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Clinical lectures: Yr2 > Urticaria > Flashcards

Urticaria Flashcards

Dermatology (57 cards)

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1
Q

Define urticaria (hives)?

A

Inflammatory skin condition characterised by wheals

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2
Q

What condition usually occurs with urticaria and why?

A

Angioedema

Both have same immune process

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3
Q

Define angioedema?

A

Swelling in subcutaneous tissue (under skin) that lasts up to 3 days

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4
Q

Is urticaria equally common in all ages?

A

No, less common in children than adults

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5
Q

Does everyone develop urticaria during their lifetime?

A

No, up to 20% individuals will develop urticaria once in their lifetime

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6
Q

What cell type causes the pathophysiology of urticaria?

A

Mast cells

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7
Q

How is mast cell degranulation triggered, in the pathophysiology of urticaria?

A

Autoantibodies/allergens bind to high affinity IgE receptors on mast cells or basophils, or bind to IgE that is already bound to receptor

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8
Q

What 6 substances are released from mast cell granules, in the pathophysiology of urticaria?

A

Histamines

Proteases

Platelet activating factor

Leukotriene C4

Prostaglandin D2

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9
Q

How does mast cell degranulation cause urticaria symptoms?

A

Causes plasma leakage from capillaries, which causes swelling and itching

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10
Q

Does urticaria always occur due to the same immune mechanism?

A

No, can result from different immune mechanisms that have similar presentations

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11
Q

Give 2 examples of immune mechanisms that can cause urticaria?

A

Type 1 immediate hypersensitivity due to an allergen, which is tested for with skin-prick testing

Type V stimulatory hypersensitivity due to an autoantibody

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12
Q

What is the main difference between acute and chronic urticaria?

A

Acute urticaria lasts less than 6 weeks

Chronic urticaria lasts more than 6 weeks

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13
Q

Give 7 known causes of acute urticaria?

A

Food

Medications (NSAIDs, aspirin, codeine)

Insect stings and bites

Viral or bacterial infection

Contact allergy to latex

Transfusion

Vaccination or idiopathic

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14
Q

Does acute urticaria always have a known cause?

A

No, can be idiopathic

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15
Q

What is the most dangerous complication of severe acute urticaria?

A

Can progress to anaphylactic shock

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16
Q

What is the difference between chronic inducible urticaria and chronic spontaneous urticaria?

A

Inducible: Has known trigger

Spontaneous: Has unknown trigger (idiopathic)

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17
Q

Give 5 conditions that can cause chronic inducible urticaria?

A

Autoimmune conditions eg. urticarial vasculitis

Autoantibodies

Neoplastic

Urticaria pigmentosa

Idiopathic

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18
Q

What type of urticaria is caused by lightly scratching skin?

A

Symptomatic dermographism: lightly scratching patient’s skin causes raised, inflamed lines or welts that tend to go away in less than 30 minutes

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19
Q

What type of urticaria is caused by sunlight?

A

Solar urticaria

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20
Q

What type of urticaria is caused by cold air, water or ice?

A

Cold contact urticaria

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21
Q

What type of urticaria is caused by heat?

A

Heat contact urticaria

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22
Q

What type of urticaria is caused by sweating?

A

Cholinergic urticaria

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23
Q

What type of urticaria is caused by pressure?

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A

Delayed pressure urticaria

24
Q

What type of urticaria is caused by contact with chemicals?

