Allergic diseases – anaphylaxis a nd anaphylactoid reactions, urticaria, angioedema, eczema

1. Allergic diseases – anaphylaxis and anaphylactoid reactions, urticaria, angioedema, eczema Małgorzata Sokołowska-Wojdyło MD, MSc, PhD Department of Dermatology, Venereology, Allergology, Medical University of Gdansk, Poland

2. Anaphylaxis - definition • the maximal variant of the immediate IgE-mediated allergic reaction that affects the entire body • the antigen is either injected or ingested and then spreads via the blood • contact can happened through the mucosal surfaces or the skin also

3. Etiology • medications • preservatives • dyes • foods • occupational exposure • insect toxins

4. Etiology • aeroallergens • seminal fluid • echinococcal cysts • cold • warmth • light

5. Etiology • contact urticaria • C1 INH deficiency • systemic mastocytosis • many of the above factors together • idiopathic (cause unknown)

6. Anaphylaxis - diagnostic criteria I.Pruritus, flushing, urticaria, angioedema II.Pruritus, flushing, urticaria, angioedema; nausea, cramps; rhinorrhea, hoarseness, dyspnea; tachycardia, hypotension, arrythmias III.Pruritus, flushing, urticaria, angioedema; vomiting, defecation; laryngeal edema, bronchospasm, cyanosis, shock IV.Pruritus, flushing, urticaria, angioedema; vomiting, defecation;respiratory arrest, cardiac arrest

7. Caution!! In addition to the classic signs of acute urticaria and angioedema, an early clue may be tingling of the tongue, palms, soles and tip of the nose.

14. Anaphylaxis - investigations • anamnesis (history) and the observation • prick an patch tests • C1 INH blood level test

16. Anaphylaxis - treatment • standard medications and equipment necessaryto the resuscitation • avoiding the causing factor

17. An anaphylactoid reaction - refers to the same clinical reaction pattern, but in the absence of an acute type I reaction - differentiation between anaphylaxis and an anaphylactoidreaction - general examination, lab tests, observation - the patient is treated in the same manner

18. Urticaria - definition • common reaction pattern in which pink,itchy or “burning” swellings can occurr anywhere on the body • individual wheals lasting not longer than 24 h, but new ones continuing to appear for days, months or even years. Urticaria that persists for more than 6 weeks is classified as chronic.

19. Urticaria - epidemiology • Appearance - 20-30% of individuals have at least one attack of acute urticaria in their lifetime (urticaria is one of the most common skin disorders). • Occasionaly urticaria is combined with angioedema.

20. Urticaria - cause the signs and symptoms of urticaria are caused by mast cell degranulation, with release of histamine

21. Urticaria - classification • Physical urticaria: - Cold urticaria - Solar urticaria - Heat urticaria - Cholinergic urticaria - Immediate pressure urticaria - dermographism - Delayed pressure urticaria

22. Urticaria - classification 2. Hypersensitivity urticaria 3. Autoimmune urticaria 4. Pharmacological urticaria 5. Contact urticaria

23. Urticaria spectrum Friedman P.S.: Assessment of urticaria and angio-oedema. Clinical an Experimental Allergy, 1998, 29, 109-112

24. Clinical features and course • Most types of urticaria share the sudden appearance of pink itchy wheals, which can come up anywhere on the skin surface. • The course of an urticarial reaction depends on its triggering factor.

35. Cold induced urticaria - Ice Cube Test

36. Cold induced urticaria - Ice Cube Test Result Caution! - the linear urticaria along the "running drip", lower right.

37. Urticaria - Dermagraphism

38. What can cause the cholinergic urticaria? • Exercise • Hot baths/showers • Fever • Occlusive dressings • Spicy food • Emotional stress

41. The reasons of acute urticaria • Medications • Penicillins • NSAIDs • ASA • Cephalosporins • Sulfonamides • Isoniazid • Barbituranes • Carbamazepine 2. Insectantigens ( bee, wasporhornettoxinsfollowingsensitization) 3. Infections and infestations ( parasites, hepatitis B, infectiousmononucleosis, bacterialtoxins)

42. The reasons of acute urticaria 5. Food - fish, shellfish - coca, chocolate - tonik water - some spices - cheese especially with mould - fruits: strawberries, walnuts, citrus fruits, kiwi - vegetables: peanuts, beans and peas, tomatoes, celery root, dill 5. Animals

43. Complications • interference with daily activities • sleep disturbances • depression • asthma • asphyxiaction

44. The investigations • anamnesis, history (especially: prescribed drugs) • general medicalexamination - the physical test • laboratory tests • prick tests • RAST

45. The differential diagnosis • insect bites or stings • infestations • erythema multiforme • urticarial vasculitis • dermatitis herpetiformis

46. Urticaria - diagnostics Zuberbier T.: EAACI/GA/LEN/EDF quideline: definition, classification and diagnosois of urticaria. Allergy, 2006,61,316-320

47. The treatment • to eliminate a cause / triggeringfactors • theantihistaminica (medicaments) • the diet ex. onlyrice, potatoes and water 7 days • themastcellstabilizers ( ketotifen, cromylonsodium) • thedistracters and antipruriticointents and creams • „ theblindtherapy” ( antibiotics, anticandidaldrugs, antifungalagents, antimalarialagents) • systemic steroids, cyclosporine(in case of autologicalurticaria)

48. Angioedema definition acute subcutaneous edema causing circumsribed irregular cutaneous swelling

49. Etiology • medications • preservatives • dyes • food • occupational exposure • insect toxins • aeroallergens • seminal fluid