RESUMO
These recommendations for the definition, diagnosis and management of chronic inducible urticaria (CIndU) extend, revise and update our previous consensus report on physical urticarias and cholinergic urticaria (Allergy, 2009). The aim of these recommendations is to improve the diagnosis and management of patients with CIndU. Our recommendations acknowledge the latest changes in our understanding of CIndU, and the available therapeutic options, as well as the development of novel diagnostic tools.
Assuntos
Urticária/diagnóstico , Urticária/etiologia , Doença Crônica , Testes Diagnósticos de Rotina , Gerenciamento Clínico , Humanos , Guias de Prática Clínica como AssuntoAssuntos
Pavilhão Auricular , Herpes Simples/patologia , Dermatopatias Virais/patologia , Adulto , Humanos , MasculinoRESUMO
The recommendations for the definition and diagnosis presented in this position paper are the result of a panel consensus meeting held in December 2008 in Berlin. This consensus meeting was a joint initiative of EAACI (European Academy of Allergology and Clinical Immunology) Dermatology Section, the EU-funded network of excellence, GA(2)LEN (Global Allergy and Asthma European Network), the EDF (European Dermatology Forum) and UNEV (urticaria network e.V.). The aim of these recommendations is to improve the diagnosis and management of patients with physical urticaria or cholinergic urticaria and to promote research and a better understanding of these diseases. Our recommendations used the paper produced by a 1996 expert meeting (1) and they acknowledge the latest changes in our understanding of physical urticarias and cholinergic urticaria as well as the recent development of novel diagnostic tools. In addition, this consensus paper highlights areas of need for further research.
Assuntos
Urticária/diagnóstico , Diagnóstico , Gerenciamento Clínico , Humanos , Urticária/classificação , Urticária/epidemiologia , Urticária/etiologiaRESUMO
Malaria is one of the world's most important parasitic infections and is endemic in over 100 countries. The number of cases of malaria in Ireland has increased significantly over the last 10 years. The aim of this study was to retrospectively examine cases of paediatric malaria presenting to Our Lady of Lourdes Hospital Drogheda over a one year period to identify the reason for travel to endemic areas, to establish if prophylaxis was received on travelling and to determine the clinical course and post-treatment follow up. Five children presented during the study period, all children were infected with the Plasmodium falciparum, two had evidence of cerebral involvement, all were children travelling to visit family and none of the children received adequate prophylaxis. This study highlights the importance of parental education on the risks associated with non-compliance with malaria prophylaxis and the complications associated with malaria infection in children.
Assuntos
Surtos de Doenças , Malária/epidemiologia , Viagem , Adolescente , Animais , Criança , Proteção da Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Irlanda/epidemiologia , Malária/transmissão , Malária Cerebral/epidemiologia , Masculino , Plasmodium falciparum , Estudos Retrospectivos , Fatores de Risco , Fatores de TempoRESUMO
BACKGROUND: For centuries, medicated baths have been one of the first lines of treatment for psoriasis. Even today, with sophisticated immunosuppressive treatments available, Dead Sea salts and spa waters are recognized to be beneficial in the management of psoriatic patients. OBJECTIVE: To assess statistically the efficacy of sodium bicarbonate (NaHCO3) baths in psoriasis patients. METHODS: Thirty-one patients with mild-moderate psoriasis were admitted to this study; Nineteen patients were treated with sodium bicarbonate baths and compared with twelve patients who were administered a placebo. Assessments were made on days 0 and 21. RESULTS: Almost all patients who used NaHCO3 reported a statistically valuable improvement. NaHCO3 baths reduced itchiness and irritation; in general, the patients themselves recognized a beneficial impact on their psoriasis, so much so that they have continued to bathe in NaHCO3 even after the end of the study. CONCLUSION: We maintain that even with sophisticated immunosuppressive and highly specific anti-cytokine and anti-chemokines treatments available for the treatment of psoriasis, an older and often forgotten treatment can still play a role.
Assuntos
Banhos , Psoríase/terapia , Bicarbonato de Sódio/uso terapêutico , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do TratamentoRESUMO
The term harlequin fetus is used to describe the most severe form of congenital ichthyosis. All except one previously reported patient died during the first few weeks of life. The development of one such fetus to the age of 2 years 6 months is reported, along with a photographic record of progress. Details of the progress of another harlequin fetus to 6 months of age are given. The clinical diagnosis of the former patient is nonbullous ichthyosiform erythroderma.
Assuntos
Ictiose/patologia , Fatores Etários , Feminino , Seguimentos , Humanos , Ictiose/genética , Recém-Nascido , LinhagemRESUMO
We studied the natural history, the prevalence of atopy, and the frequency of systemic symptoms during attacks in 35 patients with cholinergic urticaria, the histologic condition of the eruption in seven patients (20%), and the response to intradermal injections of acetylcholine, histamine, and methacholine in 18 patients (51%). In most patients symptoms began between the ages of 10 and 30 years, persisted for many years, and caused them to modify their activities to avoid the provoking factors of exercise, emotion, and heat. The condition usually improved with time, and five patients (14%) had a spontaneous remission. Atopy, present in about 12 (34%) of the patients, was more frequent than in the general population. Systemic symptoms were uncommon during attacks, and patients had no greater responses than controls to the intradermal tests. The histologic study revealed neutrophils in and around the walls of superficial subpapillary dermal vessels.
