DOCSLIB.ORG

Ana M. Giménez-Arnau Howard I. Maibach Editors Diagnosis And

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Ana M. Giménez-Arnau Howard I. Maibach Editors Diagnosis And Updates in Clinical Dermatology Series Editors: John Berth-Jones · Chee Leok Goh · Howard I. Maibach Ana M. Giménez-Arnau Howard I. Maibach Editors Contact Urticaria Syndrome Diagnosis and Management Updates in Clinical Dermatology Series Editors: John Berth-Jones Chee Leok Goh Howard I. Maibach More information about this series at http://www.springer.com/series/13203 Ana M. Giménez-Arnau Howard I. Maibach Editors Contact Urticaria Syndrome Diagnosis and Management Editors Ana M. Giménez-Arnau, PhD Howard I. Maibach, MD Hospital del Mar - Institut Mar Department of Dermatology d’Investigacions Mediques University of California San Francisco Universitat Autònoma de Barcelona San Francisco, CA, USA (UAB) Department of Dermatology Barcelona, Spain ISSN 2523-8884 ISSN 2523-8892 (electronic) Updates in Clinical Dermatology ISBN 978-3-319-89763-9 ISBN 978-3-319-89764-6 (eBook) https://doi.org/10.1007/978-3-319-89764-6 Library of Congress Control Number: 2018946545 © Springer International Publishing AG, part of Springer Nature 2018 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Printed on acid-free paper This Springer imprint is published by the registered company Springer International Publishing AG part of Springer Nature. The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland I dedicate this book to my family, colleagues and patients – who give me confidence in my daily work. Ana M. Giménez-Arnau Preface We, as subjects who live in this world, are constantly exposed to environmen- tal agents capable of stimulating our innate and acquired immunity. Our skin, as a complete immunological organ, recognizes such environmental agents and develops a mechanism of protection. But why does our cutaneous immune system sometimes recognize common environmental agents as for- eign and develop active diseases such as eczema or urticaria? Are allergies a sign of a weak immune system? Signs and symptoms of the contact urticaria syndrome are associated with a substantial burden in the context of health. Eczema and urticaria are preva- lent disabling diseases that interfere with the quality of life and have a well- recognized occupational relevance. For this reason, early diagnosis of these diseases is recommended. From the very beginning it is crucial that the patient receive correct information. What is needed is fast identification of the disease and immediate recommendation of the patient to the correct specialist who will develop an etiological diagnosis using the proper complementary tools. All physicians should be capable of recognizing clinically the typical signs and symptoms that define an immediate skin contact reaction, diagnos- tic of contact urticaria, and protein contact dermatitis. This book includes a glossary of the essential concepts necessary to understand contact urticaria syndrome. The source of exposure to potential responsible agents is broad, and wherever possible it should be verified. This book is designed to give proper general information for the correct understanding of these prevalent skin cutaneous diseases in a practical way. Young and veteran professionals, chemists, and physicians involved in dif- ferent specialties such as dermatology, allergy, or occupational medicine built the chapters of the book. We thank them all for their enthusiasm and very good work. From epidemiology to the clinical management of specific cases, pathogenic, clinical expression, and diagnostic tools are extensively reviewed and clear protocols and algorithms are provided. vii viii Preface Our goal was to make this book easy to read, easy to understand, and easy to apply in your daily practice. We recommend including this text in your library. It will help improve your capacity for diagnosis and consequently your relationship with your population of reference. Barcelona, Spain Ana M. Giménez-Arnau San Francisco, CA, USA Howard I. Maibach Contents 1 Essentials and Updated Concepts . 