ABSTRACT
Antecedentes: La urticaria aguda es una dermatosis frecuente, se calcula que ocurre en 20% de la población mundial. La tasa de preva-lencia varía de acuerdo con la población de cada país entre 3.4 y 6.4%. En Honduras en el Instituto Hondureño de Seguridad Social (IHSS), la urticaria aguda es la cuarta causa más frecuente de dermatosis en consulta externa dermatológica pediátrica. Objetivo: Determi-nar las características clínicas-sociodemográ -cas y el manejo en salas de Emergencia del Hospital Nacional Mario Catarino Rivas (HNMCR) y IHSS ambos hospitales en SPS, en el período enero 2016julio 2017. Pacientes y Métodos: El diseño de la investigación fue transversal observacional, con alcance descrip-tivo. Se incluyeron 83 pacientes en edad pediá-trica con diagnóstico de urticaria aguda, evaluados en las emergencias del IHSS y HNMCR. Resultados: El grupo etario y raza afectados fueron los lactantes menores 68.67% (n=57) y raza mestiza 86.75% (n=72). No tenían antecedentes inmunoalérgicos 63.86% (n=53). El alimento relacionado con urticaria fue el huevo 9.64% (n=8) y entre los medicamentos; los antibióticos 23.08% (n=19). El tratamiento administrado con mayor frecuencia fue la doble terapia 65.21% (n=30) y se ingresaron 17 pacientes (20.48%). Conclusión: El manejo terapéutico y los criterios de ingreso utilizado en el servicio de emergencia no siguen los lineamientos de guías internacionales...(AU)
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Urticaria/therapy , Hospitals, Pediatric , Skin Diseases/complications , Ambulatory CareABSTRACT
Abstract BACKGROUND: Chronic urticaria is characterized by transient, pruritic lesions of varying sizes, with central pallor and well-defined edges, with disease duration longer than six weeks. Its cellular infiltrate consists of neutrophils, lymphocytes and eosinophils. There is a subgroup of patients with eosinophilic or neutrophilic urticaria, resistant to the treatment with antihistamines, but that respond to a combination of antihistamine with other drugs. OBJECTIVE: To evaluate the present infiltration in chronic urticaria biopsies and correlate it with the clinical disease activity and response to treatment. METHODS: Forty-one patients with chronic urticaria were classified according to the score of severity of the disease, response to treatment and type of perivascular infiltrate. Inflammatory infiltrates were divided in eosinophilic (46.30%), neutrophilic and mixed. RESULTS: An association was found between the eosinophilic infiltrate and clinical scores of greater severity (p = 0.002). CONCLUSION: This association shows that the eosinophilic inflammatory infiltrates denote high clinical activity, which means more severe and exuberant clinical pictures of the disease.
Subject(s)
Humans , Male , Female , Adult , Urticaria/physiopathology , Urticaria/pathology , Neutrophil Infiltration/physiology , Eosinophils/pathology , Reference Values , Urticaria/therapy , Biopsy , Severity of Illness Index , C-Reactive Protein/analysis , Immunoglobulin E/analysis , Chronic Disease , Cross-Sectional Studies , Treatment Outcome , Statistics, NonparametricABSTRACT
La oruga procesionaria del pino, forma larvaria de la mariposa nocturna Thaumetopoea pityocampa, es una de las principales plagas forestales del sur de Europa. Con frecuencia, estas orugas producen reacciones locales en humanos debidas a los pelillos urticantes microscópicos que las recubren. La mayoría de los síntomas ocasionados son cutáneos, como urticaria aguda, y son mucho más infrecuentes las reacciones sistémicas. Se presenta un caso de reacción sistémica, con edema orofacial, babeo y urticaria tras la ingesta de una oruga procesionaria del pino en un lactante de 11 meses, en el cual el tratamiento farmacológico fue suficiente para la resolución de los síntomas. No tuvo, en ningún momento, compromiso de la vía aérea ni otros datos de anafilaxia, por lo que se desestimaron actuaciones más agresivas, como intubación orotraqueal, endoscopía o laringoscopía.
