Chronic urticaria: Difference between revisions
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==Clinical Features== | ==Clinical Features== | ||
*Hives and/or angioedema | *[[Acute allergic reaction|Hives]] and/or [[angioedema]] | ||
===Types=== | |||
*Physical <ref> Sachdeva, S, et al; Chronic Urticaria; PMID: 22345759 </ref> | |||
**Contact | |||
**Dermatographism | |||
**Cold | |||
**Cholinergic (heat, exercise, stress) | |||
*Autoimmune | |||
**[[Systemic lupus erythematosus|SLE]] | |||
**[[Juvenile idiopathic arthritis|Juvenile rheumatoid arthritis]] | |||
**[[Hyperthyroidism|Graves disease]] | |||
**Malignant | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
Revision as of 16:56, 1 August 2019
Background
- Recurrent urticaria at least twice per week for 6 weeks [1]
- Often autoimmune etiology
Clinical Features
- Hives and/or angioedema
Types
- Physical [2]
- Contact
- Dermatographism
- Cold
- Cholinergic (heat, exercise, stress)
- Autoimmune
- SLE
- Juvenile rheumatoid arthritis
- Graves disease
- Malignant
Differential Diagnosis
Acute allergic reaction
- Allergic reaction/urticaria
- Anaphylaxis
- Angioedema
- Anxiety attack
- Asthma exacerbation
- Carcinoid syndrome
- Cold urticaria
- Contrast induced allergic reaction
- Scombroid
- Shock
- Transfusion reaction
Evaluation
- Rule out anaphylaxis
- Identify any causative agents
Management
- H1/H2 blockers
- 2nd line agents: TCAs
- Doxepin [3]
- Start at 10 mg daily and increase to 10 mg TID [4]
- Avoid if recent MI
- Avoid if liver dysfunction
- Mirtazapine
- 15 mg daily [5]
- Doxepin [3]
- Consider corticosteroids
- methylprednisolone 125mg IV/IM OR prednisone 60mg PO
Disposition
- Discharge if no concern for anaphylaxis
See Also
External Links
References
- ↑ Grattan, et al, Chronic urticaria; PMID: 22345759
- ↑ Sachdeva, S, et al; Chronic Urticaria; PMID: 22345759
- ↑ Simons FE, et al; Histamine and H1-antihistamines: celebrating a century of progress. PMID: 22035879
- ↑ Yadav, S, et al; Management of difficult urticaria. PMID: 20161863
- ↑ Bigatà X, et al; Severe chronic urticaria: response to mirtazapine. PMID: 16243165