1 Ana M. Giménez-Arnau and Howard I. Maibach 2 Basic Epidemiology Concepts Relevant in Contact Urticaria . 13 Jose Hernán Alfonso 3 Occupational Relevance of Contact Urticaria Syndrome ���������� 25 Jose Hernán Alfonso 4 Clinical Diagnosis of Immediate Contact Skin Reactions ���������� 45 Ana M. Giménez-Arnau and Marléne Isaksson 5 Oral Allergy Syndrome: Rethinking Concepts . 57 Jorge Sánchez and Ricardo Cardona 6 Wheals and Eczema: Pathogenic Mechanism in Immediate Contact Reactions . 65 Eduardo Rozas-Muñoz and Esther Serra-Baldrich 7 Immediate Skin Contact Reactions Induced by Proteins . 75 Kayria Muttardi and Emek Kocatürk 8 Immediate Skin Contact Reactions Induced by Chemicals . 91 Elena Giménez-Arnau 9 Immunoglobulin E: Pathogenic Relevance in Immediate Contact Reactions �������������������������������������������������������������������������� 111 Maria Estela Martinez-Escala, Leah Ariella Kaplan, and Ana M. Giménez-Arnau 10 Diagnostic Methods: Cutaneous Provocation Tests in Contact Urticaria Syndrome ���������������������������������������������������� 123 Sarah H. Wakelin ix x Contents 11 Molecular Diagnosis in Contact Urticaria Caused by Proteins �������������������������������������������������������������������������������������� 131 Joaquin Sastre 12 Preventive Measures for Occupationally Induced Immediate Contact Reactions . 149 Jose Hernán Alfonso 13 Management and Treatment of Contact Urticaria Syndrome ���������������������������������������������������������������������������������������� 161 Gustavo Deza and Ana M. Giménez-Arnau 14 Management of Contact Urticaria Through Clinical Cases . 171 Tabi A. Leslie and David Orton Index �������������������������������������������������������������������������������������������������������� 181 Contributors Jose Hernán Alfonso, MD, PhD Department of Occupational Medicine and Epidemiology, National Institute of Occupational Health, Oslo, Norway Ricardo Cardona, MD, MSc, EAC Group of Clinical and Experimental Allergy (GACE), IPS Universitaria, University of Antioquia, Medellín, Colombia Gustavo Deza, MD Hospital del Mar - Institut Mar d’Investigacions Mediques, Universitat Autònoma de Barcelona (UAB), Department of Dermatology, Barcelona, Spain Ana M. Giménez-Arnau, MD, PhD Hospital del Mar - Institut Mar d’Investigacions Mediques, Universitat Autònoma de Barcelona (UAB), Department of Dermatology, Barcelona, Spain Elena Giménez-Arnau, MD Dermatochemistry Laboratory, Institut de Chimie de Strasbourg (CNRS UMR 7177), Université de Strasbourg, Strasbourg, France Marléne Isaksson Department of Occupational and Environmental Dermatology, Lund University, Malmö University Hospital, Malmö, Sweden Leah Ariella Kaplan, BFA Tulane University, New Orleans, LA, USA Emek Kocatürk, MD Okmeydanı Training and Research Hospital, Department of Dermatology, İstanbul, Turkey Tabi A. Leslie, BSc(Hons), MBBS(Hons) Royal Free Hospital, London, UK Howard I. Maibach, MD Department of Dermatology, University of California, San Francisco, San Francisco, CA, USA Maria Estela Martinez Escala, MD, PhD Department of Dermatology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA Kayria Muttardi, MBBS, BSc, MRCP (Dermatology) West Hertfordshire NHS Trust, Department of Dermatology, Hertfordshire, UK David Orton, BSc, MSc (Allergy), MBBS, FRCP The Hillingdon Hospitals NHS Trust, Uxbridge, UK xi xii Contributors Eduardo Rozas-Muñoz, MD Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain Jorge Sánchez, MD, MSC, Allergist Group of Clinical and Experimental Allergy, IPS Universitaria, University of Antioquia, Medellin, Colombia Foundation for the Development of Medical and Biological Sciences (FUNDEMEB), Cartagena, Colombia Joaquin Sastre, MD, PhD Allergy Department Fundación Jiménez Díaz, Universidad Autónoma de Madrid, and CIBER de Enfermedades Respiratorias (CIBERES, Institute Carlos III, Ministry of Economy and Competitiveness), Madrid, Spain Esther Serra-Baldrich, MD Hospital de la Santa Creu i Sant Pau, Department of Dermatology, Barcelona, Spain Sarah H. Wakelin, BSc, MBBS, FRCP St. Mary’s Hospital, Imperial College Healthcare Trust, London, UK Essentials and Updated Concepts 1 Ana M. Giménez-Arnau and Howard I. Maibach The skin is a protective interface developed to environment. Microorganisms, toxins, physical preserve the homeostasis of the human body. A phenomena, or chemical agents are, among
