
Contents
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Introduction Introduction
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Definitions Definitions
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Urticaria (wheals) Urticaria (wheals)
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Dermographism Dermographism
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Pathogenesis Pathogenesis
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Causes of urticaria Causes of urticaria
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Spontaneous (idiopathic) urticaria Spontaneous (idiopathic) urticaria
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Physical or inducible urticarias Physical or inducible urticarias
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Aquagenic urticaria and aquagenic pruritus Aquagenic urticaria and aquagenic pruritus
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Cholinergic (or heat-induced urticaria) Cholinergic (or heat-induced urticaria)
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Cold Cold
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Exercise induced Exercise induced
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Pressure Pressure
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Solar Solar
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Vibration Vibration
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Management of urticaria and angioedema Management of urticaria and angioedema
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General General
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First-line treatments First-line treatments
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Second-line treatments Second-line treatments
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Types of angioedema Types of angioedema
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Ordinary Ordinary
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Hereditary angioedema (HA) Hereditary angioedema (HA)
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Three reported types of HA Three reported types of HA
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Acquired angioedema Acquired angioedema
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Investigations of urticaria and angioedema Investigations of urticaria and angioedema
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Adrenaline injection: dose and administration Adrenaline injection: dose and administration
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Anaphylaxis
Anaphylaxis
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Management of anaphylaxis
Management of anaphylaxis
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Non-medical environment Non-medical environment
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Hospital environment Hospital environment
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Adrenaline injection: dose and administration Adrenaline injection: dose and administration
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Actions of adrenaline Actions of adrenaline
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Differential diagnosis of urticarial rashes Differential diagnosis of urticarial rashes
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Neonatal and infantile urticated rashes Neonatal and infantile urticated rashes
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Common Common
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Erythema toxicum neonatorum (syn. urticaria neonatorum) Erythema toxicum neonatorum (syn. urticaria neonatorum)
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Scabies Scabies
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Rare Rare
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Neonatal lupus erythematosus Neonatal lupus erythematosus
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Congenital infections Congenital infections
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Acute haemorrhagic oedema of infancy Acute haemorrhagic oedema of infancy
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Annular erythema of infancy Annular erythema of infancy
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Metabolic disorders Metabolic disorders
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‘Moving’ annular urticated rash ‘Moving’ annular urticated rash
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Common Common
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Granuloma annulare Granuloma annulare
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Rare Rare
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Systemic lupus erythematosus (SLE) Systemic lupus erythematosus (SLE)
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Other ‘annular erythemas’ Other ‘annular erythemas’
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Erythema marginatum Erythema marginatum
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Erythema chronicum migrans Erythema chronicum migrans
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Familial annular erythema Familial annular erythema
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‘Fixed’ annular urticated rash ‘Fixed’ annular urticated rash
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Erythema multiforme Erythema multiforme
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Cutaneous mastocytosis Cutaneous mastocytosis
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Urticarial rash with angioedema (rare) Urticarial rash with angioedema (rare)
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Acute haemorrhagic oedema of infancy Acute haemorrhagic oedema of infancy
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Urticarial vasculitis Urticarial vasculitis
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Urticarial rash with systemic symptoms (rare) Urticarial rash with systemic symptoms (rare)
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Mastocytosis (cutaneous or systemic) Mastocytosis (cutaneous or systemic)
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Juvenile idiopathic arthritis Juvenile idiopathic arthritis
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Autoimmune disorders Autoimmune disorders
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Urticarial vasculitis Urticarial vasculitis
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Dermatitis herpetiformis Dermatitis herpetiformis
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Kawasaki disease Kawasaki disease
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Malignancy and metabolic disorders Malignancy and metabolic disorders
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Periodic fever syndromes Periodic fever syndromes
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Urticaria is the main cutaneous presentation Urticaria is the main cutaneous presentation
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References References
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Cite
Abstract
This chapter covers definitions of urticaria, angioedema (acute and chronic), and dermographism. Urticaria pathogenesis and causes/trigger factors are discussed (idiopathic, drugs, contact, allergic, physical, and possible associated systemic diseases). Assessment is highlighted and guidance given on investigations. The urticaria management section covers general recommendations, first-line therapy (including antihistamines, and where appropriate for severe cases systemic steroids and adrenaline) and second-line treatments (leukotriene receptor antagonists, anti-IgE therapy, and systemic immunosuppressive agents). Angioedema subtypes (ordinary, hereditary, and acquired) are discussed, relevant investigations, and also management of both acute angioedema and therapies used for prophylaxis. The anaphylaxis section covers the definition, symptoms, and management, including adrenaline actions, age-related doses and current injectable devices, antihistamine, and steroid age-appropriate doses, and general supportive measures. A separate section covers the differential diagnoses of urticarial rashes, including neonatal and infantile rashes, moving annular urticated rashes, fixed annular urticated rashes, urticarial rash with angioedema, and urticarial rashes with systemic symptoms, helping the reader to narrow down the possible differential diagnoses when confronted with a patient with an urticarial rash.
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