The larval form of the moth Thaumetopoea pityocampa, known as pine processionary caterpillar, is one of the main forest pests in southern Europe. Often, these caterpillars cause local reactions in humans, due to their microscopic stinging hairs. Most symptoms affect skin, in form of acute urticaria. Systemic reactions are rare. An eleven month old infant with a systemic reaction after ingestion of a pine processionary caterpillar is presented. The boy reached the Emergency Room with orofacial edema, drooling and urticaria. Drug treatment was enough to resolve the symptoms. The patient did not present airway commitment, nor anaphylaxis data at any moment, so more aggressive actions, such as endotracheal intubation, endoscopy or laryngoscopy, were rejected.
Subject(s)
Humans , Male , Infant , Urticaria/therapy , Eating , Edema/therapy , Conservative Treatment , Larva , Moths , Urticaria/etiology , Edema/etiology , AnimalsABSTRACT
É relatado um caso de paciente com quadro de urticária crônica e angioedema com mais de 18 anos de evolução. Mal controle de sintomas com tratamento convencional e visitas cada vez mais frequentes ao pronto socorro deterioravam sua qualidade de vida e traziam insegurança devido ao potencial de gravidade do quadro. Em sua primeira consulta homeopática foi verificado alto grau de semelhança sintomática com a patogenesia de Apis mellifica, o qual foi introduzido e modificou a história de vida da paciente em questão, com excelente controle do quadro clínico. Foi realizada revisão da literatura sobre urticária e o policresto Apis mellifica. Este relato tem como objetivos chamar atenção para a existência e importância de recursos terapêuticos não convencionais, como é o caso da homeopatia, e também compartilhar com os colegas homeopatas a condução do caso, desde o diagnóstico e escolha do medicamento, ao seguimento da paciente.
We report the case of a patient with chronic urticaria and angioedema for more than 18 years. The symptoms were poorly checked with conventional treatment and increasingly frequent visits to the emergency department seriously affected the patients quality of life, in addition to making her feel insecure about the severity of her condition. During the first homeopathic consultation we detected a high degree of similarity with the pathogenetic symptoms of Apis mellifica. The remedy was prescribed and changed the patients life history, achieving excellent control of her clinical condition. A literature review was performed on urticaria and polycrest medicine Apis mellifica. The aim of this case report is to call the attention to the availability and relevance of non-conventional therapeutic resources, such as homeopathy, and to share with colleagues aspects of the case management from diagnosis and medicine selection to follow up.
Subject(s)
Female , Humans , Young Adult , Angioedema/therapy , Bees/therapeutic use , Homeopathy , Urticaria/therapyABSTRACT
Chronic urticaria (UC), defined as recurrence of wheals with or without angioedema for more than 6 weeks, is a quite common disease that may severely worsen the quality of life. Although the actual athophysiological mechanisms are still unknown, what we do know is that the main cells involved in their pathology are mast cells and eosinophils. The present article reviews recent findings showing an additional pathogenic mechanisms in UC patients: activation of the coagulation cascade resulting in thrombin production. Several investigators have demonstrated the activation of coagulation that is due to the involvement of eosinophils and a tissue factor pathway with generation of thrombin potentially contributing to an increased vascular permeability. CU patients often present with elevation of coagulation and fibrinolysis markers, such as prothrombin fragment F1+2 and D-dimer, which correlate with the disease severity. Preliminary data indicate that anticoagulant treatment with heparin and warfarin may be effective in reducing the symptoms of this disorder...
Subject(s)
Humans , Blood Coagulation , Urticaria/etiology , Urticaria/blood , Urticaria/therapy , Chronic DiseaseABSTRACT
FUNDAMENTO: la urticaria acuagénica es una rara forma de presentación de las urticarias físicas. OBJETIVO: describir el cuadro clínico y conducta a seguir de la urticaria acuagénica en una lactante. CASO CLÍNICO: lactante blanca, femenina de siete meses. Refieren los padres que desde su nacimiento comenzó la aparición de pequeñas ronchas en el tronco, brazos y piernas, que coincidían con el horario del baño, desaparecían a los 30-60 minutos posterior al mismo. A pesar de modificar el tipo de jabón y la temperatura del agua se mantenía el cuadro. Señalan que no le aparecen las lesiones de piel con el baño de mar. Los antecedentes atópicos familiares son positivos. Al bañarse la niña se comprueba la aparición de las lesiones de piel. Se diagnosticó la presencia de urticaria acuagénica y se prescribió tratamiento con antihistamínicos con una buena evolución del cuadro. CONCLUSIONES: la urticaria acuagénica es poco frecuente en lactantes, de su correcto diagnóstico y tratamiento, depende la buena evolución, así como la vida del paciente que puede verse comprometida por acompañarse esta de manifestaciones extracutáneas.