Load more

Recommended publications
  • Vibratory Urticaria
    Vibratory urticaria Description Vibratory urticaria is a condition in which exposing the skin to vibration, repetitive stretching, or friction results in allergy symptoms such as hives (urticaria), swelling ( angioedema), redness (erythema), and itching (pruritus) in the affected area. The reaction can be brought on by towel drying, hand clapping, running, a bumpy ride in a vehicle, or other repetitive stimulation. Headaches, fatigue, faintness, blurry vision, a metallic taste in the mouth, facial flushing, and more widespread swelling (especially of the face) can also occur during these episodes, especially if the stimulation is extreme or prolonged. The reaction occurs within a few minutes of the stimulation and generally lasts up to an hour. Affected individuals can have several episodes per day. Frequency Vibratory urticaria is a rare disorder; its prevalence is unknown. It belongs to a class of disorders called physical urticarias in which allergy symptoms are brought on by direct exposure to factors such as pressure, heat, cold, or sunlight. Physical urticarias have been estimated to occur in up to 5 per 1,000 people. Causes Vibratory urticaria can be caused by a mutation in the ADGRE2 gene. This gene provides instructions for making a protein found in several types of immune system cells, including mast cells. Mast cells, which are found in many body tissues including the skin, are important for the normal protective functions of the immune system. They also play a role in allergic reactions, which occur when the immune system overreacts to stimuli that are not harmful. The specific role of the ADGRE2 protein in mast cells is not well understood.
    [Show full text]
  • Etiology, Classification, and Treatment of Urticaria
    CONTINUING MEDICAL EDUCATION Etiology, Classification, and Treatment of Urticaria Kjetil Kristoffer Guldbakke, MD; Amor Khachemoune, MD, CWS GOAL To understand urticaria to better manage patients with the condition OBJECTIVES Upon completion of this activity, dermatologists and general practitioners should be able to: 1. Discuss the clinical classification of urticaria. 2. Recognize how to diagnose urticaria. 3. Identify treatment options. CME Test on page 50. This article has been peer reviewed and approved Einstein College of Medicine is accredited by by Michael Fisher, MD, Professor of Medicine, the ACCME to provide continuing medical edu- Albert Einstein College of Medicine. Review date: cation for physicians. December 2006. Albert Einstein College of Medicine designates This activity has been planned and imple- this educational activity for a maximum of 1 AMA mented in accordance with the Essential Areas PRA Category 1 CreditTM. Physicians should only and Policies of the Accreditation Council for claim credit commensurate with the extent of their Continuing Medical Education through the participation in the activity. joint sponsorship of Albert Einstein College of This activity has been planned and produced in Medicine and Quadrant HealthCom, Inc. Albert accordance with ACCME Essentials. Drs. Guldbakke and Khachemoune report no conflict of interest. The authors discuss off-label use of colchi- cine, cyclophosphamide, cyclosporine, dapsone, intravenous immunoglobulin, methotrexate, montelukast sodium, nifedipine, plasmapheresis, rofecoxib, sulfasalazine, tacrolimus, thyroxine, and zafirlukast. Dr. Fisher reports no conflict of interest. Urticaria is among the most common skin dis- autoimmune mechanisms are now recognized as a eases. It can be acute, chronic, mediated by a cause of chronic urticaria. A search of the PubMed physical stimulus, or related to contact with an database (US National Library of Medicine) for urticant.
