Urticaria Causes And Treatments
Touching, eating, injecting, or breathing certain things can cause an itching rash or hives in allergic persons. For more details, see Allergic Reactions, p.' 166. Hives are thick, raised spots or patches that look like bee stings and itch like mad. They may come and go rapidly or move from one spot to another. Be on the watch for any reaction caused by certain medicines, especially injections of penicillin and the antivenoms or antitoxins made from horse serum. A rash or hives may appear from a few minutes up to 10 days after the medicine has been injected. If you get an itching rash, hives, or any other allergic reaction after taking or being injected with any medicine, stop using it and never use that medicine again in your life
There are a number of urticarial conditions, but apart from hives they are uncommon. 1. Urticaria thus usually refers to hives, which are areas of transient, localized, pruritic oedema, varying in size from 1 20 cm and in number from one to more than 100. They are usually caused by food sensitivity (mostly due to the degranulating chemicals used as colouring and flavouring agents) and aspirin. The main treatment of hives and indeed of urticaria in general is with antihistamines and if severe with adrenaline and corticosteroids. Photochemotherapy has been used. 2. Angioedema (q.v.). 3. Physical, due especially to cold, but also to heat or sun. Cold urticaria is produced in some patients by IgE autoantibodies to a cold-dependent skin antigen. It occurs particularly during rewarming and is usually associated with systemic symptoms, such as headache, tachycardia, syncope and wheeze. If severe, it resembles leukocytoclastic vasculitis (see below). 4. Systemic mastocytosis produces a...
Hereditary angioedema (HAE) is due to a deficiency of C inhibitor (Cj INH), a serine protease like many activated coagulation factors. HAE is an autosomal dominant condition, with affected heterozygotes having 5 30 of the normal concentration of Cj INH. The oedema is not associated with erythema, pruritus or local discomfort (except sometimes for intestinal colic, due to associated visceral angioedema). Recently, cases have been reported to have been caused by ACE inhibitors and occasionally by the complementary medicine, echinacea. Drug-induced angioedema is of course well known as one of the major features of anaphylaxis, the most dramatic manifestation of drug allergy (q.v.).
Erythematous, warm, urticarial wheals (hives) seen over trunk, legs, and arms no angioedema or respiratory distress. Mast cells and basophils are focal to urticarial reaction. When stimulated by certain immunologic or nonimmunologic mechanisms, storage granules in these cells release histamine and other mediators, such as kinins and leukotrienes. These agents produce the localized vasodilatation and transudation of fluid that characterize urticaria.
(2) Among the signs and symptoms of a histamine imbalance reaction are itching, a flushed appearance, watery eyes, faintness, hives, nausea, and breathing difficulties. In a mild response of this type, the patient may feel hot, faint, or nauseated. A moderate reaction might evoke watering of the eyes, localized swelling (especially of the face and hands), and a flushed appearance. In its most serious form, breathing problems due to swollen bronchial passages appear. Untreated severe bronchial constriction can produce death by suffocation. Generally, this reaction occurs quickly, but the specialist must be watchful for possible delayed reactions.
Papular lesions, scabs, hives, and scratch marks are seen. As with pediculosis capitis, symptoms begin only after several weeks of infestation or sooner in cases of reinfestation (Fig. 41.5). Pruritis is the main symptom, although with secondary infection there may be pain, fever, malaise and lymphadenopathy. To confirm the diagnosis, meticulous examination of the clothing will reveal lice and nits.
Angiotensin can also be formed to some extent via pathways other than renin. Since the angiotensin receptor antagonists do not block the inactivation of bradykinin like the ACE inhibitors do, they were not expected to produce cough or angioedema, but this early promise has not been borne out in practice. On the other hand, the potentiation of bradykinin may be responsible also for some of the beneficial effects of the ACE inhibitors. In addition, the ARAs have been reported to cause occasional hepatotoxicity and to exacerbate hyperglycaemia in some diabetics. In clinical trials, angiotensin receptor antagonists have been found to be as effective as ACE inhibitors in hypertension and more effective in reducing mortality in heart failure.
Hives (patchy swellings on skin) or a rash with itching Hives, or a rash with itching, can appear a few hours or up to several days after getting an injection. If the same medicine is given to the person again, it may cause a very severe reaction or even death (see p. 70). Hives, or a rash with itching, can appear a few hours or up to several days after getting an injection. If the same medicine is given to the person again, it may cause a very severe reaction or even death (see p. 70).