BACKGROUND: aquagenic urticaria is an uncommon presentation of physical urticaria. OBJECTIVE: to describe the clinical manifestations and the behavior to follow in an infant. CLINICAL CASE: a seven-months-old, white, female infant. The parents said that since she was born, some little wheals started to appear in the trunk, arms and legs that coincided with the bath time and disappeared 30-60 minutes later. In spite of changing soaps and the water temperature the manifestations remained. The parents also said that the lesions in the skin did not appear when taking a bathe in the sea. Family atopic antecedents were positive. When the baby is given a bath, the appearance of the lesions in the skin could be verified. The presence of aquagenic urticaria was diagnosed and antihistamines were prescribed for the treatment. The patient condition had a good progress. CONCLUSIONS: aquagenic urticaria is not frequent in infants. The good progress and the life of the patient, which could be affected by the disease since extracutaneous manifestations come with it, depend on the correct diagnosis and treatment.
Subject(s)
Humans , Infant , Skin/injuries , Urticaria/diagnosis , Urticaria/ethnology , Urticaria/therapyABSTRACT
La urticaria crónica (VC), es una variante común de la urticaria que se define como un síndrome reactivo de la piel y mucosas caracterizado por la presencia de placas eritematosas, habones o ronchas edematosas y pruriginosas que se prolonga durante más de seis semanas. La etiología de la VC no es muy clara en la mayoría de los casos, multitud de causas se han implicado. La patogenia es compleja. El conocimiento y estudio de cada uno de los factores celulares y solubles, su interacción dinámica, vías efectoras y trama de citoquinas conducirá al logro de una terapéutica efectiva y racional de la urticaria crónica.
Chronic urticaria (VC) is a common variant of urticaria which is defined as a reactive skin and mucous membranes syndrome characterized by the presence of plaques erythematous, wheals, or swollen and itchy hives that lasts more than six weeks. The etiology of the VC is not very clear in the majority of cases, multitude of causes have been implicated. The pathogenesis is complex. Knowledge and study of each cell and soluble factors, their dynamic interaction, effector pathways and cytokines plot will lead to the achievement of an effective and rational therapy of chronic urticaria.
Subject(s)
Urticaria/diagnosis , Urticaria/epidemiology , Urticaria/etiology , Urticaria/history , Urticaria/pathology , Urticaria/therapy , Clinical Diagnosis , Medical IllustrationABSTRACT
La urticaria es una reacción de la piel caracterizada clínicamente por la aparición de elevaciones cutáneas eritematosas o blanquecinas, edematosas, pruriginosas y transitorias, que pueden localizarse en cualquier parte de la superficie cutáneao en las mucosas. Su etiología es variada y sus mecanismos etiopatogénicos también suelen ser múltiples. La lesión típica es el habón o roncha, el cuál cambia de lugar en horas, su forma y tamaño son variables, puede persistir minutos, horas o semanas. La mayoría de las urticarias no presenta sintomatología sistémica. Suele clasificarse regularmente en urticaria aguda, cuando lleva menos de 6 semanas de aparición, y en urticaria crónica, cuando lleva más de 6 semanas. El diagnóstico es fundamentalmente clínico. Es una entidad frecuente que por su gran expresividad motivan constantes y reiteradas consultas a los servicios de urgencia. En este artículo se examinarán los mecanismos que llevan a la urticaria y angioedema, y se revisará la patogénesis, los aspectos clínicos, los estudios de laboratorio necesarios y el tratamiento de la urticaria aguda.
The urticaria is a skin reaction characterized clinically by the on set of erythematous skin elevations or whitish, oedematous,pruritic and transient, you can locate anywhere on the surface of the skin or the mucous membranes. Its etiology is varied and its mechanisms etiopathogenic also tend to be multiple. The typical lesion is the wheal or bump, which changes from place with inhours, its size and shape are variable, may persist for minutes, hours or weeks. The majority of the hives does not pose systemic symptoms. Usually qualify regularly in acute urticaria, when it takes less than 6 weeks of appearance, and chronic urticaria, when it takes over 6 weeks. The diagnosis is primarily clinical. Itis a common entity that by their expressivity motivate constants and repeated consultations to emergency services. This article will xamine the mechanisms that lead to angioedema and urticaria, he pathogenesis, clinical aspects, necessary laboratory studies and eatment.
