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DEFINITION U rticaria Angioedem a (nettle-rash,hives) (gianturticaria,angioneuroticedem a / Q uinckes edem a) lesion Papules/wheals;circumscribed sw elling Lightly erythem atous >>centralclearing/blanched blanched w ith pressure location uppercorium of deep derm is the derm is subcutaneous /subm ucosa layer sensation pruritus painful,burning

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  • DEFINITION

    Sheet1

    DEFINITION

    UrticariaAngioedema

    (nettle-rash, hives)(giant urticaria, angioneuroticedema /

    Quinckes edema)

    lesionPapules/wheals; circumscribedswelling

    Lightly erythematous

    >>central clearing/blanched

    blanched with pressure

    locationupper corium ofdeep dermis

    the dermissubcutaneous / submucosa layer

    sensationprurituspainful, burning

    Sheet2

    Sheet3

    Sheet1

    DEFINITION

    UrticariaAngioedema

    (nettle-rash, hives)(giant urticaria, angioneuroticedema /

    Quinckes edema)

    lesionPapules/wheals; circumscribedswelling

    Lightly erythematous

    >>central clearing/blanched

    blanched with pressure

    locationupper corium ofdeep dermis

    the dermissubcutaneous / submucosa layer

    sensationprurituspainful, burning

    Sheet2

    Sheet3

    Sheet1

    DEFINITION

    UrticariaAngioedema

    (nettle-rash, hives)(giant urticaria, angioneuroticedema /

    Quinckes edema)

    lesionPapules/wheals; circumscribedswelling

    Lightly erythematous

    >>central clearing/blanched

    blanched with pressure

    locationupper corium ofdeep dermis

    the dermissubcutaneous / submucosa layer

    sensationprurituspainful, burning

    Sheet2

    Sheet3

    Sheet1

    DEFINITION

    UrticariaAngioedema

    (nettle-rash, hives)(giant urticaria, angioneuroticedema /

    Quinckes edema)

    lesionPapules/wheals; circumscribedswelling

    Lightly erythematous

    >>central clearing/blanched

    blanched with pressure

    locationupper corium ofdeep dermis

    the dermissubcutaneous / submucosa layer

    sensationprurituspainful, burning

    Sheet2

    Sheet3

  • PATHOPHYSIOLOGY

  • CLASSIFICATION

    Sheet1

    CLASSIFICATION

    I.Duration

    Acute: < 6 weeks

    Chronic: > 6 weeks

    II.Ethiology & pathophysiologic mechanism

    A.Immunologic

    Hypersensitive reaction

    B.Anaphylactoic

    1.Hereditary Angioedema

    2.Histamine liberators

    3.Aspirin

    C.Physical:

    1.Dermatographia ("writing on the skin")

    2.Cold urticaria

    3.Cholinergic urticaria

    4.Heat urticaria

    5.Solar urticaria

    6.Pressure urticaria & angioedema

    7.Vibratory angioedema

    8.Aquagenic urticaria

    D.Miscellaneous

    1.Papular urticaria

    2.Urticaria pigmentosa

    3.Systemic mastocytosis

    4.Infection + urticaria

    5.Urticaria with underlying systemic disease

    a. Collagen vascular diseases

    b. Malignancies

    c. Endocrine hormone imbalance

    6.Psychogenic factors

    7.Idiopathics urticaria & angioedema

    Sheet2

    Sheet3

  • CLASSIFICATION

    Sheet1

    CLASSIFICATION

    I.Duration

    Acute: < 6 weeks

    Chronic: > 6 weeks

    II.Ethiology & pathophysiologic mechanism

    A.Immunologic

    Hypersensitive reaction

    B.Anaphylactoic

    1.Hereditary Angioedema

    2.Histamine liberators

    3.Aspirin

    C.Physical:

    1.Dermatographia ("writing on the skin")

    2.Cold urticaria

    3.Cholinergic urticaria

    4.Heat urticaria

    5.Solar urticaria

    6.Pressure urticaria & angioedema

    7.Vibratory angioedema

    8.Aquagenic urticaria

    D.Miscellaneous

    1.Papular urticaria

    2.Urticaria pigmentosa

    3.Systemic mastocytosis

    4.Infection + urticaria

    5.Urticaria with underlying systemic disease

    a. Collagen vascular diseases

    b. Malignancies

    c. Endocrine hormone imbalance

    6.Psychogenic factors

    7.Idiopathics urticaria & angioedema

    Sheet2

    Sheet3

  • CLASSIFICATION

    Sheet1

    CLASSIFICATION

    I.Duration

    Acute: < 6 weeks

    Chronic: > 6 weeks

    II.Ethiology & pathophysiologic mechanism

    A.Immunologic

    Hypersensitive reaction

    B.Anaphylactoic

    1.Hereditary Angioedema

    2.Histamine liberators

    3.Aspirin

    C.Physical:

    1.Dermatographia ("writing on the skin")

    2.Cold urticaria

    3.Cholinergic urticaria

    4.Heat urticaria

    5.Solar urticaria

    6.Pressure urticaria & angioedema

    7.Vibratory angioedema

    8.Aquagenic urticaria

    D.Miscellaneous

    1.Papular urticaria

    2.Urticaria pigmentosa

    3.Systemic mastocytosis

    4.Infection + urticaria

    5.Urticaria with underlying systemic disease

    a. Collagen vascular diseases

    b. Malignancies

    c. Endocrine hormone imbalance

    6.Psychogenic factors

    7.Idiopathics urticaria & angioedema

    Sheet2

    Sheet3

  • CLASSIFICATION

    Sheet1

    CLASSIFICATION

    I.Duration

    Acute: < 6 weeks

    Chronic: > 6 weeks

    II.Ethiology & pathophysiologic mechanism

    A.Immunologic

    Hypersensitive reaction

    B.Anaphylactoic

    1.Hereditary Angioedema

    2.Histamine liberators

    3.Aspirin

    C.Physical:

    1.Dermatographia ("writing on the skin")

    2.Cold urticaria

    3.Cholinergic urticaria

    4.Heat urticaria

    5.Solar urticaria

    6.Pressure urticaria & angioedema

    7.Vibratory angioedema

    8.Aquagenic urticaria

    D.Miscellaneous

    1.Papular urticaria

    2.Urticaria pigmentosa

    3.Systemic mastocytosis

    4.Infection + urticaria

    5.Urticaria with underlying systemic disease

    a. Collagen vascular diseases

    b. Malignancies

    c. Endocrine hormone imbalance

    6.Psychogenic factors

    7.Idiopathics urticaria & angioedema

    Sheet2

    Sheet3

  • HYPERSENSITIVITY

    Sheet1

    TYPE I

    - Ig-E mediated mediator release

    - E/ : fish, berries, nut, egg, chocolate, drugs, bee-sting, animal danders/saliva

