Habif - 6 Urticaria And Angioedema

Front 1

Darier's sign

Back 1

Tongue blade across arm/back producing whealing 2 mm or more in width in 1 - 3 min (Dermographism)

Front 2

Triple response of Lewis

Back 2

1) Vasodilation (local erythema - red line, occurs in 3 - 15 seconds)
2)Axon reflex (peripheral flare pruritis, broadening erythema)
3)Wheal (replaces red line, transudation of fluid through dilated capillaries)

Front 3

Physical urticarias (types)

Back 3

Dermographism, Presure urticaria, Cholinergic urticaria, Exercise-induced, Cold, Solar, Heat/water/and vibration, Aquagenic pruritis

Front 4

Distinguishing features of physical urticarias

Back 4

-Induced by external/physical stimuli
-Attacks are BRIEF! (last 30-60 min vs. a few hours as in typical)
-Young adults
-Account for 20% of all case of CU

Front 5

Dermographism

Back 5

-MC physical urticaria
--5% of population
-Sudden onset, young people, last wks - yrs
-Viral infection, abx (PCN), emotional upset
-NO mucosal or angioedema

Front 6

Darier's sign (dermographism) is seen in which disease

Back 6

Urticaria pigmentosa (cutaneous mastocytosis)

Front 7

Pressure Urticaria sx and timing

Back 7

Deer, itchy, burning, or painful swelling
2-6 hours after pressure
Lasts 8-72 hours

Front 8

Who gets pressure Urticaria and for how long

Back 8

30 yo
Lasts 9 years

Front 9

Pressure urticaria occurs with what other two things in the same pt?

Back 9

Angioedema and chronic urticaria

Front 10

Where does you get pressure urticaria

Back 10

Hands, feet, trunk, buttocks, lips, face
(worse with walking, sitting, underwear...)

Front 11

Treatment for pressure urticaria

Back 11

-Antihistamines NOT effective
-Protect pressure points
-Systemic steroids (short duration)
-Cetirizine (high dose)
-Dapsone

Front 12

other sx associated with pressure urticaria

Back 12

Flu-like sx

Front 13

Most common physical urticaria

Back 13

Cholinergic (heat bumps)

Front 14

Sx of cholinergic urticaria

Back 14

(adolescents, young adults)
mild
HUGE flare and pin point wheals (2 - 4 mm)
during or after exercise (1 hour)
Lasts for minutes/hours (30 min)

Front 15

Three things that cause cholinergic urticaria

Back 15

-Exercise
-heat
-emotional stress

Front 16

Dx of cholinergic urticaria

Back 16

Hx
Exercise test
Immersion in hot water (will be negative if exercise induced)

Front 17

Tx of cholinergic urticaria

Back 17

Limit PT
Hot shower (deplete histamine for 24 hours)
Immediate cooling after PT
Cetirizine, Hydroxizine
Stanozolol

Front 18

Describe sx and lesions of exercise induced anaphylaxis

Back 18

Pruritis, urticaria, respiratory distress, hypotension after exercise
(jogging)
BIGGER than cholinergic urt.

Front 19

Types of cold urticaria

Back 19

Primary acquired cold urticaria (essential) - 95%, children, young adult
Secondary acquired cold urt - 5%

Front 20

Characteristics of primary acquired cold urticaria

Back 20

Starts in a few minutes, lasts 30 min
Oropharynx after cold drink
Sx symptoms may occur

Front 21

Incudes priary acquired cold urt

Back 21

Viral infection (mycoplasma pneumoniae), drugs, stress

Front 22

Wheals of secondary acquired cold urt

Back 22

Persistant
May have purpura

Front 23

3 C's present in secondary acquired cold urt

Back 23

Cryoglobulin (search for hep b/c, lymphoreticular )malignancy, glandular fever
Cold agglutinin
Cryofibrinogens

Front 24

Characteristics of solar urticaria

Back 24

Occurs after minutes
Disappear in less than 1 hour
(photoallergic d/o)

Front 25

Who gets solar urticaria

Back 25

young female
syncope!!