Subject(s)
Humans , Male , Female , Angioedema , Urticaria/classification , Urticaria/epidemiology , Urticaria/etiology , Urticaria/pathology , Urticaria/therapy , Education, Medical, Continuing , Histamine/pharmacologyABSTRACT
Os autores apresentam uma revisão das dermatoses neutrofílicas que possuem grande repercussão à saúde dos pacientes: síndrome de Sweet, pioderma gangrenoso, doença de Behçet e urticária neutrofílica. São discutidos, baseados nos resultados e conclusões de estudos relevantes publicados recentemente e na experiência dos autores, os principais aspectos clínicos, as importantes alterações histopatológicas e as opções para o manejo.
The authors present a review of neutrophilic dermatoses that have great impact on the health of patients: Sweet syndrome, pyoderma gangrenosum, Behçet's disease and neutrophilic urticaria. Major clinical aspects, histopathological changes and management options are discussed based on the results and conclusions of relevant studies recently published and on the authors' experience.
Subject(s)
Female , Humans , Male , Behcet Syndrome/pathology , Neutrophil Infiltration , Pyoderma Gangrenosum/pathology , Sweet Syndrome/pathology , Urticaria/pathology , Behcet Syndrome/therapy , Dermatologic Agents/therapeutic use , Pyoderma Gangrenosum/therapy , Sweet Syndrome/therapy , Urticaria/therapyABSTRACT
Se presenta el caso de una niña con diagnóstico de urticaria autoinmunitaria y su evolución terapéutica con omalizumab. Caso clínico. Paciente de sexo femenino de 12 años de edad con un cuadro de urticaria crónica grave y angioedema de 14 meses de evolución, escasa respuesta a dosis máximas de 3 antihistamínicos combinados, antileucotrienos y corticoides, y gran afectación de su calidad de vida. Se realizó una prueba de suero autólogo, que fue positiva hasta la dilución 1:100, llegándose al diagnóstico de urticaria crónica autoinmunitaria. La falta de respuesta al tratamiento lleva a indicar terapia con omalizumab, con una reducción notable de los síntomas hacia la tercera dosis y ausencia de ellos tras 12 meses de tratamiento. Conclusión. El omalizumab podría ser una opción terapéutica para pacientes con urticaria autoinmunitaria que no responden a otros tratamientos.
We report the case of a child with diagnosis of chronic urticaria/angioedema and its evolution upon omalizumab treatment. Case report. Our patient is a 12-years-old female who suffered for 14 months severe chronic urticaria/angioedema. She had a poor response to the highest doses of combined therapy with 3 antihistamines, steroids and anti-leukotrienes and great impairmentof her quality of life. An autologous serum skin test was positive until 1:100 dilutions, leading to the diagnosis of chronic autoimmune urticaria. Due to the lack of response to treatment, therapy with omalizumab was administered. A notable reduction in symptoms toward the third dose was observed. After 12 months of this treatment, the patient is asymptomatic and has a negative autologousserum test. Conclusion. Omalizumab could be a therapeutic option for patients with autoimmune urticaria unresponsive to other treatments.
Subject(s)
Humans , Child , Female , Autoimmune Diseases , Anti-Allergic Agents , Angioedema/etiology , Angioedema/physiopathology , Angioedema/therapy , Urticaria/physiopathology , Urticaria/therapyABSTRACT
Apesar dos avanços terapêuticos, a urticária constitui uma das dermatoses mais freqüentes. O objetivo do presente estudo foi avaliar o perfil e a evolução clínica dos pacientes com urticária crônica (UC) atendidos em consultório de especialidade. Foi realizado um estudo observacional, seccional, de 249 pacientes com diagnóstico de urticária crônica, atendidos em um serviço privado de Alergologia de Juiz de Fora, no período de 1993 a 2005. Pacientes com diagnóstico de urticária aguda foram excluídos. As variáveis analisadas foram idade, sexo, etiologia, bem como evolução clínica e tratamento. A média da idade foi 36,8 anos (DP=18,4). Considerando-se a variável sexo, 74,7% (186/249) eram do sexo feminino. Na evolução clínica, verificou-se que 67,1% (167/249) dos pacientes continuaram em acompanhamento, com uma mediana de duas consultas subseqüentes. Nestes, os resultados demonstraram: melhora clínica completa com 50,3% (84/167); a interrupção do tratamento com referência de melhora parcial em 47,3% (79/167); e a interrupção do tratamento com referência de nenhuma melhora clínica em 2,4% (4/167). Quanto à etiologia, em 68,3% (170/249) dos pacientes não se conseguiu estabelecer uma causa específica. Entre os 31,7% (79/249) pacientes que apresentaram uma causa para a UC, 40,5% (32/79) tinham alguma alteração laboratorial ligada à tireóide. Observamos que o perfil epidemiológico dos pacientes segue o demonstrado na literatura, com predomínio em adultos e no sexo feminino, sendo elevado o número de pacientes que não dão continuidade ao acompanhamento ou com interrupção com melhora parcial.