    - Ig-E passive transfer -----> Prausnitz-Kustner rct

    - D/ : avoidance-challenge test

    skin prich / scratch / intradermal test

    serum Ig-E total/specific

    Eosinophyl count

    TYPE II

    Tranfusion Reaction Cytotoxic Ig-G & Ig-M >< isoantigen

    Complement activation

    C3a & C5a

    Mediator release

    ( Histamine )

    TYPE III

    Serum sickness : urticaria, arthralgia fever

    Sheet2

    Sheet3

    Sheet1

    TYPE I

    - Ig-E mediated mediator release

    - E/ : fish, berries, nutch, egg, chocolate, drugs, bee-sting, animal danders/saliva

    - Ig-E passive transfer -----> Prausnitz-Kustner rct

    - D/ : avoidance-challenge test

    skin prich / scratch / intradermal test

    serum Ig-E total/specific

    Eosinophil count

    TYPE II

    Tranfusion Reaction Cytotoxic Ig-G & Ig-M >< isoantigen

    Complement activation

    C3a & C5a

    Mediator release

    ( Histamine )

    TYPE III

    Serum sickness : urticaria, arthralgia fever

    Sheet2

    Sheet3

    Sheet1

    TYPE I

    - Ig-E mediated mediator release

    - E/ : fish, berries, nutch, egg, chocolate, drugs, bee-sting, animal danders/saliva

    - Ig-E passive transfer -----> Prausnitz-Kustner rct

    - D/ : avoidance-challenge test

    skin prich / scratch / intradermal test

    serum Ig-E total/specific

    Eosinophil count

    TYPE II

    Tranfusion Reaction Cytotoxic Ig-G & Ig-M >< isoantigen

    Complement activation

    C3a & C5a

    Mediator release

    ( Histamine )