Front 26

Ddx of solar urt.

Back 26

PMLE (lasts for days, not urticarial, occurs hours after exposure)

Front 27

Pathogenesis of solar urt

Back 27

IgE
6 types based on 6 different wavelengths
290 - 500
allergic rxt to antigen formed in skin by light waves

Front 28

'Aquagenic urticaria looks like:

Back 28

micropapular hives of cholinergic urt

Front 29

Aquagenic pruritis sx, pathophys, ddx

Back 29

1 -15 min of water contact of ANY temp
prickling discomfort
NO skin lesions
NO histamine pathogenesis
R/o Polycythemia rubra vera

Front 30

Anaphylotoxin

Back 30

C3a/C3a des-arginine

Front 31

Types of cutaneous mastocytosis

Back 31

-Solitary or multiple mastocytomas
-Urticaria pigmentosa (maculopapular cutaneous mastocytosis)
-Diffuse cutaneous mastocytosis
-Telangiectasia macularis eruptiva perstans

Front 32

Two types of Diffuce cutaneous mastocytosis

Back 32

Diffues erythrodermic cutaneous mastocytosis
Pseudoxanthomatous mastocytosis/xanthelasmoidea

Front 33

Best stain for mastocysotis

Back 33

IHC stain with tryptase
Geimsa or toludine blue (metachromatic stain)

Front 34

Drugs that cause serum sickness

Back 34

PCN, sulfa drugs, thioruacils, cholecystographic dyes, hydantoins, aminosalicylic acid, streptomycin

Front 35

MC cause serum sickness

Back 35

Rx

Front 36

Rx that lead to mast cell degranulation (be careful in mastocytosis)

Back 36

PROMSS
Polymixin B
Radiocontrast media
Opiates
Muscles relaxants
Salicylates/NSAIDS
Succinylcholine

Front 37

Tx of mastocytosis

Back 37

For cutanoues:
H1/H2 antagonists
Oral disodium cromoglycate
0.05% betamethasone
ILK
Systemic:
H1/H2
Cromolyn for GI sx
Ketotifen (mast cell stabilizer for EYES)
Glucocorticoids
PUVA
Epi pen

Front 38

What is tryptase

Back 38

Protein component of secretory granules of mast cells (measurable for 30 - 60 min - several hours; histamine only for a few min)

Front 39

Protooncogene in systemic mastocytosis

Back 39

CKIT (codon 816 c-kit point mutation)

Front 40

Two types of AAE

Back 40

Type I - lymphoproliferative diseases (MGUS, high grade lymphoma; consume C1 INH)
Type II - autoimmune, antibody to C1 INH

Front 41

Two types of HAE

Back 41

Type I - 85%, insufficient production
Type II - 15%, functionally deficient

Front 42

Treatment of HAE

Back 42

C1 INH concentrate infusion
Attentuated androgens (Danazol)
Tranexamic acid

Front 43

Angioedema + abdominal pain and no urticaria

Back 43

HAE

Front 44

Anaphylaxis (recurrent) + syncope/near syncopal episode and no urticaria or angioedema

Back 44

Mastocytosis

Front 45

Urticarial rash due to serum sickness in a child

Back 45

CEFACLOR

Front 46

Best screening blood test for HAE

Back 46

C4 levels

Front 47

Ddx of "hives"

Back 47

Urticaria (itch)
EM (tender, not itch, target-like)
Urticarial vasculitis (burn, fixed...)

Front 48

Fish that give you hives

Back 48

Scrombroid - tuna, albacore, mackerel
Non-scrombroid - mahi mahi, amberjack big, sardines
(histadine --> histamine)

Front 49

Drug of choice for secondary acquired cold urticaria

Back 49

Cyproheptadine (Periactin)