Despite therapeutic advances, urticaria is one of the most common dermatoses. The objective of this study was to evaluate the clinical profile and the evolution of patients with chronic urticaria (CU) seen in a specialist office. We conducted an observational and sectional study of 249 patients diagnosed with CU, examined in a private service of Allergology of Juiz de Fora, in the period from 1993 to 2005. Patients with diagnosis of acute urticaria were excluded. The variables examined were age, sex, etiology and clinical evolution and treatment. The mean age was 36.8 years (SD = 18.4). 74.7% (186/249) were female. As for clinical course, it was found that 67.1% (167/249) of patients were followed up, with a median of two subsequent consultations. In the latter, the results showed that: complete clinical improvement with 50.3% (84/167); the treatment with reference to partial improvement in 47.3% (79/167); and treatment with reference to any clinical improvement in 2.4% (4 /167). There was no specific cause of CU in 68.3% (170/249) of patients. Among the 31.7% (79/249) patients who had a cause for the CU, 40.5% (32/79) had thyroiditis. We observed that the epidemiological profile with prevalence in adults and in females, as well as the high number of patients who are lost to follow-up were supported by the literature.
Subject(s)
Skin Diseases , Urticaria , Thyroid Gland , Thyroiditis , Urticaria/etiology , Urticaria/therapy , Health Profile , Clinical Evolution/methods , Allergy and Immunology , Chronic UrticariaABSTRACT
Concepto: El prurito (de prurio: picor, picazón, comezón) es un síntoma subjetivo y de difícil definición, sin embargo también es de fácil compresión, pues con seguridad todos los individuos lo han experimentado alguna vez en la vida. La definición clásica del prurito es: sensación desagradable que conduce al rascado. Es un hecho fisiológico que surge ante estímulos externos o internos en forma súbita y autolimitada y que provoca como repuesta el rascado. No obstante, el prurito también puedes ser patológico y acompañarse de diversas enfermedades cutáneas o sistémicas. El prurito es un síntoma aflictivo tan difícil de soportar como el dolor, ya que puede deteriorar la calidad de vida desde el punto de vista psíquico y psicológico...
Subject(s)
Humans , Dermatitis , Dermatitis, Atopic , Pruritus , Urticaria , Dermatitis, Atopic/etiology , Urticaria/physiopathology , Urticaria/therapyABSTRACT
La urticaria es una condición heterogénea que puede manifestarse clínicamente de formas muy diversas, cuyo signo más común es el habón o roncha. Existen muchas posibles causas de urticaria, y la gravedad y patrón clínico pueden variar considerablemente de paciente a paciente. Por este motivo el tratamiento debe ser individualizado y debe modificarse caso a caso. Clínicamente consiste en una erupción temporal de zonas eritematosas y edematosas que corresponden a aumentos de volumen de la dermis, generalmente acompañados de prurito. La urticaria es clasificada en aguda y crónica según su duración, considerándose seis semanas como el tiempo máximo para hablar de urticaria aguda, cuando las lesiones están presentes por más de seis semanas, hablamos de urticaria crónica (UC). Existen múltiples factores gatillantes de urticaria, como alimentos, inhalantes, fármacos, infecciones, etc. El tratamiento es complejo y consiste en medidas no farmacológicas (ambientales), las que pueden llevarse a cabo más fácilmente en la medida que se identifiquen los factores gatillantes, y en el uso de fármacos principalmente antagonistas anti H1. En este artículo se discutirá sobre los aspectos generales de la urticaria crónica, los tratamientos que hoy existen y aquellos que se están desarrollando.