent
frequency
2Precipitantheatvarious wave - length (light)pressure
3Onset2 - 5 minutes1 - 5 minutes3 - 12 hours
rarely: few hours
4Duration1 hours15 minutes - 3 hours8 - 48 hours
5Symptomes
a. localpruriticpruriticred
whealsmorbiliform erythemedeep swelling
whealtender
b. systemic-wheezingfever, chills
dizzinessarthralgia
syncopeESR, lekositosis
6Testshot water filled -light exposure --> variableapply weight
cylinder --> skinwave length( 7 - 14 kg); 10 minutes
copro porphyrine
7Mechanismhistamine?passive transfer?
complement?Ig-E
Histamine?
8Treatmentavoidance of precipitantavoidanceavoidance
antihistamineantihistaminesevere:
desensitizationsunscreenantihistamine
corticosteroid
dss alternate
NSAID
Sheet2
Sheet3
Sheet1
HEAT, SOLAR, PRESSURE
H e a tS o l a rP r e s s u r e
1Relativerareuncommonfrequent
frequency
2Precipitantheatvarious wave - length (light)pressure
3Onset2 - 5 minutes1 - 5 minutes3 - 12 hours
rarely: few hours
4Duration1 hours15 minutes - 3 hours8 - 48 hours
5Symptomes
a. localpruriticpruriticred
whealsmorbiliform erythemedeep swelling
whealtender
b. systemic-wheezingfever, chills
dizzinessarthralgia
syncopeESR, lekositosis
6Testshot water filled -light exposure --> variableapply weight
cylinder --> skinwave length( 7 - 14 kg); 10 minutes
copro porphyrine
7Mechanismhistamine?passive transfer?
complement?Ig-E
Histamine?
8Treatmentavoidance of precipitantavoidanceavoidance
antihistamineantihistaminesevere:
desensitizationsunscreenantihistamine
corticosteroid
dss alternate
NSAID
Sheet2
Sheet3
Sheet1
HEAT, SOLAR, PRESSURE
H e a tS o l a rP r e s s u r e
1Relativerareuncommonfrequent
frequency
2Precipitantheatvarious wave - length (light)pressure
3Onset2 - 5 minutes1 - 5 minutes3 - 12 hours
rarely: few hours
4Duration1 hours15 minutes - 3 hours8 - 48 hours
5Symptomes
a. localpruriticpruriticred
whealsmorbiliform erythemedeep swelling
whealtender
b. systemic-wheezingfever, chills
dizzinessarthralgia
syncopeESR, lekositosis
6Testshot water filled -light exposure --> variableapply weight
cylinder --> skinwave length( 7 - 14 kg); 10 minutes
copro porphyrine
7Mechanismhistamine?passive transfer?
complement?Ig-E
Histamine?
8Treatmentavoidance of precipitantavoidanceavoidance
antihistamineantihistaminesevere:
desensitizationsunscreenantihistamine
corticosteroid
dss alternate
NSAID
Sheet2
Sheet3
Sheet1
HEAT, SOLAR, PRESSURE
H e a tS o l a rP r e s s u r e
1Relativerareuncommonfrequent
frequency
2Precipitantheatvarious wave - length (light)pressure
3Onset2 - 5 minutes1 - 5 minutes3 - 12 hours
rarely: few hours
4Duration1 hours15 minutes - 3 hours8 - 48 hours
5Symptomes
a. localpruriticpruriticred
whealsmorbiliform erythemedeep swelling
whealtender
b. systemic-wheezingfever, chills
dizzinessarthralgia
syncopeESR, lekositosis
6Testshot water filled -light exposure --> variableapply weight
cylinder --> skinwave length( 7 - 14 kg); 10 minutes
copro porphyrine
7Mechanismhistamine?passive transfer?
complement?Ig-E
Histamine?
8Treatmentavoidance of precipitantavoidanceavoidance
antihistamineantihistaminesevere:
desensitizationsunscreenantihistamine
corticosteroid
dss alternate
NSAID
Sheet2
Sheet3
Sheet1
HEAT, SOLAR, PRESSURE
H e a tS o l a rP r e s s u r e
1Relativerareuncommonfrequent
frequency
2Precipitantheatvarious wave - length (light)pressure
3Onset2 - 5 minutes1 - 5 minutes3 - 12 hours
rarely: few hours
4Duration1 hours15 minutes - 3 hours8 - 48 hours
5Symptomes
a. localpruriticpruriticred
whealsmorbiliform erythemedeep swelling
whealtender
b. systemic-wheezingfever, chills
dizzinessarthralgia
syncopeESR, lekositosis
6Testshot water filled -light exposure --> variableapply weight
cylinder --> skinwave length( 7 - 14 kg); 10 minutes
copro porphyrine
7Mechanismhistamine?passive transfer?
complement?Ig-E
Histamine?
