URTICARIAURTICARIA PathogenesisPathogenesis Immunologic Mechanism:Immunologic Mechanism:

(A) Type I HYPERSENSITIVITY REACTION(A) Type I HYPERSENSITIVITY REACTION

(B) Type III(B) Type III HYPERSENSITIVITY REACTIONHYPERSENSITIVITY REACTION non Immunologic Mechanismnon Immunologic Mechanism

(a) direct effect (a) direct effect

(b) effect on archidonic acid metabolism-(b) effect on archidonic acid metabolism-

Leukotrien B4 Leukotrien B4

(C) idiopathic or undetermined(C) idiopathic or undetermined

Kinin, Protease, slow releasing substances, Kinin, Protease, slow releasing substances, Prostaglandins Prostaglandins

ClassificationClassification

I- Ordinary I- Ordinary urticaria/angiooedemaurticaria/angiooedema

(a) acute persist < 6week . (a) acute persist < 6week .

(b) chronic >6 week(b) chronic >6 week..

Provoking factorsProvoking factors food item: spicy food, egg, fish, strawberry even milk and it food item: spicy food, egg, fish, strawberry even milk and it

product.product. food additives: as benzoate compound –Azodyes. food additives: as benzoate compound –Azodyes. Drug: aspirin, certain antibiotics, NSAID. ,codeine , Drug: aspirin, certain antibiotics, NSAID. ,codeine ,

morphine morphine inhalants :- pollen - spore – house dust mite.inhalants :- pollen - spore – house dust mite. infection and infestation: infection and infestation: psychological factor play important role psychological factor play important role certain systemic diseases : CTD esp. SLE , malignancy certain systemic diseases : CTD esp. SLE , malignancy

[lymphoma ] endocrine diseases as [thyrotoxicosis . [lymphoma ] endocrine diseases as [thyrotoxicosis . polycythemia] , liver disease, pregnancy polycythemia] , liver disease, pregnancy

about 50% idiopathic about 50% idiopathic

ANGIO EDEMAANGIO EDEMA

Hereditary Hereditary angiooedema:angiooedema:

autosomal dominantautosomal dominant

C1 esterase inhibitor C1 esterase inhibitor deficiency deficiency

II. Physical urticariaII. Physical urticaria

1. cholinergic urticaria1. cholinergic urticaria

2. dermographisim2. dermographisim

3. pressure urticaria3. pressure urticaria

4. solar urticaria4. solar urticaria

5. cold urticaria5. cold urticaria

6. heat urticaria6. heat urticaria

7. Aquagenic urticaria7. Aquagenic urticaria

8. Vibratory urticaria8. Vibratory urticaria

III. URTICARIAL VasculitisIII. URTICARIAL Vasculitis

IV. Papular urticariaIV. Papular urticaria

V. contact urticariaV. contact urticaria

VI. Urticaria VI. Urticaria PigmentosaPigmentosa (mastocytosis(mastocytosis))

InvestigationsInvestigations:: General : CBP , ESR, GSE, GUE, urine and General : CBP , ESR, GSE, GUE, urine and

blood sugar, liver and renal function testsblood sugar, liver and renal function tests Skin test: commonly used in patient with chronic Skin test: commonly used in patient with chronic

urticariaurticaria We must exclude certain disease commonly We must exclude certain disease commonly

associated with chronic urticaria As *chronic associated with chronic urticaria As *chronic suppurative infection especially sinus infection, suppurative infection especially sinus infection, UTI, *CTD, *hyperthyroidism, D.M., *intestinal UTI, *CTD, *hyperthyroidism, D.M., *intestinal warms, *internal malignancy, lymphoma, warms, *internal malignancy, lymphoma, *pregnancy and *chronic exposure to external *pregnancy and *chronic exposure to external allergen.allergen.

TreatmentTreatment

Avoid provoking factorAvoid provoking factor Oral antihistamine :Oral antihistamine : H1 BLOCKER: -H1 BLOCKER: - Sedative antihistamine DIPHENHYDRAMINE, Sedative antihistamine DIPHENHYDRAMINE,

HYDROXYZIN, PROMITHAZINE, TRIPROLIDIN HYDROXYZIN, PROMITHAZINE, TRIPROLIDIN

Low sedative antihistamine: - ASTEMIZOLE, Low sedative antihistamine: - ASTEMIZOLE, TERFINADIN, LORATIDIN, CETRIZIN, TERFINADIN, LORATIDIN, CETRIZIN,

DESLORATIDINDESLORATIDIN

DoxepinDoxepin

H2 BLOCKER H2 BLOCKER

in acute sever urticaria we can start in acute sever urticaria we can start Treatment by IM antihistamine , I.V. steroid Treatment by IM antihistamine , I.V. steroid {hydrocortisone} and S.C. adrenaline{hydrocortisone} and S.C. adrenaline

Systemic steroids Systemic steroids

Topical Treatment usually CALAMIN lotionTopical Treatment usually CALAMIN lotion resistant chronic urticaria as resistant chronic urticaria as

CYCLOSPORIN, METHOTREXATECYCLOSPORIN, METHOTREXATE Leukotrein receptor antagonist:Leukotrein receptor antagonist:

Zafilukast, Montelukast Zafilukast, Montelukast