荨麻疹和血管神经性水肿英文

,Introduction:Urticaria and Angioedema,Urticaria,Angioedema,Etiology of Urticarial Reactions:Allergic Triggers,Acute UrticariaDrugsFoodsFood additivesViral infectionshepatitis A, B, CEpstein-Barr virusInsect bites and stingsContactants and inhalants (includes animal dander and latex),Chronic UrticariaPhysical factorscoldheatdermatographicpressuresolarIdiopathic,The Pathogenesis of Chronic Urticaria:Cellular Mediators,Histamine as a Mast Cell Mediator,Role of Mast Cells in Chronic Urticaria:Lower Threshold for Histamine Release,Release threshold decreased by:Cytokines & chemokines in the cutaneous microenvironmentAntigen exposureHistamine-releasing factorAutoantibodyPsychological factors,Release threshold increased by:CorticosteroidsAntihistaminesCromolyn (in vitro),Cutaneous mass cell,An Autoimmune Basis for Chronic Idiopathic Urticaria: Antibodies to IgE,Initial Workup of Urticaria,Patient historySinusitisArthritisThyroid diseaseCutaneous fungal infectionsUrinary tract symptomsUpper respiratory tract infection (particularly important in children)Travel history (parasitic infection)Sore throatEpstein-Barr virus, infectious mononucleosisInsect stingsFoodsRecent transfusions with blood products (hepatitis)Recent initiation of drugs,Physical examSkinEyesEarsThroatLymph nodesFeetLungsJointsAbdomen,Laboratory Assessment for Chronic Urticaria,Possible tests for selected patientsStool examination for ova and parasitesBlood chemistry profileAntinuclear antibody titer (ANA)Hepatitis B and CSkin tests for IgE-mediated reactions,Initial testsCBC with differentialErythrocyte sedimentation rateUrinalysis,RAST for specific IgEComplement studies: CH50CryoproteinsThyroid microsomal antibodyAntithyroglobulinThyroid stimulating hormone (TSH),Histopathology,Group 2:Polymorphous perivascular infiltrateNeutrophilsEosinophilsMononuclear cells,Group 3:Sparse perivascular lymphocytes,Urticaria Associated With Other Conditions,Collagen vascular disease (eg, systemic lupus erythematosus)Complement deficiency, viral infections (including hepatitis B and C), serum sickness, and allergic drug eruptionsChronic tinea pedisPruritic urticarial papules and plaques of pregnancy (PUPPP)Schnitzlers syndrome,H1-Receptor Antagonists: Pros and Cons for Urticaria and Angioedema,First-generation antihistamines (diphenhydramine and hydroxyzine)Advantages: Rapid onset of action, relatively inexpensiveDisadvantages: Sedating, anticholinergicSecond-generation antihistamines (astemizole, cetirizine, fexofenadine, loratadine)Advantages: No sedation (except cetirizine); no adverse anticholinergic effects; bid and qd dosingDisadvantages: Prolongation of QT interval; ventricular tachycardia (astemizole only) in a patient subgroup,Four-week Treatment Period:Fexofenadine HCl,Mean Pruritus Scores/Mean Number of Wheals/Mean Total Symptom Scores,An Approach to the Treatment of Chronic Urticaria,Treatment of Urticaria: Pharmacologic Options,Antihistamines, othersFirst-generation H1Second-generation H1Antihistamine/decongestant combinationsTricyclic antidepressants (eg, doxepin)Combined H1 and H2 agentsBeta-adrenergic agonistsEpinephrine for acute urticaria (rapid but short-lived response)Terbutaline,CorticosteroidsSevere acute urticariaavoid long-term useuse alternate-day regimen when possibleAvoid in chronic urticaria (lowest dose plus antihistamines might be necessary)MiscellaneousPUVAHydroxychloroquineThyroxine,Atopic Dermatitis: Acute, Subacute, and Chronic Lesions,Acute Cutaneous LesionsErythematous, intensely pruritic papules and vesiclesConfined to areas of predilectioncheeks in infantsantecubitalpoplitealSubacute Cutaneous LesionsErythema excoriation, scalingBleeding and oozing lesionsChronic LesionsExcoriations with crustingThickened lichenified lesionsPostinflammatory hyperpigmentationNodular prurigo,Atopic Dermatitis: Physical Distribution by Age Group,Immune Response in Atopic Dermatitis,Markedly elevated serum IgE levelsPeripheral blood eosinophiliaHighly complex inflammatory responses IgE-dependent immediate hypersensitivityMultifunctional role of IgE (beyond mediation of specific mast cell or basophil degranulation)Cell types that express IgE on surfacemonocyte/macrophagesLangerhans cellsmast cellsbasophils,Atopic Dermatitis:Tests to Identify Specific Triggers,Skin prick testing for specific environmental and/or food allergensRAST, ELISA, etc, to identify serum IgE directed to specific allergens in patients with extensive cutaneous involvementTzanck smear for herpes simplexKOH preparation for dermatophytosisGrams stain for bacterial infectionsCulture for antibiotic sensitivity for staphylococcal infection; supplement with bacterial culturesCultures to support tests bacterial, viral, or fungal,Topical Corticosteroids,Ranked from high to low potency in 7 classesGroup 1 (most potent): betamethasone dipropionate 0.05%Group 4 (intermediate potency): hydrocortisone valerate 0.2%Group 7 (least potent): hydrocortisone hydrochloride 1%Local side effects: Development of striae and atrophy of the skin, perioral dermatitis, rosacea Systemic effects: Depend on potency, site of application, occlusiveness, percentage of body covered, length of useMay cause adrenal suppression in infants and small children if used long term,Antihistamines and Other Treatments,Standar