Assuntos
Fibras Colinérgicas/fisiopatologia , Urticária/fisiopatologia , Adolescente , Adulto , Feminino , Temperatura Alta/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Neutrófilos/patologia , Esforço Físico , Estresse Psicológico/complicações , Urticária/etiologia , Urticária/patologiaAssuntos
Angiomatose/complicações , Hemangioma/complicações , Síndrome de Klippel-Trenaunay-Weber/complicações , Hemorragia Uterina/etiologia , Neoplasias Uterinas/complicações , Adulto , Feminino , Hemangioma/diagnóstico por imagem , Humanos , Radiografia , Neoplasias Uterinas/diagnóstico por imagemRESUMO
BACKGROUND: Cutaneous spider naevi are commonly considered to be a clinical sign of chronic liver disease. Little is known about their occurrence in children. AIM: To evaluate the occurrence of spider naevi in children with and without liver disease. METHODS: The presence of spider naevi was investigated in 460 children, 34 of whom had chronic liver disease. RESULTS: Of children without liver involvement, 38% had at least one spider naevus. The prevalence of spider naevi increased with age. Of control patients aged 5 to 15 years, 2.5% had more than five spiders present. Although eight of 10 children with cirrhosis had at least one spider naevus, only four of 34 children with chronic liver disease had five or more spiders present. Most spiders were on the hands and very few were >5 mm in size. CONCLUSIONS: Children with liver disease rarely have large numbers of spider naevi. Although the finding of five or more spider naevi is more common in liver disease, many normal children also have one or more of these lesions.
Assuntos
Hepatopatias/complicações , Nevo/etiologia , Neoplasias Cutâneas/etiologia , Adolescente , Fatores Etários , Estudos de Casos e Controles , Criança , Pré-Escolar , Doença Crônica , Feminino , Humanos , Lactente , MasculinoRESUMO
A harlequin fetus seen at birth was treated with etretinate and more general measures, including careful attention to fluid balance, calorie intake and temperature control. She improved, continued to develop, and had survived to 5 months at the time of this report.
Assuntos
Etretinato/uso terapêutico , Ictiose/congênito , Feminino , Humanos , Ictiose/tratamento farmacológico , Ictiose/genética , Recém-Nascido , LinhagemRESUMO
Angioedema is characterized by localized swelling of sudden onset affecting the skin and/or mucous membranes. It can be classified into hereditary and acquired forms. Hereditary angioedema is a rare disease inherited as an autosomal dominant trait and caused by a deficiency of C1-esterase inhibitor. Acute attacks are life threatening and cannot be managed by antihistamines, corticosteroids, or adrenergic drugs. Prophylactic therapy is possible with danazol or stanozolol. Acquired angioedema includes nonhereditary C1-esterase inhibitor deficiency; idiopathic, allergic, and drug-induced forms; angioedema associated with lupus erythematosus and hypereosinophilia; and angioedema caused by physical stimuli. Treatment of these forms of angioedema depends on identifying and avoiding the cause, induction of tolerance, or symptomatic treatment with systemic antihistamines.
Assuntos
Angioedema , Angioedema/tratamento farmacológico , Angioedema/etiologia , Angioedema/genética , Angioedema/fisiopatologia , HumanosRESUMO
New therapeutic approaches in urticaria are presented with special respect to chronic and physical types including symptomatic dermographism, cholinergic urticaria, pressure and solar urticaria as well as vibratory angioedema. Clinical efficacies of several antihistamines (clemastine, astemizole, terfenadine, acrivastine, hydroxyzine, cimetidine), of ketotifen as a H1 receptor antagonist and mast cell stabilizer, of tricyclic antidepressant doxepin with H1 and H2 antagonist properties, of the calcium channel antagonist nifedipine, of topical corticosteroids and of the attenuated androgen danazol are presented. The data are specified by a detailed description of the design and particular conditions of the underlying study protocols.
Assuntos
Urticária/tratamento farmacológico , Angioedema/tratamento farmacológico , Antagonistas dos Receptores Histamínicos H1/uso terapêutico , Humanos , Urticária/etiologiaRESUMO
The effect of nifedipine on subjective symptoms and objective dermographometer induced whealing was assessed independently in two double-blind cross-over trials in which active drug or placebo were taken for 2 weeks. The lower dose study used nifedipine 5 mg 3 times daily and gave rise to symptomatic improvement as assessed by diary card and visual analogue scale in 5 of 11 patients. This was not statistically significant and was not accompanied by a reduction in dermographometer-induced wheal and flare responses except at highest pressures. In a separate study 7 patients were treated with nifedipine 10 mg 3 times daily. No change in whealing occurred, 3 patients' symptoms became worse and only 1 showed symptomatic improvement on nifedipine. Side effects were frequent at this dose. The reasons for the unfavourable response despite in vitro evidence for inhibition of mast cell degranulation by this drug are discussed.
Assuntos
Nifedipino/administração & dosagem , Urticária/tratamento farmacológico , Adolescente , Adulto , Ensaios Clínicos como Assunto , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nifedipino/efeitos adversos , Distribuição AleatóriaRESUMO
We report a patient who has an immediate wealing response to pressure in the absence of symptomatic dermographism, which we designate 'immediate-pressure urticaria'. Our patient also suffered from cholinergic urticaria and chronic idiopathic urticaria in the past, demonstrating the clustering of urticarias which frequently occurs.