    [Show full text]
  • Local Heat Urticaria
    Volume 23 Number 12 | December 2017 Dermatology Online Journal || Case Presentation DOJ 23 (12): 10 Local heat urticaria Forrest White MD, Gabriela Cobos MD, and Nicholas A Soter MD Affiliations: 1 New York University Langone Health, New York Abstract PHYSICAL EXAMINATION: A brisk, mechanical stroke elicited a linear wheal. Five minutes after exposure We present a 38-year-old woman with local heat to hot water, she developed well-demarcated, urticaria confirmed by heat provocation testing. Heat erythematous blanching wheals that covered the urticaria is a rare form of physical urticaria that is distal forearm and entire hand. triggered by exposure to a heat source, such as hot water or sunlight. Although it is commonly localized Conclusion and immediate, generalized and delayed onset forms Physical or inducible urticarias are a group of exist. Treatment options include antihistamines urticarias that are triggered by various external and heat desensitization. A brisk, mechanical stroke physical stimuli, such as mechanical stimuli, pressure, elicited a linear wheal. Five minutes after exposure cold, light, or temperature change. Urticarias due to hot water, she developed well-demarcated, to temperature change include heat urticaria (HU), erythematous blanching wheals that covered the cholinergic urticaria, and cold urticaria. distal forearm and entire hand. HU is a rare form of chronic inducible urticaria, with Keywords: urticaria, local heat urticaria, physical approximately 60 reported cases [1]. In HU, contact urticaria with a heat source such as hot water, sunlight, hot air, radiant heat, or hot objects results in wheal formation Introduction HISTORY: A 38-year-old woman presented to the Skin and Cancer Unit for the evaluation of recurrent, intensely pruritic eruptions that were precipitated by exposure to heat, which included hot water and sunlight.
    [Show full text]
  • Edderm101 CORE DISEASES V2.09
    ed.derm.101: core diseases almost everything you need to know to survive dermatology* “Two thirds of what we see is behind our eyes” “Explain, explain,” grumbled Étienne. “If you people can’t name something you’re incapable of seeing it.”— Cortázar, 1966, Hopscotch “Learning results from what the student does and thinks and only from what the student does and thinks. The teacher can advance learning only by influencing what the student does to learn.” Herbert Simon, Nobel Laureate. ! " *the first of many outright lies exaggerations. You need to know skincancer909 too, and ed.derm.101: core concepts, but these are also free. Professor Jonathan Rees FMedSci Grant Chair of Dermatology University of Edinburgh email me reestheskin.me: about me reestheskinblog.me: unreasonable views from the edge of education and medicine skincancer909: an online textbook of skin cancer for medical students V2.09, 25 September 2019 at 13:18 Distributed under a Creative Commons Attribution-Non Commercial ShareAlike 4.0 License !1 Preface The purpose of ed.derm.101: core diseases is to cover all the clinical material that we expect students to know, that is not covered in either ed.derm.101: core concepts or skincancer909. I assume you have already worked your way through ed.derm.101: core concepts (because what follows is heavily dependent on this foundational reading). A few words of advice about studying this aspect of dermatology and ed.derm.101: - It is hard to learn about a disease without some sort of mental image of what it looks like. In skincancer909 I was able to make use of a bespoke library of images that were developed as part of a research project funded by the Wellcome Trust.