    TYPE III

    Serum sickness : urticaria, arthralgia, fever

    Sheet2

    Sheet3

  • PATHOPHYSIOLOGY

  • HEREDITARY ANGIOEDEMA

    Sheet1

    HEREDITARY ANGIOEDEMA

    1Relative frequency-

    2PrecipitantMinor trauma, emotional disorders, infection

    sudden temperature change

    3Onset-

    4Duration2 - 4 days

    5Symptomes

    a. localrecurrent, angioedema, urticaria (-), non pruritic

    b. systemicheadeache, recurrent abdominal pain,

    laryngeal edema,

    6TestsAsymptomatic : C4 , C2

    Attack : C4 (-), C2

    CH30 C1 - INH

    7MechanismC1-INH deficiency/malfunction

    8TreatmentInfusion : C1 - esterase inhibitor concentrate

    Analgesics

    Endotracheal incubation

    shock ---> Intravenous solution

    Sheet2

    Sheet3

    Sheet1

    HEREDITARY ANGIOEDEMA

    1Relative frequency-

    2PrecipitantMinor trauma, emotional disorders, infection

    sudden temperature change

    3Onset-

    4Duration2 - 4 days

    5Symptomes

    a. localrecurrent, angioedema, urticaria (-), non pruritic

    b. systemicheadeache, recurrent abdominal pain,

    laryngeal edema,

    6TestsAsymptomatic : C4 , C2

    Attack : C4 (-), C2

    CH30 C1 - INH

    7MechanismC1-INH deficiency/malfunction

    8TreatmentInfusion : C1 - esterase inhibitor concentrate

    Analgesics

    Endotracheal incubation

    shock ---> Intravenous solution

    Sheet2

    Sheet3

    Sheet1

    HEREDITARY ANGIOEDEMA

    1Relative frequency-

    2PrecipitantMinor trauma, emotional disorders, infection

    sudden temperature change

    3Onset-

    4Duration2 - 4 days

    5Symptomes

    a. localrecurrent, angioedema, urticaria (-), non pruritic

    b. systemicheadeache, recurrent abdominal pain,

    laryngeal edema,

    6TestsAsymptomatic : C4 , C2

    Attack : C4 (-), C2

    CH30 C1 - INH

    7MechanismC1-INH deficiency/malfunction

    8TreatmentInfusion : C1 - esterase inhibitor concentrate

    Analgesics

    Endotracheal incubation

    shock ---> Intravenous solution

    Sheet2

    Sheet3

    Sheet1

    HEREDITARY ANGIOEDEMA

    1Relative frequency-

    2PrecipitantMinor trauma, emotional disorders, infection

    sudden temperature change

    3Onset-

    4Duration2 - 4 days

    5Symptomes

    a. localrecurrent, angioedema, urticaria (-), non pruritic

    b. systemicheadeache, recurrent abdominal pain,

    laryngeal edema,

    6TestsAsymptomatic : C4 , C2

    Attack : C4 (-), C2

    CH30 C1 - INH

    7MechanismC1-INH deficiency/malfunction

    8TreatmentInfusion : C1 - esterase inhibitor concentrate

    Analgesics

    Endotracheal incubation

    shock ---> Intravenous solution

    Sheet2

    Sheet3

    Sheet1

    HEREDITARY ANGIOEDEMA

    1Relative frequency-

    2PrecipitantMinor trauma, emotional disorders, infection

    sudden temperature change

    3Onset-

    4Duration2 - 4 days

    5Symptomes

    a. localrecurrent, angioedema, urticaria (-), non pruritic

    b. systemicheadeache, recurrent abdominal pain,

    laryngeal edema,

    6TestsAsymptomatic : C4 , C2

    Attack : C4 (-), C2

    CH30 C1 - INH

    7MechanismC1-INH deficiency/malfunction

    8TreatmentInfusion : C1 - esterase inhibitor concentrate

    Analgesics

    Endotracheal incubation

    shock ---> Intravenous solution

    Sheet2

    Sheet3

    Sheet1

    HEREDITARY ANGIOEDEMA

    1Relative frequency-

    2PrecipitantMinor trauma, emotional disorders, infection

    sudden temperature change

    3Onset-

    4Duration2 - 4 days

    5Symptomes

    a. localrecurrent, angioedema, urticaria (-), non pruritic

    b. systemicheadeache, recurrent abdominal pain,

    laryngeal edema,

    6TestsAsymptomatic : C4 , C2

    Attack : C4 (-), C2

    CH30 C1 - INH

    7MechanismC1-INH deficiency/malfunction

    8TreatmentInfusion : C1 - esterase inhibitor concentrate

    Analgesics

    Endotracheal incubation

    shock ---> Intravenous solution

    Sheet2

    Sheet3

    Sheet1

    HEREDITARY ANGIOEDEMA

    1Relative frequency-

    2PrecipitantMinor trauma, emotional disorders, infection

    sudden temperature change

    3Onset-

    4Duration2 - 4 days

    5Symptomes

    a. localrecurrent, angioedema, urticaria (-), non pruritic

    b. systemicheadeache, recurrent abdominal pain,

    laryngeal edema,

    6TestsAsymptomatic : C4 , C2

    Attack : C4 (-), C2

    CH30 C1 - INH

    7MechanismC1-INH deficiency/malfunction

    8TreatmentInfusion : C1 - esterase inhibitor concentrate

    Analgesics

    Endotracheal incubation

    shock ---> Intravenous solution

    Sheet2

    Sheet3

    Sheet1

    HEREDITARY ANGIOEDEMA

    1Relative frequency-

    2PrecipitantMinor trauma, emotional disorders, infection

    sudden temperature change

    3Onset-

    4Duration2 - 4 days

    5Symptomes

    a. localrecurrent, angioedema, urticaria (-), non pruritic

    b. systemicheadeache, recurrent abdominal pain,

    laryngeal edema,

    6TestsAsymptomatic : C4 , C2

    Attack : C4 (-), C2

    CH30 C1 - INH

    7MechanismC1-INH deficiency/malfunction

    8TreatmentInfusion : C1 - INH concentrate

    Analgesics

    Endotracheal incubation

    shock ---> Intravenous solution

    Sheet2

    Sheet3

  • PHYSICAL URTICARIA

    Sheet1

    PHYSICAL URTICARIA

    1Relative frequencyMost frequent

    2PrecipifantStroking skin

    3Onsetimmediate minutes

    delayed: 3-8 hours

    4Durationimmediate: 2-3 hours

    delayed: 24-48 hours

    5Symptomes

    a. localimmediate: erythema, wheal, pruritus +/-

    delayed: erythema, wheal, pruritus +/-,

    nodule

    b. systemicnone

    6Testsscratch skin

    7Mechanismimmediate: histamine

    delayed: ?

    8Treatmentantihistamine continuous

    1st + 2nd generation

    Sheet2

    Sheet3

    Sheet1

    PHYSICAL URTICARIA

    1Relative frequencyMost frequent

    2PrecipitantStroking skin

    3Onsetimmediate minutes

    delayed: 3-8 hours

    4Durationimmediate: 2-3 hours

    delayed: 24-48 hours

    5Symptomes

    a. localimmediate: erythema, wheal, pruritus +/-

    delayed: erythema, wheal, pruritus +/-,

    nodule

    b. systemicnone

    6Testsscratch skin

    7Mechanismimmediate: histamine

    delayed: ?

    8Treatmentantihistamine continuous

    1st + 2nd generation

    Sheet2

    Sheet3

    Sheet1

    PHYSICAL URTICARIA

    1Relative frequencyMost frequent

    2PrecipifantStroking skin

    3Onsetimmediate minutes

    delayed: 3-8 hours

    4Durationimmediate: 2-3 hours

    delayed: 24-48 hours

    5Symptomes

    a. localimmediate: erythema, wheal, pruritus +/-

    delayed: erythema, wheal, pruritus +/-,

    nodule

    b. systemicnone

    6Testsscratch skin

    7Mechanismimmediate: histamine

    delayed: ?

    8Treatmentantihistamine continuous

    1st + 2nd generation

    Sheet2

    Sheet3

    Sheet1

    PHYSICAL URTICARIA

    1Relative frequencyMost frequent

    2PrecipifantStroking skin

    3Onsetimmediate minutes

    delayed: 3-8 hours

    4Durationimmediate: 2-3 hours

    delayed: 24-48 hours

    5Symptomes

    a. localimmediate: erythema, wheal, pruritus +/-

    delayed: erythema, wheal, pruritus +/-,

    nodule

    b. systemicnone

    6Testsscratch skin

    7Mechanismimmediate: histamine

    delayed: ?

    8Treatmentantihistamine continuous

    1st + 2nd generation

    Sheet2

    Sheet3

    Sheet1

    PHYSICAL URTICARIA

    1Relative frequencyMost frequent

    2PrecipifantStroking skin

    3Onsetimmediate minutes

    delayed: 3-8 hours

    4Durationimmediate: 2-3 hours

    delayed: 24-48 hours

    5Symptomes

    a. localimmediate: erythema, wheal, pruritus +/-

    delayed: erythema, wheal, pruritus +/-,

    nodule

    b. systemicnone

    6Testsscratch skin

    7Mechanismimmediate: histamine

    delayed: ?

    8Treatmentantihistamine continuous

    1st + 2nd generation

    Sheet2

    Sheet3

    Sheet1

    PHYSICAL URTICARIA

    1Relative frequencyMost frequent

    2PrecipifantStroking skin

    3Onsetimmediate minutes

    delayed: 3-8 hours

    4Durationimmediate: 2-3 hours

    delayed: 24-48 hours

    5Symptomes

    a. localimmediate: erythema, wheal, pruritus +/-

    delayed: erythema, wheal, pruritus +/-,

    nodule

    b. systemicnone

    6Testsscratch skin

    7Mechanismimmediate: histamine

    delayed: ?

    8Treatmentantihistamine continuous

    1st + 2nd generation

    Sheet2

    Sheet3

    Sheet1

    PHYSICAL URTICARIA

    1Relative frequencyMost frequent

    2PrecipifantStroking skin

    3Onsetimmediate minutes

    delayed: 3-8 hours

    4Durationimmediate: 2-3 hours

    delayed: 24-48 hours

    5Symptomes

    a. localimmediate: erythema, wheal, pruritus +/-

    delayed: erythema, wheal, pruritus +/-,

    nodule

    b. systemicnone

    6Testsscratch skin

    7Mechanismimmediate: histamine

    delayed: ?

    8Treatmentantihistamine continuous

    1st + 2nd generation

    Sheet2

    Sheet3

    Sheet1

    PHYSICAL URTICARIA

    1Relative frequencyMost frequent

    2PrecipifantStroking skin

    3Onsetimmediate minutes

    delayed: 3-8 hours

    4Durationimmediate: 2-3 hours

    delayed: 24-48 hours

    5Symptomes

    a. localimmediate: erythema, wheal, pruritus +/-

    delayed: erythema, wheal, pruritus +/-,

    nodule

    b. systemicnone

    6Testsscratch skin

    7Mechanismimmediate: histamine

    delayed: ?

    8Treatmentantihistamine continuous

    1st + 2nd generation

    Sheet2

    Sheet3

    Sheet1

    PHYSICAL URTICARIA

    Dermo / Dermato

    Graphism

    Writing on the skin

    1Relative frequencyMost frequent

    2PrecipitantStroking skin

    3Onsetimmediate minutes

    delayed: 3-8 hours

    4Durationimmediate: 2-3 hours

    delayed: 24-48 hours

    5Symptomes

    a. localimmediate: erythema, wheal, pruritus +/-

    delayed: erythema, wheal, pruritus +/-,

    nodule

    b. systemicnone

    6Testsscratch skin

    7Mechanismimmediate: histamine

    delayed: ?

