Medical Archive

Introduction

Urticaria and angioedema

Definition

Localized non-pitting edema (dermal edema)
Urticaria?? angioedema? ? ?? ? ?? 

Predisposing factors and etiology

Clinical presentation and pathophysiology

Acute urticaria

Pathophysiology

• Idiopathic (~50%)
• IgE-mediated degranulation of mast cells.
  • Foods, vespid stings,
  • Medications (eg, beta-lactam and sulfonamide antibiotics)
• Non-IgE-mediated degranulation
  • By activation of PKA, PI3K ? direct mast cell activation
  • Opiates, radiocontrast agents, and some antibiotics (eg, vancomycin)
  • Physical urticaria
    • ????? – IgE ??
    • ??????
    • ??????
      • ?? ??? 1~2mm ?? ???.
      • Methacholine ID test, ??????
    • ???? ??????
    • ??????
      • ???? ??, cold agglutinin, cryoglubulin
    • ???????

Clinical presentation

• Well-circumscribed, raised erythematous plaques
• Lesions can be oval, round or serpiginous up to several centimeters in diameter
• Intense pruritus
• Lesions can worsen over minutes to hours, then resolve within 24 hours.

Chronic urticaria

6? ?? ???.
??? idiopathic. ?? ???? 40% autoimmune disease.
??? ??? ?? H1 antihistamine ??

Angioedema

• The face, neck, lips, and tongue are most commonly affected, but internal organs may also be involved.
• Mast cell-mediated
  • Type I hypersensitivity reactions (IgE-mediated)
    • Aspirin and NSAIDs
  • Direct mast cell activation (e.g., opioids)
• Bradykinin-mediated
  • Hereditary (AD)
    • Type 1: C1INH deficiency (85%)
    • Type 2: C1 inhibitor dysfunction
    • C2, C4?? ??
    • Bradykinin ??? ?? ??? ??
    • ?????? ???? ?? X
    • ???? colicky? ??, ????
  • Acquired
    • ACEi – angioedema can occur at ANYTIME.
    • ???? ?? ???? ??
    • C2, C4?, C1 INH?, C1q?

Diagnosis

Treatment

H1 anti-histamine (TOC)
(hydroxyzine, chlorpheniramine)
Topical GC? ?? ??
Systemic GC? chronic???

Allergic rhinitis

Definition

Predisposing factors and etiology

Pathophysiology and manifestations

Diagnosis

Treatment