    [Show full text]
  • Chinese Herbal Medicine for Chronic Urticaria and Psoriasis Vulgaris: Clinical Evidence and Patient Experience
    Chinese Herbal Medicine for Chronic Urticaria and Psoriasis Vulgaris: Clinical Evidence and Patient Experience A thesis submitted in fulfilment of the requirement for the degree of Doctor of Philosophy Jingjie Yu BMed, MMed School of Health & Biomedical Sciences College of Science, Engineering and Health RMIT University August 2017 Declaration I certify that except where due acknowledgement has been made, the work is that of the author alone; the work has not been submitted previously, in whole or in part, to qualify for any other academic award; the content of the thesis is the result of work which has been carried out since the official commencement date of the approved research program; and, any editorial work, paid or unpaid, carried out by a third party is acknowledged. Jingjie Yu __________________ Date 21 August 2017 i Acknowledgements First, I would like to express my deepest gratitude to my parents, Mr Mingzhong Yu and Mrs Fengqiong Lv, for your endless love, encouragement and support throughout these years. I would also like to express my sincere appreciation to my supervisors, Professor Charlie Changli Xue, Professor Chuanjian Lu, Associate Professor Anthony Lin Zhang and Dr Meaghan Coyle. To my joint senior supervisor, Professor Charlie Changli Xue, thank you for providing me the opportunity to undertake a PhD at RMIT University. To my joint senior supervisor, Professor Chuanjian Lu, thank you for teaching me the truth in life and for the guidance you have given me since I stepped into your consultation room in our hospital seven years ago. To my joint associate supervisor Associate Professor Anthony Lin Zhang, I thank you for your continuous guidance and support during my study at RMIT University.
    [Show full text]
  • 10 Chronic Urticaria As an Autoimmune Disease
    10 Chronic Urticaria as an Autoimmune Disease Michihiro Hide, Malcolm W. Greaves Introduction Urticaria is conventionally classified as acute, intermittent and chronic (Grea- ves 2000a). Acute urticaria which frequently involves an IgE-mediated im- munological mechanism, is common, its causes often recognised by the patient, and will not be considered further. Intermittent urticaria – frequent bouts of unexplained urticaria at intervals of weeks or months – will be dis- cussed here on the same basis as ‘ordinary’ chronic urticaria. The latter is conventionally defined as the occurrence of daily or almost daily whealing for at least six weeks. The etiology of chronic urticaria is usually obscure. The different clinical varieties of chronic urticaria will be briefly considered here, and attention will be devoted to a newly emerged entity – autoimmune chronic urticaria, since establishing this diagnosis has conceptual, prognostic and the- rapeutic implications. Contact urticaria and angioedema without urticaria will not be dealt with in this account. Classification of Chronic Urticaria The clinical subtypes of chronic urticaria are illustrated in the pie-chart of Fig. 1. The frequency of these subtypes is based upon the authors’ experience at the St John’s Institute of Dermatology in UK. Whilst there may well be mi- nor differences, it is likely that the frequency distribution of these subtypes will be essentially similar in most centres in Europe and North America (Grea- ves 1995, 2000b). However, our experience suggests that the incidence of angioedema, especially that complicated by ordinary chronic urticaria is sub- stantially lower in Japan and south Asian countries (unpublished observation). 310 Michihiro Hide and Malcolm W.
    [Show full text]
  • Urticaria and Angioedema
    Urticaria and Angioedema This guideline, developed by Robbie Pesek, MD and Allison Burbank, MD, in collaboration with the ANGELS team, on July 23, 2013, is a significantly revised version of the guideline originally developed by Jeremy Bufford, MD. Last reviewed by Robbie Pesek, MD September 14, 2016. Key Points Urticaria and angioedema are common problems and can be caused by both allergic and non- allergic mechanisms. Prompt diagnosis of hereditary angioedema (HAE) is important to prevent morbidity and mortality. Several new therapeutic options are now available. Patients with urticaria and/or angioedema should be referred to an allergist/immunologist for symptoms that are difficult to control, suspicion of HAE, or to rule out suspected allergic triggers. Definition, Assessment, and Diagnosis Definitions Urticaria is a superficial skin reaction consisting of erythematous, raised, blanching, well- circumscribed or confluent pruritic, edematous wheals, often with reflex erythema.1-3 Urticarial lesions are typically pruritic, and wax/wane with resolution of individual lesions within 24 hours. Angioedema is localized swelling of deep dermal, subcutaneous, or submucosal tissue resulting from similar vascular changes that contribute to urticaria.1,2 Angioedema may be pruritic and/or painful and can last for 2-3 days depending on etiology.3 1 Urticaria alone occurs in 50% of patients and is associated with angioedema in 40% of patients. Isolated angioedema occurs in 10% of patients.1,2 Hereditary angioedema (HAE) is a disorder involving defects in complement, coagulation, kinin, and fibrinolytic pathways that results in recurrent episodes of angioedema without urticaria, usually affecting the skin, upper airway, and gastrointestinal tract.4 In children, acute urticaria is more common than chronic forms.