    8Treatmentantihistamine continuous

    1st + 2nd generation

    Sheet2

    Sheet3

  • COLD URTICARIA/ANGIOEDEMA

    Sheet1

    COLD URTICARIA/ANGIOEDEMA

    FamilialAcquired

    IdiopathicUnderlying disease *

    1Relativeraremore commonrare

    frequency

    2Precipifantcold

    3Onsetimmediate: 0-4 hoursfew minutes-

    delayed: 9-18 hours

    4Duration1-2 hours

    5Symptomeserythematous

    a. localimmediate: patches/urticaria/angioedemaurticaria/angioedema

    papules - nonpruritic,

    burning

    delayed: deep swelling

    b. systemicFever, arthralgias, chills,headache, hypotension,~ underlying desease

    headache, myalgias,syncope, wheezing

    lekositosis

    6Testsapply cold material on skinapply cold material on skinVDRL, abnormal cold-

    (-)(+)dependent proteins,

    malignant, blood cells

    7Mechanismautosomal dominantpassive transfer IgE (IgM)vasculitis ?

    in heritancehistamine

    delayed: ?

    8Treatmentprecipitant avoidance antihistamine desensitization

    Sheet2

    Sheet3

    Sheet1

    COLD URTICARIA/ANGIOEDEMA

    FamilialAcquired

    IdiopathicUnderlying disease *

    1Relativeraremore commonrare

    frequency

    2Precipifantcold

    3Onsetimmediate: 0-4 hoursfew minutes-

    delayed: 9-18 hours

    4Duration1-2 hours

    5Symptomeserythematous

    a. localimmediate: patches/urticaria/angioedemaurticaria/angioedema

    papules - nonpruritic,

    burning

    delayed: deep swelling

    b. systemicFever, arthralgias, chills,headache, hypotension,~ underlying desease

    headache, myalgias,syncope, wheezing

    lekositosis

    6Testsapply cold material on skinapply cold material on skinVDRL, abnormal cold-

    (-)(+)dependent proteins,

    malignant, blood cells

    7Mechanismautosomal dominantpassive transfer IgE (IgM)vasculitis ?

    in heritancehistamine

    delayed: ?

    8Treatmentprecipitant avoidance antihistamine desensitization

    Sheet2

    Sheet3

    Sheet1

    COLD URTICARIA/ANGIOEDEMA

    FamilialAcquired

    IdiopathicUnderlying disease *

    1Relativeraremore commonrare

    frequency

    2Precipitantcold

    3Onsetimmediate: 0-4 hoursfew minutes-

    delayed: 9-18 hours

    4Duration1-2 hours

    5Symptomeserythematous

    a. localimmediate: patches/urticaria/angioedemaurticaria/angioedema

    papules - nonpruritic,

    burning

    delayed: deep swelling

    b. systemicFever, arthralgias, chills,headache, hypotension,~ underlying desease

    headache, myalgias,syncope, wheezing

    lekositosis

    6Testsapply cold material on skinapply cold material on skinVDRL, abnormal cold-

    (-)(+)dependent proteins,

    malignant, blood cells

    7Mechanismautosomal dominantpassive transfer IgE (IgM)vasculitis ?

    in heritancehistamine

    delayed: ?

    8Treatmentprecipitant avoidance antihistamine desensitization

    Sheet2

    Sheet3

    Sheet1

    COLD URTICARIA/ANGIOEDEMA

    FamilialAcquired

    IdiopathicUnderlying disease *

    1Relativeraremore commonrare

    frequency

    2Precipifantcold

    3Onsetimmediate: 30' - 4 hoursfew minutes-

    delayed: 9 -18 hours

    4Duration1-2 hours

    5Symptomeserythematous

    a. localimmediate: patches/urticaria/angioedemaurticaria/angioedema

    papules - nonpruritic,

    burning

    delayed: deep swelling

    b. systemicFever, arthralgias, chills,headache, hypotension,~ underlying desease

    headache, myalgias,syncope, wheezing

    lekositosis

    6Testsapply cold material on skinapply cold material on skinVDRL, abnormal cold-

    (-)(+)dependent proteins,

    malignant, blood cells

    7Mechanismautosomal dominantpassive transfer IgE (IgM)vasculitis ?

    in heritancehistamine

    delayed: ?

    8Treatmentprecipitant avoidance antihistamine desensitization

    Sheet2

    Sheet3

    Sheet1

    COLD URTICARIA/ANGIOEDEMA

    FamilialAcquired

    IdiopathicUnderlying disease *

    1Relativeraremore commonrare

    frequency

    2Precipifantcold

    3Onsetimmediate: 0-4 hoursfew minutes-

    delayed: 9-18 hours

    4Duration1-2 hours

    5Symptomeserythematous

    a. localimmediate: patches/urticaria/angioedemaurticaria/angioedema

    papules - nonpruritic,

    burning

    delayed: deep swelling

    b. systemicFever, arthralgias, chills,headache, hypotension,~ underlying desease

    headache, myalgias,syncope, wheezing

    lekositosis

    6Testsapply cold material on skinapply cold material on skinVDRL, abnormal cold-

    (-)(+)dependent proteins,

    malignant, blood cells

    7Mechanismautosomal dominantpassive transfer IgE (IgM)vasculitis ?

    in heritancehistamine

    delayed: ?

    8Treatmentprecipitant avoidance antihistamine desensitization

    Sheet2

    Sheet3

    Sheet1

    COLD URTICARIA/ANGIOEDEMA

    FamilialAcquired

    IdiopathicUnderlying disease *

    1Relativeraremore commonrare

    frequency

    2Precipifantcold

    3Onsetimmediate: 0-4 hoursfew minutes-

    delayed: 9-18 hours

    4Duration1-2 hours

    5Symptomeserythematous

    a. localimmediate:urticaria/angioedemaurticaria/angioedema

    papules, nonpruritic,

    burning

    delayed: deep swelling

    b. systemicFever, arthralgias, chills,headache, hypotension,~ underlying disease

    headache, myalgias,syncope, wheezing

    lekositosis

    6Testsapply cold material on skinapply cold material on skinVDRL, abnormal cold-

    (-)(+)dependent proteins,

    malignant, blood cells

    7Mechanismautosomal dominantpassive transfer IgE (IgM)vasculitis ?

    in heritancehistamine

    delayed: ?

    8Treatmentprecipitant avoidance antihistamine desensitization

    Sheet2

    Sheet3

    Sheet1

    COLD URTICARIA/ANGIOEDEMA

    FamilialAcquired

    IdiopathicUnderlying disease *

    1Relativeraremore commonrare

    frequency

    2Precipifantcold

    3Onsetimmediate: 0-4 hoursfew minutes-

    delayed: 9-18 hours

    4Duration1-2 hours

    5Symptomeserythematous

    a. localimmediate: patches/urticaria/angioedemaurticaria/angioedema

    papules - nonpruritic,

    burning

    delayed: deep swelling

    b. systemicFever, arthralgias, chills,headache, hypotension,~ underlying desease

    headache, myalgias,syncope, wheezing

    lekositosis

    6Testsapply cold material on skinapply cold material on skinVDRL, abnormal cold-

    (-)(+)dependent proteins,

    malignant, blood cells

    7Mechanismautosomal dominantpassive transfer IgE (IgM)vasculitis ?

    in heritancehistamine

    delayed: ?