The risk of a serious reaction is greater in a person who has previously been injected with one of these medicines or with another medicine of the same group. This risk is especially great if the medicine caused an allergic reaction (hives, rash, itching, swelling, or trouble breathing) a few hours or days after the injection was given.
Introduced species in Australia appear to have greatest impact in disturbed, or naturally open, habitats. In largely unfragmented tracts of forest in East Gippsland, the European Honeybee occupied only 1 of all hollows suitable for occupancy by vertebrate fauna (Gibbons 1999) compared with 8 in disturbed woodland near Melbourne (Wood and Wallis 1998b). Burgman and Lindenmayer (1998) recommended careful placement of bee hives, and limits on the size, or number, of hives in certain areas to minimise impacts of the European Honeybee on native fauna. Populations of other pest species are also more prevalent in open and disturbed habitats. The Common Myna near Canberra made significantly greater use of nest boxes in open and edge habitats compared with 'interior' woodland (Pell and Tidemann 1997b).
Frequently in all degrees of cold injury, the affected individual becomes sensitized to further exposure to cold. With milder injuries, sensitization to cold may persist only days or weeks, but in more severe injuries, cold sensitivity of the injured part may be permanent. Consequently, additional precautions must be taken by a person once injured by cold to prevent further injuries. In certain cases, true cold sensitivity or allergy may exist. Such persons may demonstrate urticaria or hives with intense burning, itching, and swelling when exposed to cold. Generally, this happens to persons who have had a cold injury. Rarely, however, this reaction may be a family trait or happen to a person who has plasma cryoglobulin or cold agglutinins. In such persons, cold exposure may cause a systemic reaction of generalized urticaria, asthma, and even shock.
(2) All transfusion reactions should be investigated, primarily to detect the small number of reactions in which there is hemolysis (primarily caused by destruction of transfused erythrocytes). The investigation, described below, is applicable to most transfusion reaction workups (see Table 3-5). If a reaction occurs that involves more than just urticaria, the blood infusion should be stopped immediately but the intravenous line should be kept open, for example, with physiologic saline. If urticaria (hives) is the only manifestation of a transfusion reaction, treatment with an antihistamine will usually suffice this is the only situation in which the blood can continue to be infused. Next, a properly identified sample of blood (preferably an anticoagulated one and a clotted one) obtained from the recipient, the blood bag (clamped or sealed off), and the compatibility slip should be sent to the blood bank with a description of the transfusion reaction.
The honeybee (Figure 2-3) forms permanent colonies that survive from year to year indefinitely. This social colonial hymenopterous insect (Apis mellifera) is usually kept in hives for the honey and wax that it produces. A honeybee differs from the related wasp especially in the heavier, hairier body and in having sucking as well as chewing mouthparts that feed on and store pollen and nectar. The honeybee has a rounded abdomen and when it stings, its stinger remains in the victim. The bee will fly away and die. On the other hand, a wasp, hornet, and yellow jacket (slender body with elongated body) retain their stingers and can sting repeatedly. The venom from the honeybee is a water-clear liquid having a sharp, bitter taste and it can incur neurotoxic, hemorrhagic, or hemolytic damage. The severe reactions to bee stings are usually caused by sensitivity to bee protein, not the venom. If the victim has reactions other than local swelling or irritation, consult a physician for...
Tungiasis is a typical tropical disease caused by the sand flea Tunga penetrans (jigger, chigger or chigae). This infestation is widespread in the tropics and is usually contracted in Central and South America, the Caribbean, India, Pakistan and tropical Africa. By way of example, we report a survey carried out on 5,595 primary school children in Lagos State, Nigeria (Acta Trop 1981, 38 79-84). It showed that most of the children were over-loaded with parasitic infestations which included malaria (37.7 ), schistosomiasis (13.4 ), ascariasis (74.2 ), trichuriasis (75.8 ), hookworm (29.5 ) and tungiasis (49.5 ). Tungiasis is rarely diagnosed in Italy or in other European countries or North America, so it can really be considered a tourism-transmitted disease, contracted by tourists in endemic areas. French authors have reported examing 269 patients in a tropical disease unit in Paris over a 2-year period (Clin Infect Dis 1995 20 542-548). The average age of these patients was 30 years,...