    [Show full text]
  • FULL TEXT BOOK Scientific Program Lecture Summaries Oral Presentations Poster Presentations 1 INVITATION
    FULL TEXT BOOK Scientific Program Lecture Summaries Oral Presentations Poster Presentations 1 INVITATION Dear colleagues, We are pleased to announce the 5th INDERCOS Congress, taking place 12-15 March 2020 in İstanbul-TURKEY. The main topics of this meeting will be “Immunogenetics in Dermatology and Aging”. Through plenaries and parallel workshop sessions, we aim to share insights and experiences and discuss how advances in aesthetic and general dermatology. In order to success this, we have very distinctive international speakers with extensive experience and a range of expertise across aesthetic dermatology and dermatology. Several major histocompatibility complex and nonmajor histocompatibility complex genetic polymorphisms have been identified which may contribute to the inflammatory skin diseases and skin aging. Most of these genetic variants are associated with mechanisms attributed to the pathogenesis of skin disease and aging, including pathways involved in cytokines, chemokine and vitamin regulation and ultraviolet light exposure and other environmental factors. Immunogenetics is a subspeciality of medicine that studies the relationship between genetics and immunology. Immunogenetics helps in understanding the pathogenesis of several autoimmune, malign, infectious skin diseases and also skin aging. 5th INDERCOS congress focuses on the genetic research areas of autoimmune skin diseases such as connective tissue diseases, psoriasis, skin cancers, vasculitis, skin aging and skin infections. Lectures on genetics of cell interaction with immune system, immune response to transplantation, immune based therapies for treatment of cancers and inflammatory skin diseases and aging, antigenic phylogeny of alleles, alloantigens will be discussed. We hope you will be together with us in this fascinating, high quality scientifically educational congress and we look forward to your precious participation and feedback.
    [Show full text]
  • 5 Allergic Diseases (And Differential Diagnoses)
    Chapter 5 5 Allergic Diseases (and Differential Diagnoses) 5.1 Diseases with Possible IgE Involve- tions (combination of type I and type IVb reac- ment (“Immediate-Type Allergies”) tions). Atopic eczema will be discussed in a separate section (see Sect. 5.5.3). There are many allergic diseases manifesting in The maximal manifestation of IgE-mediated different organs and on the basis of different immediate-type allergic reaction is anaphylax- pathomechanisms (see Sect. 1.3). The most is. In the development of clinical symptoms, common allergies develop via IgE antibodies different organs may be involved and symp- and manifest within minutes to hours after al- toms of well-known allergic diseases of skin lergen contact (“immediate-type reactions”). and mucous membranes [also called “shock Not infrequently, there are biphasic (dual) re- fragments” (Karl Hansen)] may occur accord- action patterns when after a strong immediate ing to the severity (see Sect. 5.1.4). reactioninthecourseof6–12harenewedhy- persensitivity reaction (late-phase reaction, LPR) occurs which is triggered by IgE, but am- 5.1.1 Allergic Rhinitis plified by recruitment of additional cells and 5.1.1.1 Introduction mediators.TheseLPRshavetobedistin- guished from classic delayed-type hypersensi- Apart from being an aesthetic organ, the nose tivity (DTH) reactions (type IV reactions) (see has several very interesting functions (Ta- Sect. 5.5). ble 5.1). It is true that people can live without What may be confusing for the inexperi- breathing through the nose, but disturbance of enced physician is familiar to the allergist: The this function can lead to disease. Here we are same symptoms of immediate-type reactions interested mostly in defense functions against are observed without immune phenomena particles and irritants (physical or chemical) (skin tests or IgE antibodies) being detectable.