    8Treatmentprecipitant avoidance antihistamine desensitization

    Sheet2

    Sheet3

    Sheet1

    COLD URTICARIA/ANGIOEDEMA

    FamilialAcquired

    IdiopathicUnderlying disease *

    1Relativeraremore commonrare

    frequency

    2Precipifantcold

    3Onsetimmediate: 0-4 hoursfew minutes-

    delayed: 9-18 hours

    4Duration1-2 hours

    5Symptomeserythematous

    a. localimmediate: patches/urticaria/angioedemaurticaria/angioedema

    papules - nonpruritic,

    burning

    delayed: deep swelling

    b. systemicFever, arthralgias, chills,headache, hypotension,~ underlying desease

    headache, myalgias,syncope, wheezing

    lekositosis

    6Testsapply cold material on skinapply cold material on skinVDRL, abnormal cold-

    (-)(+)dependent proteins,

    malignant, blood cells

    7Mechanismautosomal dominantpassive transfer IgE (IgM)vasculitis ?

    in heritancehistamine

    delayed: ?

    8Treatmentprecipitant avoidance antihistamine desensitization

    Sheet2

    Sheet3

    Sheet1

    COLD URTICARIA/ANGIOEDEMA

    FamilialAcquired

    IdiopathicUnderlying disease *

    1Relativeraremore commonrare

    frequency

    2Precipifantcold

    3Onsetimmediate: 0-4 hoursfew minutes-

    delayed: 9-18 hours

    4Duration1-2 hours

    5Symptomeserythematous

    a. localimmediate: patches/urticaria/angioedemaurticaria/angioedema

    papules - nonpruritic,

    burning

    delayed: deep swelling

    b. systemicFever, arthralgias, chills,headache, hypotension,~ underlying desease

    headache, myalgias,syncope, wheezing

    lekositosis

    6Testsapply cold material on skinapply cold material on skinVDRL, abnormal cold-

    (-)(+)dependent proteins,

    malignant, blood cells

    7Mechanismautosomal dominantpassive transfer IgE (IgM)vasculitis ?

    in heritancehistamine

    delayed: ?

    8Treatmentprecipitant avoidance antihistamine desensitization

    Sheet2

    Sheet3

    Sheet1

    COLD URTICARIA/ANGIOEDEMA

    FamilialAcquired

    IdiopathicUnderlying disease *

    1Relativeraremore commonrare

    frequency

    2Precipitantcold

    3Onsetimmediate: 0-4 hoursfew minutes-

    delayed: 9-18 hours

    4Duration1-2 hours

    5Symptomeserythematous

    a. localimmediate: patches/urticaria/angioedemaurticaria/angioedema

    papules - nonpruritic,

    burning

    delayed: deep swelling

    b. systemicFever, arthralgias, chills,headache, hypotension,~ underlying disease

    headache, myalgias,syncope, wheezing

    lekositosis

    6Testsapply cold material on skinapply cold material on skinVDRL, abnormal cold-

    (-)(+)dependent proteins,

    malignant, blood cells

    7Mechanismautosomal dominantpassive transfer IgE (IgM)vasculitis ?

    in heritancehistamine

    delayed: ?

    8Treatmentprecipitant avoidance antihistamine desensitization

    *Infection,syphilitic paroxysmal cold hemoglobinuria, infectious mononucleosis cryofibrinogenemia,

    cryoglobulinenemia, cold agglutinine diseases, connective tissue vasculer disease, hematopoetic malignancies

    Sheet2

    Sheet3

  • CHOLINERGIC

    Sheet1

    CHOLINERGIC

    1Relative frequencyvery frequent

    2Precipitantgeneral overheating/pyrexia

    stress

    vigorous exercise

    spicy food

    3Onsetminutes

    4Duration30' - 1 hour

    5Symptomes

    a. localerythematous, multiple distinctive wheals

    1 - 3 mm

    b. systemicdizziness, headeache, nausea, vomiting, syncope

    pulmonary function, BHR, wheezing

    6Tests- exercise challenge

    - hot water bath

    - metacholine skin test

    7Mechanismpassive transfer parasympathetic

    stimulating (achethylcholine)

    8Treatmentprecipitant avoidance

    rapid cooling

    antihistamine

    refractory: anticholinergic

    Sheet2

    Sheet3

    Sheet1

    CHOLINERGIC

    1Relative frequencyvery frequent

    2Precipitantgeneral overheating/pyrexia

    stress

    vigorous exercise

    spicy food

    3Onsetminutes

    4Duration30' - 1 hour

    5Symptomes

    a. localerythematous, multiple distinctive wheals

    1 - 3 mm

    b. systemicdizziness, headeache, nausea, vomiting, syncope

    pulmonary function, BHR, wheezing

    6Tests- exercise challenge

    - hot water bath

    - metacholine skin test

    7Mechanismpassive transfer parasympathetic

    stimulating (achethylcholine)

    8Treatmentprecipitant avoidance

    rapid cooling

    antihistamine

    refractory: anticholinergic

    Sheet2

    Sheet3

    Sheet1

    CHOLINERGIC

    1Relative frequencyvery frequent

    2Precipitantgeneral overheating/pyrexia

    stress

    vigorous exercise

    spicy food

    3Onsetminutes

    4Duration30' - 1 hour

    5Symptomes

    a. localerythematous, multiple distinctive wheals

    1 - 3 mm

    b. systemicdizziness, headeache, nausea, vomiting, syncope

    pulmonary function, BHR, wheezing

    6Tests- exercise challenge

    - hot water bath

    - metacholine skin test

    7Mechanismpassive transfer parasympathetic

    stimulating (achethylcholine)

    8Treatmentprecipitant avoidance

    rapid cooling

    antihistamine

    refractory: anticholinergic

    Sheet2

    Sheet3

    Sheet1

    CHOLINERGIC

    1Relative frequencyvery frequent

    2Precipitantgeneral overheating/pyrexia

    stress

    vigorous exercise

    spicy food

    3Onsetminutes

    4Duration30' - 1 hour

    5Symptomes

    a. localerythematous, multiple distinctive wheals

    1 - 3 mm

    b. systemicdizziness, headeache, nausea, vomiting, syncope

    pulmonary function, BHR, wheezing

    6Tests- exercise challenge

    - hot water bath

    - metacholine skin test

    7Mechanismpassive transfer parasympathetic

    stimulating (achethylcholine)

    8Treatmentprecipitant avoidance

    rapid cooling

    antihistamine

    refractory: anticholinergic

    Sheet2

    Sheet3

    Sheet1

    CHOLINERGIC

    1Relative frequencyvery frequent

    2Precipitantgeneral overheating/pyrexia

    stress

    vigorous exercise

    spicy food

    3Onsetminutes

    4Duration30' - 1 hour

    5Symptomes

    a. localerythematous, multiple distinctive wheals

    1 - 3 mm

    b. systemicdizziness, headeache, nausea, vomiting, syncope

    pulmonary function, BHR, wheezing

    6Tests- exercise challenge

    - hot water bath

    - metacholine skin test

    7Mechanismpassive transfer parasympathetic

    stimulating (achethylcholine)