The use of psychostimulants for cognitive decline in patients with AIDS has been reviewed 253,254 . A potential use of these drugs is for the depressive symptoms that are frequently associated with the disease. When depression is treated aggressively, cognitive improvement may also occur. Psychostimulants have been found to be beneficial in the majority of patients from several open-label trials of men with AIDS 255 . Patients in these trials often had cognitive problems associated with their depressive symptoms. Dextram-phetamine doses ranged from 5 to 60 mg day and methylphenidate doses ranged from 10 to 90mg day. Reported side effects included increased anxiety, dyskinesias, motor tension and possibly facial angioedema in one case. Abuse of psychostimulants and appetite suppression, although a theoretical risk, were not reported as a significant issue in these trials. The methodological limitations of these studies include no women patients, lack of blinding and small sample sizes....
The answer is b. (Schwartz, 7 e, pp 211-212.) This patient is having an anaphylactoid reaction with destabilization of the cardiovascular and respiratory systems. Anaphylactoid reactions are most commonly caused by iodinated contrast media, -lactam antibiotics (e.g., penicillin), and Hymenoptera stings. Manifestations of anaphylactoid reactions include both the lethal (bronchospasm, laryngospasm, hypotension, dysrhythmia) and the nonlethal (pruritus, urticaria, syncope, weakness, and seizure). Epinephrine is the initial treatment for laryngeal obstruction and bron-chospasm, followed by histamine antagonists (H1 and H2 blockers), amino-phylline, and hydrocortisone. Vasopressors and fluid challenges may be given for shock. Conscious patients are usually stabilized with injected or inhaled epinephrine, while unconscious patients and those with refractory hypotension or hypoxia should be intubated.
Type I reactions involve elements of strong Th2 responses that lead to increased IgE, eosinophilia, and eosinophil and mast cell activation. Adverse reactions of this type include the development of urticaria (with several helminthic parasites), the occurrence of potentially life-threatening anaphylactic shock in IgE-mediated mast cell degranulation (e.g., triggered by systemic release of antigens from echinococcal cysts99), and exuberant eosinophilic infiltration of tissues due to migrating helminth larvae (e.g., Loffler's pneumonia with the pulmonary migration of Ascaris larvae).
Whenever a transfusion reaction involving more than just hives is suspected, the transfusion should be immediately discontinued, but the intravenous line kept open. The remaining blood, a new sample from the recipient, plus the reaction report, should be sent to the blood bank for prompt investigation. The detailed clinical management of adverse effects of blood transfusion may be obtained elsewhere, but Table 3-4 contains suggested treatment regimens.
Glucagon is a polypeptide hormone normally produced by the pancreatic islets of Langerhans. It causes an increase in blood glucose, but is perhaps better known for its clinical use as a hypotonic agent for the stomach, small bowel, and colon. Glucagon relaxes the smooth muscle of the gastrointestinal tract and is thought to improve bowel distension and decrease patient discomfort due to spasm. The effectiveness of glucagon is dependent upon location, and it has been found to be most effective on the duodenum and least effective on the colon (Chernish and Maglinte 1990). Although uncommon, the most frequently encountered side effects of glucagon are nausea, vomiting and headache. One study found that 4 of patients experienced nausea following the intravenous administration of gluca-gon prior to CT colonography.(Morrin et al. 2002). Rarely, generalized allergic-type reactions such as urticaria, respiratory distress and hypotension may occur. Glucagon is contraindicated in patients with...
Urticariogenic plants cause immediate contact dermatitis. Some plants have stinging hairs that introduce irritating plant toxins through mechanical breaks in the skin (e.g., stinging trees of Australia and stinging nettle). Others cause a hypersen-sitivity response through direct contact alone (e.g., strawberry, castor bean, and chrysanthemum). Contact with these plants causes hives, pruritus, and sometimes anaphylaxis and shock.84 Treatment of simple urticaria involves use of cold compresses and antihistamines. Systemic reactions may require more intensive therapy.
Generally, three clinical stages of infection can be delineated. In the first phase, there is an itchy erythematous or petechial rash at the sites of penetrates of the cercariae, the free-swimming larvae this lasts from two to five days. In the second clinical phase, four to five weeks later, the symptoms are primarily allergic and of varied severity. There may be fever, urticaria, malaise, respiratory symptoms, and the liver and the spleen may be temporarily enlarged. In two to eight weeks, the person becomes asymptomatic. The final clinical phase, which can occur six months to several years after infection, is characterized by diarrhea, dysentery, intestinal tumors, portal hypertension, and hepatic insufficiency. It should be noted that these parasites can live for many years. Some people with light infections are asymptomatic and never have signs or symptoms of parasitic disease.