    [Show full text]
  • ลมพิษ (Urticaria) (1,2)
    1 (1,2) ลมพิษ (URTICARIA) เพ็ญพรรณ วัฒนไกร พ.บ. ว.ว. (อายุรศาสตร์ ตจวิทยา) Certificate in Contact Dermatitis and Environmental Skin Disorders Certificate in Cosmetic Dermatology ผชู้ ่วยศาสตราจารย ์ หน่วยโรคผิวหนงั ภาควชิ าอายรุ ศาสตร์ คณะแพทยศาสตร์โรงพยาบาลรามาธิบดี ลมพิษเป็นอาการและอาการแสดงทางผวิ หนงั ที่พบไดบ้ ่อย ทา ใหเ้ กิดผนื่ นูนแดง และคนั ซ่ึงมกั จะเป็นอยไู่ มเ่ กิน 24-28 ชว่ั โมง จึงยบุ ลง หลงั จากน้นั จะกลบั มีผนื่ ข้ึนใหมอ่ ีก เป็นๆหายๆ ส่วนใหญ่ของผู้ป่วยลมพิษจะเป็นลมพิษเฉียบพลัน (acute urticaria) คือเป็นไมเ่ กิน 6 สัปดาห์ ถา้ เป็นนานเกิน 6 สัปดาห์เรียก ลมพิษเร้ือรัง (chronic urticaria) ซ่ึงพบไดบ้ อ่ ยใน หญิงวยั กลางคน ผนื่ ลมพิษอาจมีอาการบวมของผวิ หนงั และเยอื่ บุช้นั ลึก และช้นั ไขมนั ใตผ้ วิ หนงั ร่วมดว้ ยเรียก angioedema หรืออาจมีแต่อาการบวม angioedema อยา่ งเดียวโดยไมม่ ีลมพิษ แตพ่ บไดไ้ มบ่ อ่ ย ความส าคัญของโรค (Introduction) พบลมพิษไดบ้ อ่ ย ประมาณ 15-20% ของประชากรทว่ั ไปจะมีผนื่ ลมพิษข้ึนอยา่ งนอ้ ยคร้ังหน่ึงในช่วงชีวติ (2) จาก การศึกษาในนักศึกษาแพทย์ โรงพยาบาลศิริราช 428 คน พบวา่ มีร้อยละ 51.6 % เคยเป็นลมพิษ ร้อยละ 19.6 % เคยเป็น angioedema และพบร่วมกนั ใน 13.6 % ในกลุ่มที่เป็นลมพิษแบง่ เป็นลมพิษเฉียบพลัน 93.2 % และ ลมพิษเร้ือรัง 5.4 % (3) จากข้อมูลผปู้ ่วยนอกหน่วยตรวจผิวหนงั โรงพยาบาลรามาธิบดี ในปี พ.ศ. 2550 มีจา นวนผปู้ ่วยนอกท้งั หมด 71053 ราย ได้รับการวินิจฉัยโรคลมพิษ 2104 ราย คิดเป็น 2.96 % อาการและอาการแสดง (Clinical manifestation) ลมพิษมีลักษณะทางคลินิกที่สาคัญคือผื่นนูนแดง (wheal and flare) (รูป 1,2) ส่วนใหญม่ ีอาการคนั อาการคันจะ นอ้ ยกวา่ ใน angioedema ลักษณะรอยโรคลมพิษจะนูน บวม แดง เป็นป้ืน ขอบเขตชดั
    [Show full text]
  • Chronic Urticaria It’S More Than Just Antihistamines! Randy D
    CE/CME Chronic Urticaria It’s More Than Just Antihistamines! Randy D. Danielsen, PhD, PA, DFAAPA, PA-C Emeritus, Gabriel Ortiz, MPAS, PA-C, DFAAPA, Susan Symington, MPAS, PA-C, DFAAPA The discomfort caused by an urticarial rash, along with its unpredictable course, can interfere with a patient’s sleep and work/school. Adding to the frustration of patients and providers alike, an underlying cause is seldom identified. But a stepwise treatment approach can bring relief to all. Randy D. Danielsen is Professor and Dean CE/CME INFORMATION rticaria, often referred to as hives, is a of the Arizona School Earn credit by reading this article and common cutaneous disorder with a life- 1 of Health Sciences, successfully completing