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A

Contact urticaria

25
What type of urticaria is caused by water?
Aquagenic urticaria
26
What type of urticaria is caused by vibrations?
Vibratory urticaria
27
Give 3 causes of why angioedema can present without urticaria?
ACE inhibitor-induced angioedema Hereditary angioedema (also known as C1 esterase inhibitor deficiency) Acquired angioedema (which is complement C1q deficiency)
28
In urticaria presentation, does only one type tend to present?
Different types of urticaria often present together
29
Describe the typical appearance of wheals, in urticaria?
Superficial non-scaly plaques/swelling that are red or skin-coloured with clear edges
30
Do wheals always have pale colour and clear edges, in urticaria?
No, can be dark red with annular (prominent) edges
31
In urticaria, where do wheals tend to appear on body?
Anywhere
32
How does wheals tend to present in chronic urticaria?
Faded, pink, flat wheals with no palpable swelling that are widespread
33
How much time does it take for wheals to go down, in the usual presentation of urticaria, and do they leave any marks?
Less than 24 hours Don't leave marks, but if chronic there can be very faded marks
34
How does contact urticaria usually present?
Wheals confined to the contact area, and occurs minutes after exposure
35
When investigating urticaria, when would you do a skin biopsy?
Suspected urticarial vasculitis
36
When investigating urticaria, when would you do a skin-pricking test?
Suspected allergen/irritant
37
How do you use a TempTest to confirm cold or heat contact urticaria?
Patient puts forearm on TempTest for 5 minutes as it maintains temperature range 4-44 degrees celsius, then removes and wait 10 minutes before inspecting skin for urticaria 1. Patient develops urticaria around areas that are 4-24 degrees celsius: Suggests cold urticaria 2. Patient develops urticaria around areas that are 25-44 degrees celsius: Suggests heat urticaria
38
How do you use dermographing to confirm systemic dermographism?
Use demographer pen/demographer that is set at different pressure levels to lightly scratch patient’s skin and see after 10 minutes if urticaria develops No wheals (negative) at pressure 0 but wheals (positive) at pressures 1 and higher indicate dermographism
39
How can you confirm cholinergic urticaria?
Asking patient to exercise and see if urticaria develops after sweating
40
How can you confirm solar urticaria?
Phototesting
41
What scoring tool can be used to measure severity of urticaria?
Urticaria Activity Score (UAS7): 7-day scoring tool for measurement of disease severity
42
What UAS7 score is needed for a patient to qualify for omalizumab (anti-IgE antibody drug)?
28 or more per week over 2 weeks And if they have had the omalizumab treatment before, they need to have a score of 16 or more to qualify for further treatment
43
What is the initial management of urticaria caused by a drug/food/allergen?
Stop the offending drug/food/allergen
44
What is the initial management of urticaria caused by infection?
Treat infection
45
What is the initial management of urticaria caused by symptomatic dermographism?
Wear loose clothing
46
What is the initial management of urticaria caused by cold contact urticaria?
Dress warmly, avoid cold water and ice
47
What is the initial management of urticaria caused by delayed pressure urticaria?
Use something with narrow contact area instead of broad contact area
48
What is the initial management of urticaria caused by solar urticaria?
Sunscreen
49
What 4 types of drugs should be avoided when treating urticaria?
NSAIDs Codeine Aspirin Certain antibiotics
50
What kind of antihistamine drug is used to treat urticaria, and how often per day?
Second generation H1 antihistamine up to QDS (4 times a day) e.g. fexofenadine, cetirizine, loratadine
51
If taking second generation H1 antihistamine hasn't treated urticaria, what drugs can be added?
Montelukast 10 mg daily Cooling moisturisers e.g. menthol in aqueous cream
52
What medication is prescribed to treat urticaria flare ups?
Prednisolone 30 mg for 3-5 days
53
When combined antihistamine and montelukast is ineffective in treating urticaria, what drug is used next?
Anti IgE: Omalizumab injection
54
What drug can be added to omalizumab injections to make them more effective in treating urticaria?
Cyclosporin
55
Give 5 examples of DMARDs that can be prescribed to treat urticaria?
Cyclosporin Azathioprine Mycophenolate mofetil Dapsone Hydroxychloroquine
56
What kind of phototherapy can be used to treat urticaria?
UVB phototherapy
57
Which body areas are most affected by angioedema?
Face: Eyes, lips, mouth, tongue Hands Feet Genitals

Clinical lectures: Yr2 (63 decks)

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