The answer is a. (Fitzpatrick, 3 e, pp 314-318, 332-335, 401-405, 877-882.) Erythema multiforme (EM) minor due to the herpes infection is the most likely diagnosis in this patient. The lesions of EM are classically target lesions they are burning and pruritic. They are generalized and often involve the oral mucosa. Etiologies of EM major include drugs such as phenytoin, sulfonamides, barbiturates, and allopurinol. Finger pressure in the vicinity of a lesion in EM major leads to a sheetlike removal of the epidermis (Nikolsky sign). Pemphigus vulgaris is a chronic, bullous, autoimmune disease usually seen in middle-aged adults. The Nikolsky sign is positive in pemphigus vulgaris. Secondary syphilis appears 2-6 mo after a primary infection and consists of round to oval, maculopapular lesions 0.5-1.0 cm in diameter. The eruptions typically involve the palms and soles. Secondary syphilis lesions that are flat and soft with a predilection for the mouth, perineum, and perianal areas are...
Phenytoin, sulfonamides, barbiturates, and allopurinol. Finger pressure in the vicinity of a lesion in EM major leads to a sheetlike removal of the epidermis (Nikolsky sign). Pemphigus vulgaris is a chronic, bullous, autoimmune disease usually seen in middle-aged adults. The Nikolsky sign is positive in pemphigus vulgaris. Secondary syphilis appears 2 to 6 mo after primary infection and consists of round to oval maculopapular lesions 0.5 to 1.0 cm in diameter. The eruptions typically involve the palms and soles. Secondary syphilis lesions that are flat and soft with a predilection for the mouth, perineum, and perianal areas are called condylomata lata. The skin lesions of systemic lupus erythematosus (SLE) range from the classic butterfly malar rash to the discoid plaques of chronic cutaneous lupus erythe-matosus (CCLE). Urticaria is characterized by pruritic wheals typically lasting several hours.
In animal models, the ARBs attenuate proteinuria, glomerulosclerosis, and renal hypertrophy, slowing the progression of albuminuria and the subsequent development of overt nephropathy. Additionally, ARB do not cause cough. In individuals who develop angioedema from ACE inhibitors, ARB should not be used because of the demonstrated crossover effect.
(1) Allergic reactions following blood or plasma transfusions occur less frequently than leukocyte chill fever reactions and are usually relatively mild. Most consist of local erythema, hives, and itching which develop during transfusion and that can be easily treated with, or prevented by, administration of antihistamines.
Adverse reactions to Ty21a are minimal. These may include abdominal discomfort, nausea, vomiting, fever, headache, rash, or urticaria. Adverse reactions to the ViCPS vaccine are also minimal fever (0 -1 ), headache (1.5 -3 ), and local reactions of erythema of induration of 1 cm or greater (7 ) have been reported.
Ezetimibe continues to demonstrate an excellent overall safety in tolerability profile, however the product label was updated (effective March 2003), based on reports of hyper-sensitivity reactions, including rash and, on rare occasions, angioedema. There was no excess myopathy or rhabdomyolysis associated with ezetimibe compared with placebo or statin alone, and only a slight increase in liver function tests where coadministered with statins.
A dreaded, rare complication with ACE inhibitors is angioedema, which can present initially as lingual swelling but can progress to life-threatening respiratory difficulties. This can occur within a matter of days or several weeks after therapy is initiated. Once an individual develops angioedema from any cause, an ACE inhibitor or ARB is not indicated. The presence of angioedema is not considered to be a dose-dependent effect. Concomitant use of nonsteroidal anti-inflammatory drugs may decrease the ACE inhibitor's antihypertensive effects. ACE inhibitors should not be used in pregnancy. The ADA recommends ARBs as first-line therapy for patients with type 2 diabetes who have microalbuminuria or clinical albuminuria. ARB should not be used in patients who cannot tolerate an ACE inhibitor because of hypotension, angioedema, progressive renal dysfunction, or hyperkalemia. There are some differences between the seven ARBs available on the market. Some have insurmountable binding to the...