the posttest time incidence between 15% and 25%. and Director of the U Center for the Future at www.mdedge.com/clinicianreviews/ Urticaria is characterized by recurring pruritic of the Health ce/cme/latest. Successful completion wheals that arise due to allergic and nonallergic Professions at A.T. is defined as a cumulative score of at reactions to internal and external agents. The Still University in least 70% correct. Mesa, Arizona. name urticaria comes from the Latin word for Gabriel Ortiz This program has been reviewed and “nettle,” urtica, derived from the Latin word uro, practices at Breathe is approved for a maximum of 1.0 hour meaning “to burn.”2 America El Paso in of American Academy of Physician Urticaria can be debilitating for patients, who Texas and is a former Assistants (AAPA) Category 1 CME AAPA liaison to the may complain of a burning sensation.
    [Show full text]
  • Clinical Practice Guideline 2557 (Urticaria/Angioedema)
    Clinical Practice Guideline 2557 กก (Urticaria/Angioedema) ก ก กกก กก 238 Clinical Practice Guideline Urticaria/Angioedema Clinical Practice Guideline ก: ก ก ก กก : กก ก กก: กก ก ก ก กกก ก ก ก ก กกก: Clinical Practice Guideline Urticaria/Angioedema 239 กก/ กกก ก/ ก/ ก กก/ / ก(spontAneous urticAriA) กก กกก กก กก กกกก กก/ ก ก กก กกกก ก 2552 กกก (wheAl And flAre) /ก (AngioedemA) กก กกก ก ก กก (physicAl) ก ก กก (urticaria) ก (wheAl And flAre) ก ก กกก ก ก (AngioedemA) ก ก กกก ก ก 24 ก กก กกก 24 ก ก ก AnAphylAxis ก กก ก ก กกก (AnAphylActic shock) ก 2 1. (acute urticaria) ก กก 6 2. (chronic urticaria) ก 2 ก กก 6 240 Clinical Practice Guideline Urticaria/Angioedema 1 กก (กก (1) (2)) ก ก ก • / ก ก (SpontAneous urticAriA) (Acute spontAneous urticAriA) ก 6 • / ก ก (Chronic spontAneous urticAriA) กก 6 ก กกก • Cold urticAriA ก ก • DelAyed pressure urticAriA ก ก ก 3-12 กก (Inducible urticAriA or physicAl urticAriA) • HeAt urticAriA • SolAr urticAriA / • SymptomAtic dermogrAphism (mechAnicAl sheAring forces ) ก 1-5 กก • VibrAtory AngioedemA (pneumAtic hAmmer) ก 1-2 • AquAgenic urticAriA • Cholinergic urticAriA ก • ContAct urticAriA กกก ก กกก ก ก 1 กกกกก syndromes กก / 2 Clinical Practice Guideline Urticaria/Angioedema 241 1 กก (ก (2) (3)) Urticaria Angioedema H istory , , ? ก ACEI ? + - - + hereditAry ก AutoinflAmmAtory (HAE) Acquired > 24 ? ก ? disorder ? AngioedemA (AAE) ? + - + - - + - + DiAgnostictests Histology: Inducible vAsculitis
    [Show full text]