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Topic discussion:
Urticaria چھپاکی,دپھڑ

Is transient erythematous skin swelling, itchy in nature, pale to red with surrounding hallow ,
Few millimetres to few centimetres
Ring like or map like pattern , sometimes giant patches, lasts less than 24 hours.

Types:
Acute ( symptoms lasts less than 6 weeks)
Chronic ( more than 6 weeks)

Chronic Spontaneous ( idiopathic with no known cause)
Chronic inducible ( known triggers)

Causes:

Infections:
Viral
Parasitic
Bacterial
IgE-mediated allergic cases:
Medications
Insects
Stinging (yellow jackets, bees, wasps, hornets, fire ants)
Biting (Triatoma [kissing bugs])
Foods
Blood products (urticarial transfusion reaction)
Latex (contact or inhaled)
Contact allergens (animal saliva, raw foods)
Aeroallergens (rare)
Food additives
Direct mast cell activation:
Narcotics/opiates
Muscle relaxants (eg, succinylcholine)
Radiocontrast agents
Vancomycin
Physical stimuli:
Dermatographism
Delayed pressure
Cold
Cholinergic
Vibratory
Aquagenic
Solar
Exertion/exercise
Miscellaneous mechanisms:
Nonsteroidal anti-inflammatory drugs
Serum sickness
Transfusion reactions (distinct from IgE-mediated reactions)
Hormone-associated (progesterone)
Stinging nettle

Clinical features:
1- weals or hives formation , lasts few minutes to 24 hrs
2- angioedema ( face ,eyes , hands, genitalia , etc) can lasts for several days( 3 days)

Diagnosis: is clinical mostly
Urticaria vasculitis can be differentiated by biopsy

Treatment:
Step 1. Identify and Avoid triggering factors
Step 2. Second generation antihistamine ( cetirizine, loratidine , desloratidine )
Step 3-assess after 1-2 weeks if not relieved , increase dose ( upto 4 times)
Step 4- add one or more of following ( LTRA, First gen anti histamine, h2 blockers)
Step5- assess after 2-4 weeks
Not achieved. Add steroid ( prednisone) tab 0.5 mg per kg per day for 3-5 days.
Step 6- u can add omalizumab, cyclosporine or other agents

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