    8Treatmentprecipitant avoidance

    rapid cooling

    antihistamine

    refractory: anticholinergic

    Sheet2

    Sheet3

    Sheet1

    CHOLINERGIC

    1Relative frequencyvery frequent

    2Precipitantgeneral overheating/pyrexia

    stress

    vigorous exercise

    spicy food

    3Onsetminutes

    4Duration30' - 1 hour

    5Symptomes

    a. localerythematous, multiple distinctive wheals

    1 - 3 mm

    b. systemicdizziness, headeache, nausea, vomiting, syncope

    pulmonary function, BHR, wheezing

    6Tests- exercise challenge

    - hot water bath

    - metacholine skin test

    7Mechanismpassive transfer parasympathetic

    stimulating (achethylcholine)

    8Treatmentprecipitant avoidance

    rapid cooling

    antihistamine

    refractory: anticholinergic

    Sheet2

    Sheet3

    Sheet1

    CHOLINERGIC

    1Relative frequencyvery frequent

    2Precipitantgeneral overheating/pyrexia

    stress

    vigorous exercise

    spicy food

    3Onsetminutes

    4Duration30' - 1 hour

    5Symptomes

    a. localerythematous, multiple distinctive wheals

    1 - 3 mm

    b. systemicdizziness, headeache, nausea, vomiting, syncope

    pulmonary function, BHR, wheezing

    6Tests- exercise challenge

    - hot water bath

    - metacholine skin test

    7Mechanismpassive transfer parasympathetic

    stimulating (achethylcholine)

    8Treatmentprecipitant avoidance

    rapid cooling

    antihistamine

    refractory: anticholinergic

    Sheet2

    Sheet3

    Sheet1

    CHOLINERGIC

    1Relative frequencyvery frequent

    2Precipitantgeneral overheating/pyrexia

    stress

    vigorous exercise

    spicy food

    3Onsetminutes

    4Duration30' - 1 hour

    5Symptomes

    a. localerythematous, multiple distinctive wheals

    1 - 3 mm

    b. systemicdizziness, headeache, nausea, vomiting, syncope

    pulmonary function, BHR, wheezing

    6Tests- exercise challenge

    - hot water bath

    - metacholine skin test

    7Mechanismpassive transfer parasympathetic

    stimulating (achethylcholine)

    8Treatmentprecipitant avoidance

    rapid cooling

    antihistamine

    refractory: anticholinergic

    Sheet2

    Sheet3

  • Sheet1

    HEAT, SOLAR, PRESSURE

    H e a tS o l a rP r e s s u r e

    1Relativerareuncommonfrequent

    frequency

    2Precipitantheatvarious wave - length (light)pressure

    3Onset2 - 5 minutes1 - 5 minutes3 - 12 hours

    rarely: few hours

    4Duration1 hours15 minutes - 3 hours8 - 48 hours

    5Symptomes

    a. localpruriticpruriticred

    whealsmorbiliform erythemedeep swelling

    whealtender

    b. systemic-wheezingfever, chills

    dizzinessarthralgia

    syncopeESR, lekositosis

    6Testshot water filled -light exposure --> variableapply weight

    cylinder --> skinwave length( 7 - 14 kg); 10 minutes

    copro porphyrine

    7Mechanismhistamine?passive transfer?

    complement?Ig-E

    Histamine?

    8Treatmentavoidance of precipitantavoidanceavoidance

    antihistamineantihistaminesevere:

    desensitizationsunscreenantihistamine

    corticosteroid

    dss alternate

    NSAID

    Sheet2

    Sheet3

    Sheet1

    HEAT, SOLAR, PRESSURE

    H e a tS o l a rP r e s s u r e

    1Relativerareuncommonfrequent

    frequency

    2Precipitantheatvarious wave - length (light)pressure

    3Onset2 - 5 minutes1 - 5 minutes3 - 12 hours

    rarely: few hours

    4Duration1 hours15 minutes - 3 hours8 - 48 hours

    5Symptomes

    a. localpruriticpruriticred

    whealsmorbiliform erythemedeep swelling

    whealtender

    b. systemic-wheezingfever, chills

    dizzinessarthralgia

    syncopeESR, lekositosis

    6Testshot water filled -light exposure --> variableapply weight

    cylinder --> skinwave length( 7 - 14 kg); 10 minutes

    copro porphyrine

    7Mechanismhistamine?passive transfer?

    complement?Ig-E

    Histamine?

    8Treatmentavoidance of precipitantavoidanceavoidance

    antihistamineantihistaminesevere:

    desensitizationsunscreenantihistamine

    corticosteroid

    dss alternate

    NSAID

    Sheet2

    Sheet3

    Sheet1

    HEAT, SOLAR, PRESSURE

    H e a tS o l a rP r e s s u r e

    1Relativerareuncommonfrequent

    frequency

    2Precipitantheatvarious wave - length (light)pressure

    3Onset2 - 5 minutes1 - 5 minutes3 - 12 hours

    rarely: few hours

    4Duration1 hours15 minutes - 3 hours8 - 48 hours

    5Symptomes

    a. localpruriticpruriticred

    whealsmorbiliform erythemedeep swelling

    whealtender

    b. systemic-wheezingfever, chills

    dizzinessarthralgia

    syncopeESR, lekositosis

    6Testshot water filled -light exposure --> variableapply weight

    cylinder --> skinwave length( 7 - 14 kg); 10 minutes

    copro porphyrine

    7Mechanismhistamine?passive transfer?

    complement?Ig-E

    Histamine?

    8Treatmentavoidance of precipitantavoidanceavoidance

    antihistamineantihistaminesevere:

    desensitizationsunscreenantihistamine

    corticosteroid

    dss alternate

    NSAID

    Sheet2

    Sheet3

    Sheet1

    HEAT, SOLAR, PRESSURE

    H e a tS o l a rP r e s s u r e

    1Relativerareuncommonfrequent

    frequency

    2Precipitantheatvarious wave - length (light)pressure

    3Onset2 - 5 minutes1 - 5 minutes3 - 12 hours

    rarely: few hours

    4Duration1 hours15 minutes - 3 hours8 - 48 hours

    5Symptomes

    a. localpruriticpruriticred

    whealsmorbiliform erythemedeep swelling

    whealtender

    b. systemic-wheezingfever, chills

    dizzinessarthralgia

    syncopeESR, lekositosis

    6Testshot water filled -light exposure --> variableapply weight

    cylinder --> skinwave length( 7 - 14 kg); 10 minutes

    copro porphyrine

    7Mechanismhistamine?passive transfer?

    complement?Ig-E

    Histamine?