8Treatmentavoidance of precipitantavoidanceavoidance
antihistamineantihistaminesevere:
desensitizationsunscreenantihistamine
corticosteroid
dss alternate
NSAID
Sheet2
Sheet3
Sheet1
HEAT, SOLAR, PRESSURE
H e a tS o l a rP r e s s u r e
1Relativerareuncommonfrequent
frequency
2Precipitantheatvarious wave - length (light)pressure
3Onset2 - 5 minutes1 - 5 minutes3 - 12 hours
rarely: few hours
4Duration1 hours15 minutes - 3 hours8 - 48 hours
5Symptomes
a. localpruriticpruriticred
whealsmorbiliform erythemedeep swelling
whealtender
b. systemic-wheezingfever, chills
dizzinessarthralgia
syncopeESR, lekositosis
6Testshot water filled -light exposure --> variableapply weight
cylinder --> skinwave length( 7 - 14 kg); 10 minutes
copro porphyrine
7Mechanismhistamine?passive transfer?
complement?Ig-E
Histamine?
8Treatmentavoidance of precipitantavoidanceavoidance
antihistamineantihistaminesevere:
desensitizationsunscreenantihistamine
corticosteroid
dss alternate
NSAID
Sheet2
Sheet3
Sheet1
HEAT, SOLAR, PRESSURE
H e a tS o l a rP r e s s u r e
1Relativerareuncommonfrequent
frequency
2Precipitantheatvarious wave - length (light)pressure
3Onset2 - 5 minutes1 - 5 minutes3 - 12 hours
rarely: few hours
4Duration1 hours15 minutes - 3 hours8 - 48 hours
5Symptomes
a. localpruriticpruriticred
whealsmorbiliform erythemedeep swelling
whealtender
b. systemic-wheezingfever, chills
dizzinessarthralgia
syncopeESR, lekositosis
6Testshot water filled -light exposure --> variableapply weight
cylinder --> skinwave length( 7 - 14 kg); 10 minutes
copro porphyrine
7Mechanismhistamine?passive transfer?
complement?Ig-E
Histamine?
8Treatmentavoidance of precipitantavoidanceavoidance
antihistamineantihistaminesevere:
desensitizationsunscreenantihistamine
corticosteroid
dss alternate
NSAID
Sheet2
Sheet3
Sheet1
VIBRATORY AQUAGENIC
V I b r a t o r yA q u a g e n I c
1Relativevery rarerare
frequency
2Precipitantvibrationwater contact
3Onset2 - 5 minutesseveral - 30 minutes
4Duration1 hours30 - 45 minutes
5Symptomes
a. localpruriticpruritic
angioedemapapular
wheals
b. systemic--
6Testsvibration 4 minutestap water challenge -
various temp.
7Mechanismhereditair autosomal -? (histamine)
dominant ? (histamine)
8Treatmentavoidanceantihistamine
(diphenhydramine)
Sheet2
Sheet3
Sheet1
VIBRATORY AQUAGENIC
V I b r a t o r yA q u a g e n I c
1Relativevery rarerare
frequency
2Precipitantvibrationwater contact
3Onset2 - 5 minutesseveral - 30 minutes
4Duration1 hours30 - 45 minutes
5Symptomes
a. localpruriticpruritic
angioedemapapular
wheals
b. systemic--
6Testsvibration 4 minutestap water challenge -
various temp.
7Mechanismhereditair autosomal -? (histamine)
dominant ? (histamine)
8Treatmentavoidanceantihistamine
(diphenhydramine)
Sheet2
Sheet3
Sheet1
VIBRATORY AQUAGENIC
V I b r a t o r yA q u a g e n I c
1Relativevery rarerare
frequency
2Precipitantvibrationwater contact
3Onset2 - 5 minutesseveral - 30 minutes
4Duration1 hours30 - 45 minutes
5Symptomes
a. localpruriticpruritic
angioedemapapular
wheals
b. systemic--
6Testsvibration 4 minutestap water challenge -
various temp.
7Mechanismhereditair autosomal -? (histamine)
dominant ? (histamine)
8Treatmentavoidanceantihistamine
(diphenhydramine)
Sheet2
Sheet3
Sheet1
VIBRATORY AQUAGENIC
V I b r a t o r yA q u a g e n I c
1Relativevery rarerare
frequency
2Precipitantvibrationwater contact
3Onset2 - 5 minutesseveral - 30 minutes
4Duration1 hours30 - 45 minutes
5Symptomes
a. localpruriticpruritic
angioedemapapular
wheals
b. systemic--
6Testsvibration 4 minutestap water challenge -
various temp.
7Mechanismhereditair autosomal -? (histamine)
dominant ? (histamine)
8Treatmentavoidanceantihistamine
(diphenhydramine)
Sheet2
Sheet3
Sheet1
VIBRATORY AQUAGENIC
V I b r a t o r yA q u a g e n I c
1Relativevery rarerare
frequency
2Precipitantvibrationwater contact
3Onset2 - 5 minutesseveral - 30 minutes
4Duration1 hours30 - 45 minutes
5Symptomes
a. localpruriticpruritic
angioedemapapular
wheals
b. systemic--
6Testsvibration 4 minutestap water challenge -
various temp.