Discussion Captopril is an ACE inhibitor and thus reduces levels of angiotensin II and prevents the inactivation of bradykinin (a potent vasodilator). It is used to treat hypertension, CHF, and diabetic renal disease. It is contraindicated in pregnancy because of fe to toxicity other side effects are cough, hypotension, taste changes, rash, proteinuria, hyperkalemia, angioedema, and neutropenia
These are physicians who specialise in dealing with skin conditions which require medical treatment. The conditions that dermatologists work with include acne, psoriasis, eczema, vitiligo, urticaria and some skin cancers. They often prescribe conventional medical treatments such as steroid creams, tablets, lotions and sessions of ultraviolet light therapy and can give good advice to patients and parents of children with skin conditions on good management of the skin. Since they tend to specialise in the physiological aspects of the skin, some dermatologists do not always appreciate the psychological aspects that can be associated with the condition - and this is where psychologists and psychiatrists can come in.
The types of reactions that can be seen following Hymenoptera stings include a typical, local reaction marked by transient pain, redness, and swelling a more extensive local reaction with swelling beyond the sting site a type I (immunoglobulin E-mediated) anaphylactic response with any combination of diffuse urticaria, angioedema, laryngeal edema, bronchospasm, or hypotension and a delayed, probably immune complex-mediated, reaction.60 Examples of such delayed reactions include serum sickness and very rare atypical phenomena such as hemolysis, thrombocytopenic purpura, and poorly understood neurologic syndromes such as Guillain-Barr syndrome or transverse myelitis.59 Anaphylaxis following Hymenoptera stings represents a true emergency, requiring aggressive management of the patient's airway and circulation. Endotracheal intubation is indicated if significant respiratory distress or laryngeal edema or stridor is present. Epinephrine should be administered as soon as available (0.01 mL...
(5) Urticaria (vascular reaction of the skin marked by the transient appearance of smooth, slightly elevated patches wheals which are redder or paler than the surrounding skin and which itch severely). (6) Urticaria (same as for intestinal nematodes). b. Tissue Nematodes. Thiabendazole is the drug of choice for trichinosis. Diethycarbomazine is also used to treat tissue nematodes. When indicated, symptomatic treatment of nematodes is given prednisone for otic (ear) disorders, antihistamines for otic inflammation, corticosteroids for urticaria and rashes, analgesics for muscle pain.
Patients who have suffered systemic or increasingly severe local reactions should carry emergency treatment kits. Hyposensitization is a must for those who have had constitutional reactions and it is advised for some with severe local reactions. Patients should take measures to avoid being stung if at all possible, and should wear an emergency ID device apprising others in case this is needed. Victims known to have a sensitivity to HYMENOPTERA venom should avoid places where stinging insects are located (camp and picnic sites) stay away from the insect's feeding ground (flowers, fruit orchards, garbage, clover fields) refrain from going barefoot outdoors since yellow jackets nest on the ground do not use perfume, scented soap, or bright colors because these items attract bees keep the car windows closed when traveling use rapid-acting insecticide to spray garbage cans hire a professional exterminator for wasp hornet nests or bee hives in the home area and consider undergoing...
Loasis or filariasis Loa loa affects 13 million people in tropical Africa. It is acquired from Chrysops sp. It is manifested by cutaneous lesions and the immune reaction to destruction of the microfilariae. The incubation period is 4 months to 20 years. It is associated with pruritus of the thorax and genitalia, angioedema, and subcutaneous migration sites (Calabar swellings). Larvae in the skin form palpable, erythematous cords of less than 10 cm and that move 1 cm per minute.
There may be itching and a sensation of warmth especially near the face and on the chest. This is usually accompanied by a reddening of the skin. If the itching is generalized, a general systemic reaction is beginning. Patches of urticaria (hives) may also appear. The skin may appear pale as the peripheral blood vessels collapse. If massive angioedema occurs on the face, this is caused by the swelling of the blood vessels just underneath the skin. This may indicate upper respiratory edema.
On the RAA system, angiotensin II is also formed by enzymes other than angiotensin-converting enzymes. Thus, since ARAs bind at a site more distal to angiotensin II receptors, they more completely antagonize angiotensin II effects, including vasoconstriction, SNS activation, and aldosterone release. Unlike ACE inhibitors, ARAs do not interfere with bradykinin and prostaglandin metabolism, which has been suggested to be responsible for the cough and angioedema of ACE inhibitors.
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