    8Treatmentavoidance of precipitantavoidanceavoidance

    antihistamineantihistaminesevere:

    desensitizationsunscreenantihistamine

    corticosteroid

    dss alternate

    NSAID

    Sheet2

    Sheet3

    Sheet1

    HEAT, SOLAR, PRESSURE

    H e a tS o l a rP r e s s u r e

    1Relativerareuncommonfrequent

    frequency

    2Precipitantheatvarious wave - length (light)pressure

    3Onset2 - 5 minutes1 - 5 minutes3 - 12 hours

    rarely: few hours

    4Duration1 hours15 minutes - 3 hours8 - 48 hours

    5Symptomes

    a. localpruriticpruriticred

    whealsmorbiliform erythemedeep swelling

    whealtender

    b. systemic-wheezingfever, chills

    dizzinessarthralgia

    syncopeESR, lekositosis

    6Testshot water filled -light exposure --> variableapply weight

    cylinder --> skinwave length( 7 - 14 kg); 10 minutes

    copro porphyrine

    7Mechanismhistamine?passive transfer?

    complement?Ig-E

    Histamine?

    8Treatmentavoidance of precipitantavoidanceavoidance

    antihistamineantihistaminesevere:

    desensitizationsunscreenantihistamine

    corticosteroid

    dss alternate

    NSAID

    Sheet2

    Sheet3

    Sheet1

    HEAT, SOLAR, PRESSURE

    H e a tS o l a rP r e s s u r e

    1Relativerareuncommonfrequent

    frequency

    2Precipitantheatvarious wave - length (light)pressure

    3Onset2 - 5 minutes1 - 5 minutes3 - 12 hours

    rarely: few hours

    4Duration1 hours15 minutes - 3 hours8 - 48 hours

    5Symptomes

    a. localpruriticpruriticred

    whealsmorbiliform erythemedeep swelling

    whealtender

    b. systemic-wheezingfever, chills

    dizzinessarthralgia

    syncopeESR, lekositosis

    6Testshot water filled -light exposure --> variableapply weight

    cylinder --> skinwave length( 7 - 14 kg); 10 minutes

    copro porphyrine

    7Mechanismhistamine?passive transfer?

    complement?Ig-E

    Histamine?

    8Treatmentavoidance of precipitantavoidanceavoidance

    antihistamineantihistaminesevere:

    desensitizationsunscreenantihistamine

    corticosteroid

    dss alternate

    NSAID

    Sheet2

    Sheet3

    Sheet1

    HEAT, SOLAR, PRESSURE

    H e a tS o l a rP r e s s u r e

    1Relativerareuncommonfrequent

    frequency

    2Precipitantheatvarious wave - length (light)pressure

    3Onset2 - 5 minutes1 - 5 minutes3 - 12 hours

    rarely: few hours

    4Duration1 hours15 minutes - 3 hours8 - 48 hours

    5Symptomes

    a. localpruriticpruriticred

    whealsmorbiliform erythemedeep swelling

    whealtender

    b. systemic-wheezingfever, chills

    dizzinessarthralgia

    syncopeESR, lekositosis

    6Testshot water filled -light exposure --> variableapply weight

    cylinder --> skinwave length( 7 - 14 kg); 10 minutes

    copro porphyrine

    7Mechanismhistamine?passive transfer?

    complement?Ig-E

    Histamine?

    8Treatmentavoidance of precipitantavoidanceavoidance

    antihistamineantihistaminesevere:

    desensitizationsunscreenantihistamine

    corticosteroid

    dss alternate

    NSAID

    Sheet2

    Sheet3

    Sheet1

    HEAT, SOLAR, PRESSURE

    H e a tS o l a rP r e s s u r e

    1Relativerareuncommonfrequent

    frequency

    2Precipitantheatvarious wave - length (light)pressure

    3Onset2 - 5 minutes1 - 5 minutes3 - 12 hours

    rarely: few hours

    4Duration1 hours15 minutes - 3 hours8 - 48 hours

    5Symptomes

    a. localpruriticpruriticred

    whealsmorbiliform erythemedeep swelling

    whealtender

    b. systemic-wheezingfever, chills

    dizzinessarthralgia

    syncopeESR, lekositosis

    6Testshot water filled -light exposure --> variableapply weight

    cylinder --> skinwave length( 7 - 14 kg); 10 minutes

    copro porphyrine

    7Mechanismhistamine?passive transfer?

    complement?Ig-E

    Histamine?

    8Treatmentavoidance of precipitantavoidanceavoidance

    antihistamineantihistaminesevere:

    desensitizationsunscreenantihistamine

    corticosteroid

    dss alternate

    NSAID

    Sheet2

    Sheet3

    Sheet1

    HEAT, SOLAR, PRESSURE

    H e a tS o l a rP r e s s u r e

    1Relativerareuncommonfrequent

    frequency

    2Precipitantheatvarious wave - length (light)pressure

    3Onset2 - 5 minutes1 - 5 minutes3 - 12 hours

    rarely: few hours

    4Duration1 hours15 minutes - 3 hours8 - 48 hours

    5Symptomes

    a. localpruriticpruriticred

    whealsmorbiliform erythemedeep swelling

    whealtender

    b. systemic-wheezingfever, chills

    dizzinessarthralgia

    syncopeESR, lekositosis

    6Testshot water filled -light exposure --> variableapply weight

    cylinder --> skinwave length( 7 - 14 kg); 10 minutes

    copro porphyrine

    7Mechanismhistamine?passive transfer?

    complement?Ig-E

    Histamine?

    8Treatmentavoidance of precipitantavoidanceavoidance

    antihistamineantihistaminesevere:

    desensitizationsunscreenantihistamine

    corticosteroid

    dss alternate

    NSAID

    Sheet2

    Sheet3

  • Sheet1

    VIBRATORY AQUAGENIC

    V I b r a t o r yA q u a g e n I c

    1Relativevery rarerare

    frequency

    2Precipitantvibrationwater contact

    3Onset2 - 5 minutesseveral - 30 minutes

    4Duration1 hours30 - 45 minutes

    5Symptomes

    a. localpruriticpruritic

    angioedemapapular

    wheals

    b. systemic--

    6Testsvibration 4 minutestap water challenge -

    various temp.

    7Mechanismhereditair autosomal -? (histamine)

    dominant ? (histamine)

    8Treatmentavoidanceantihistamine

    (diphenhydramine)

    Sheet2

    Sheet3

    Sheet1

    VIBRATORY AQUAGENIC

    V I b r a t o r yA q u a g e n I c

    1Relativevery rarerare

    frequency

    2Precipitantvibrationwater contact

    3Onset2 - 5 minutesseveral - 30 minutes

    4Duration1 hours30 - 45 minutes

    5Symptomes

    a. localpruriticpruritic

    angioedemapapular

    wheals

    b. systemic--

    6Testsvibration 4 minutestap water challenge -

    various temp.

    7Mechanismhereditair autosomal -? (histamine)

    dominant ? (histamine)

    8Treatmentavoidanceantihistamine

    (diphenhydramine)

    Sheet2

    Sheet3

    Sheet1

    VIBRATORY AQUAGENIC

    V I b r a t o r yA q u a g e n I c

    1Relativevery rarerare

    frequency

    2Precipitantvibrationwater contact

    3Onset2 - 5 minutesseveral - 30 minutes

    4Duration1 hours30 - 45 minutes

    5Symptomes

    a. localpruriticpruritic

    angioedemapapular

    wheals

    b. systemic--

    6Testsvibration 4 minutestap water challenge -

    various temp.