7Mechanismhereditair autosomal -? (histamine)
dominant ? (histamine)
8Treatmentavoidanceantihistamine
(diphenhydramine)
Sheet2
Sheet3
Sheet1
VIBRATORY AQUAGENIC
V I b r a t o r yA q u a g e n I c
1Relativevery rarerare
frequency
2Precipitantvibrationwater contact
3Onset2 - 5 minutesseveral - 30 minutes
4Duration1 hours30 - 45 minutes
5Symptomes
a. localpruriticpruritic
angioedemapapular
wheals
b. systemic--
6Testsvibration 4 minutestap water challenge -
various temp.
7Mechanismhereditair autosomal -? (histamine)
dominant ? (histamine)
8Treatmentavoidanceantihistamine
(diphenhydramine)
Sheet2
Sheet3
Sheet1
VIBRATORY AQUAGENIC
V I b r a t o r yA q u a g e n I c
1Relativevery rarerare
frequency
2Precipitantvibrationwater contact
3Onset2 - 5 minutesseveral - 30 minutes
4Duration1 hours30 - 45 minutes
5Symptomes
a. localpruriticpruritic
angioedemapapular
wheals
b. systemic--
6Testsvibration 4 minutestap water challenge -
various temp.
7Mechanismhereditair autosomal -? (histamine)
dominant ? (histamine)
8Treatmentavoidanceantihistamine
(diphenhydramine)
Sheet2
Sheet3
Sheet1
VIBRATORY AQUAGENIC
V I b r a t o r yA q u a g e n I c
1Relativevery rarerare
frequency
2Precipitantvibrationwater contact
3Onset2 - 5 minutesseveral - 30 minutes
4Duration1 hours30 - 45 minutes
5Symptomes
a. localpruriticpruritic
angioedemapapular
wheals
b. systemic--
6Testsvibration 4 minutestap water challenge -
various temp.
7Mechanismhereditair autosomal -? (histamine)
dominant ? (histamine)
8Treatmentavoidanceantihistamine
(diphenhydramine)
Sheet2
Sheet3
Sheet1
VIBRATORY AQUAGENIC
V I b r a t o r yA q u a g e n I c
1Relativevery rarerare
frequency
2Precipitantvibrationwater contact
3Onset2 - 5 minutesseveral - 30 minutes
4Duration1 hours30 - 45 minutes
5Symptomes
a. localpruriticpruritic
angioedemapapular
wheals
b. systemic--
6Testsvibration 4 minutestap water challenge -
various temp.
7Mechanismhereditair autosomal -? (histamine)
dominant ? (histamine)
8Treatmentavoidanceantihistamine
(diphenhydramine)
Sheet2
Sheet3
MISCELLANEOUS
Sheet1
MISCELLANEOUS
Papular
- E/: insects bite
e.q. mosquito, bug, flea
- biphasic pruritus, papular wheal
- Hsr - type I & IV
- T/: antihistamine
Sheet2
Sheet3
Sheet1
MISCELLANEOUS
Papular
- E/: insects bite
e.q. mosquito, bug, flea
- biphasic pruritus, papular wheal
- Hsr - type I & IV
- T/: antihistamine
Sheet2
Sheet3
MISCELLANEOUS
Sheet1
MISCELLANEOUS
Urticaria pigmentosa
Darier's sign
- uncommon
- E/: strocking skin
- urticaria, hyper pigmented
- = dermatographism
biopsi : dermal infiltration of mast cells
- T/: antihistamine
Sheet2
Sheet3
Sheet1
MISCELLANEOUS
Urticaria pigmentosa
Darier's sign
- uncommon
- E/: strocking skin
- urticaria, hyper pigmented
- = dermatographism
biopsi : dermal infiltration of mast cells
- T/: antihistamine
Sheet2
Sheet3
MISCELLANEOUS
Sheet1
MISCELLANEOUS
Systemic mastocytosis
- more serious and rare
- flushing, headeache, hypotension
- mast cells accumulation: dermis, B.M., GIT
Sheet2
Sheet3
Sheet1
MISCELLANEOUS
Systemic mastocytosis
- more serious and rare
- flushing, headeache, hypotension
- mast cells accumulation: dermis, B.M., GIT
Sheet2
Sheet3
DIAGNOSTIC APPROACH
Sheet1
DIAGNOSTIC APPROACH
1. General
History :a. Foods / inhaled aromasphysical
b. drugsexamination
c. food additives
d. inhalants, contactant : dust, pollen, pet
e. occupation, hobbies
f. recent infection
suspect cause
2. Specificscreening laboratories / tests
Sheet2
Sheet3
TREATMENT
Sheet1
TREATMENT
A. General
1. Elimination :
identified remove
Cause
unidentified
avoid : histamine releasing agents
peripheral circulation pruritus
2. Antihistamine
d.o.c table
3. Adrenergic
Life threatening
s.c. inj. epinephrine : 1 / 1000 ; 0,01 ml/kg B.W. maximal 0,2 - 0,3 ml
Sheet2
Sheet3
TREATMENT
Sheet1
TREATMENT 2
4. Corticosteroid
- unresponsive to other treatment
- 2 mg/kgB.W. / day tappering off
side effects !
B. Specific :
~ D/
C. Topical :
Symptomatic (pruritus) calamin lotion
Sheet2
Sheet3
T E R I M A K A S I H
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