DEFINITION

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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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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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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

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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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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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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 - 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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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

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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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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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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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: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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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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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

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