    7Mechanismhereditair autosomal -? (histamine)

    dominant ? (histamine)

    8Treatmentavoidanceantihistamine

    (diphenhydramine)

    Sheet2

    Sheet3

    Sheet1

    VIBRATORY AQUAGENIC

    V I b r a t o r yA q u a g e n I c

    1Relativevery rarerare

    frequency

    2Precipitantvibrationwater contact

    3Onset2 - 5 minutesseveral - 30 minutes

    4Duration1 hours30 - 45 minutes

    5Symptomes

    a. localpruriticpruritic

    angioedemapapular

    wheals

    b. systemic--

    6Testsvibration 4 minutestap water challenge -

    various temp.

    7Mechanismhereditair autosomal -? (histamine)

    dominant ? (histamine)

    8Treatmentavoidanceantihistamine

    (diphenhydramine)

    Sheet2

    Sheet3

    Sheet1

    VIBRATORY AQUAGENIC

    V I b r a t o r yA q u a g e n I c

    1Relativevery rarerare

    frequency

    2Precipitantvibrationwater contact

    3Onset2 - 5 minutesseveral - 30 minutes

    4Duration1 hours30 - 45 minutes

    5Symptomes

    a. localpruriticpruritic

    angioedemapapular

    wheals

    b. systemic--

    6Testsvibration 4 minutestap water challenge -

    various temp.

    7Mechanismhereditair autosomal -? (histamine)

    dominant ? (histamine)

    8Treatmentavoidanceantihistamine

    (diphenhydramine)

    Sheet2

    Sheet3

    Sheet1

    VIBRATORY AQUAGENIC

    V I b r a t o r yA q u a g e n I c

    1Relativevery rarerare

    frequency

    2Precipitantvibrationwater contact

    3Onset2 - 5 minutesseveral - 30 minutes

    4Duration1 hours30 - 45 minutes

    5Symptomes

    a. localpruriticpruritic

    angioedemapapular

    wheals

    b. systemic--

    6Testsvibration 4 minutestap water challenge -

    various temp.

    7Mechanismhereditair autosomal -? (histamine)

    dominant ? (histamine)

    8Treatmentavoidanceantihistamine

    (diphenhydramine)

    Sheet2

    Sheet3

    Sheet1

    VIBRATORY AQUAGENIC

    V I b r a t o r yA q u a g e n I c

    1Relativevery rarerare

    frequency

    2Precipitantvibrationwater contact

    3Onset2 - 5 minutesseveral - 30 minutes

    4Duration1 hours30 - 45 minutes

    5Symptomes

    a. localpruriticpruritic

    angioedemapapular

    wheals

    b. systemic--

    6Testsvibration 4 minutestap water challenge -

    various temp.

    7Mechanismhereditair autosomal -? (histamine)

    dominant ? (histamine)

    8Treatmentavoidanceantihistamine

    (diphenhydramine)

    Sheet2

    Sheet3

    Sheet1

    VIBRATORY AQUAGENIC

    V I b r a t o r yA q u a g e n I c

    1Relativevery rarerare

    frequency

    2Precipitantvibrationwater contact

    3Onset2 - 5 minutesseveral - 30 minutes

    4Duration1 hours30 - 45 minutes

    5Symptomes

    a. localpruriticpruritic

    angioedemapapular

    wheals

    b. systemic--

    6Testsvibration 4 minutestap water challenge -

    various temp.

    7Mechanismhereditair autosomal -? (histamine)

    dominant ? (histamine)

    8Treatmentavoidanceantihistamine

    (diphenhydramine)

    Sheet2

    Sheet3

    Sheet1

    VIBRATORY AQUAGENIC

    V I b r a t o r yA q u a g e n I c

    1Relativevery rarerare

    frequency

    2Precipitantvibrationwater contact

    3Onset2 - 5 minutesseveral - 30 minutes

    4Duration1 hours30 - 45 minutes

    5Symptomes

    a. localpruriticpruritic

    angioedemapapular

    wheals

    b. systemic--

    6Testsvibration 4 minutestap water challenge -

    various temp.

    7Mechanismhereditair autosomal -? (histamine)

    dominant ? (histamine)

    8Treatmentavoidanceantihistamine

    (diphenhydramine)

    Sheet2

    Sheet3

  • MISCELLANEOUS

    Sheet1

    MISCELLANEOUS

    Papular

    - E/: insects bite

    e.q. mosquito, bug, flea

    - biphasic pruritus, papular wheal

    - Hsr - type I & IV

    - T/: antihistamine

    Sheet2

    Sheet3

    Sheet1

    MISCELLANEOUS

    Papular

    - E/: insects bite

    e.q. mosquito, bug, flea

    - biphasic pruritus, papular wheal

    - Hsr - type I & IV

    - T/: antihistamine

    Sheet2

    Sheet3

  • MISCELLANEOUS

    Sheet1

    MISCELLANEOUS

    Urticaria pigmentosa

    Darier's sign

    - uncommon

    - E/: strocking skin

    - urticaria, hyper pigmented

    - = dermatographism

    biopsi : dermal infiltration of mast cells

    - T/: antihistamine

    Sheet2

    Sheet3

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    MISCELLANEOUS

    Urticaria pigmentosa

    Darier's sign

    - uncommon

    - E/: strocking skin

    - urticaria, hyper pigmented

    - = dermatographism

    biopsi : dermal infiltration of mast cells

    - T/: antihistamine

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  • MISCELLANEOUS

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    MISCELLANEOUS

    Systemic mastocytosis

    - more serious and rare

    - flushing, headeache, hypotension

    - mast cells accumulation: dermis, B.M., GIT

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    MISCELLANEOUS

    Systemic mastocytosis

    - more serious and rare

    - flushing, headeache, hypotension

    - mast cells accumulation: dermis, B.M., GIT

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  • DIAGNOSTIC APPROACH

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    DIAGNOSTIC APPROACH

    1. General

    History :a. Foods / inhaled aromasphysical

    b. drugsexamination

    c. food additives

    d. inhalants, contactant : dust, pollen, pet

    e. occupation, hobbies

    f. recent infection

    suspect cause

    2. Specificscreening laboratories / tests

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  • TREATMENT

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    TREATMENT

    A. General

    1. Elimination :

    identified remove

    Cause

    unidentified

    avoid : histamine releasing agents

    peripheral circulation pruritus

    2. Antihistamine

    d.o.c table

    3. Adrenergic

    Life threatening

    s.c. inj. epinephrine : 1 / 1000 ; 0,01 ml/kg B.W. maximal 0,2 - 0,3 ml

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  • TREATMENT

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    TREATMENT 2

    4. Corticosteroid

    - unresponsive to other treatment

    - 2 mg/kgB.W. / day tappering off

    side effects !

    B. Specific :

    ~ D/

    C. Topical :

    Symptomatic (pruritus) calamin lotion

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  • T E R I M A K A S I H