荨麻疹和血管神经性水肿（英文）课件.ppt

Introduction:Urticaria and Angioedema Urticaria Etiology of Urticarial Reactions:Allergic Triggers Acute Urticaria Drugs Foods Food additives Viral infections hepatitis A, B, C Epstein-Barr virus Insect bites and stings Contactants and inhalants  (includes animal dander and latex) The Pathogenesis of Chronic Urticaria:Cellular Mediators Histamine as a Mast Cell Mediator Role of Mast Cells in Chronic Urticaria:Lower Threshold for Histamine Release Release threshold decreased by: Cytokines chemokines  in the cutaneous  microenvironment Antigen exposure Histamine-releasing factor Autoantibody Psychological factors An Autoimmune Basis for Chronic Idiopathic Urticaria: Antibodies to IgE Initial Workup of Urticaria Patient history Sinusitis Arthritis Thyroid disease Cutaneous fungal infections Urinary tract symptoms Upper respiratory tract infection  (particularly important in children) Travel history (parasitic infection) Sore throat Epstein-Barr virus, infectious  mononucleosis Insect stings Foods Recent transfusions with  blood products (hepatitis) Recent initiation of drugs Laboratory Assessment for Chronic Urticaria Possible tests for selected patients Stool examination for ova  and parasites Blood chemistry profile Antinuclear antibody titer (ANA) Hepatitis B and C Skin tests for IgE-mediated  reactions Histopathology Group 2: Polymorphous perivascular infiltrate Neutrophils Eosinophils Mononuclear cells Urticaria Associated With Other Conditions Collagen vascular disease (eg, systemic lupus erythematosus) Complement deficiency, viral infections (including hepatitis B  and C), serum sickness, and allergic drug eruptions Chronic tinea pedis Pruritic urticarial papules and plaques of pregnancy (PUPPP) Schnitzler’s syndrome H1-Receptor Antagonists: Pros and Cons for Urticaria and Angioedema First-generation antihistamines (diphenhydramine and hydroxyzine) Advantages: Rapid onset of action, relatively inexpensive Disadvantages: Sedat