Asunto(s)
Angioedema/inducido químicamente , Antialérgicos/efectos adversos , Erupciones por Medicamentos/etiología , Omalizumab/efectos adversos , Urticaria/inducido químicamente , Angioedema/patología , Enfermedad Crónica , Erupciones por Medicamentos/patología , Humanos , Masculino , Persona de Mediana Edad , Índice de Severidad de la Enfermedad , Factores de Tiempo , Urticaria/patologíaAsunto(s)
Humanos , Masculino , Persona de Mediana Edad , Urticaria/inducido químicamente , Erupciones por Medicamentos/etiología , Antialérgicos/efectos adversos , Omalizumab/efectos adversos , Angioedema/inducido químicamente , Factores de Tiempo , Urticaria/patología , Índice de Severidad de la Enfermedad , Enfermedad Crónica , Erupciones por Medicamentos/patología , Angioedema/patologíaRESUMEN
We report a 12-year-old girl who presented with recurrent angioedema on the face, trunk, and extremities, and concomitant marked weight gain for 5 years. During the episode, her white blood cell count increased to 47.7×109/L with 89.9% eosinophils, followed by elevated serum level of IL-5, IgE, IgM, and LDH. Histopathology showed perivascular eosinophilic infiltration and diffuse eosinophilic infiltration throughout the dermis. Possible causes of hypereosinophilia and eosinophilic infiltration of vital organs were ruled out. We also tested the FIP1L1/PDGFRa and ETV6/PDGFRb fusion gene to exclude the possibility of myeloid and lymphatic vessel neoplasms. The patient was treated with methylprednisolone and discharged with an oral prednisolone taper, which resulted in complete remission of the edema and normalization of peripheral blood eosinophil count, serum IL-5 level, IgE, IgM, and LDH.
Asunto(s)
Angioedema/complicaciones , Eosinofilia/complicaciones , Angioedema/patología , Niño , Eosinofilia/patología , Femenino , Humanos , Inmunoglobulina E/sangre , Inmunoglobulina M/sangre , Interleucinas/sangre , Recurrencia , Aumento de PesoRESUMEN
Abstract: We report a 12-year-old girl who presented with recurrent angioedema on the face, trunk, and extremities, and concomitant marked weight gain for 5 years. During the episode, her white blood cell count increased to 47.7×109/L with 89.9% eosinophils, followed by elevated serum level of IL-5, IgE, IgM, and LDH. Histopathology showed perivascular eosinophilic infiltration and diffuse eosinophilic infiltration throughout the dermis. Possible causes of hypereosinophilia and eosinophilic infiltration of vital organs were ruled out. We also tested the FIP1L1/PDGFRa and ETV6/PDGFRb fusion gene to exclude the possibility of myeloid and lymphatic vessel neoplasms. The patient was treated with methylprednisolone and discharged with an oral prednisolone taper, which resulted in complete remission of the edema and normalization of peripheral blood eosinophil count, serum IL-5 level, IgE, IgM, and LDH.
Asunto(s)
Humanos , Femenino , Niño , Eosinofilia/complicaciones , Angioedema/complicaciones , Angioedema/patología , Recurrencia , Inmunoglobulina E/sangre , Inmunoglobulina M/sangre , Aumento de Peso , Interleucinas/sangre , Eosinofilia/patologíaRESUMEN
We describe a 39-year-old woman with an apparent captopril-induced, contact mucosal-dominant pemphigus vulgaris and angioedema, who took captopril during a bout of arterial hypertension. This exposure suggests that captopril and pathophysiology of angioedema stimulated the development of pemphigus vulgaris, which was diagnosed using the novel, indirect immunofluorescence BIOCHIP mosaic, with the modification to detect serum IgG4 autoantibodies. We discuss the patient, who experienced a chain of events leading to the active stage of pemphigus vulgaris, and review concepts of pemphigus vulgaris inducible by drugs and pathological immunity.
Asunto(s)
Angioedema/inducido químicamente , Antihipertensivos/efectos adversos , Captopril/efectos adversos , Enfermedades de la Boca/inducido químicamente , Pénfigo/inducido químicamente , Adulto , Angioedema/patología , Femenino , Técnica del Anticuerpo Fluorescente Directa , Humanos , Inmunoglobulina G/sangre , Enfermedades de la Boca/patología , Mucosa Bucal/efectos de los fármacos , Mucosa Bucal/patología , Pénfigo/patologíaRESUMEN
AbstractWe describe a 39-year-old woman with an apparent captopril-induced, contact mucosal-dominant pemphigus vulgaris and angioedema, who took captopril during a bout of arterial hypertension. This exposure suggests that captopril and pathophysiology of angioedema stimulated the development of pemphigus vulgaris, which was diagnosed using the novel, indirect immunofluorescence BIOCHIP mosaic, with the modification to detect serum IgG4 autoantibodies. We discuss the patient, who experienced a chain of events leading to the active stage of pemphigus vulgaris, and review concepts of pemphigus vulgaris inducible by drugs and pathological immunity.
Asunto(s)
Adulto , Femenino , Humanos , Angioedema/inducido químicamente , Antihipertensivos/efectos adversos , Captopril/efectos adversos , Enfermedades de la Boca/inducido químicamente , Pénfigo/inducido químicamente , Angioedema/patología , Técnica del Anticuerpo Fluorescente Directa , Inmunoglobulina G/sangre , Enfermedades de la Boca/patología , Mucosa Bucal/efectos de los fármacos , Mucosa Bucal/patología , Pénfigo/patologíaRESUMEN
This interdisciplinary paper summarizes the news in the diagnosis and treatment of chronic urticaria (CU), and provides concepts, definitions and evidence-based suggestions for its management. Urticaria occurs in at least 20% of the population at some point in their lives. Acute urticaria (less than 6 weeks' duration), differs from CU in its etiology, but the onset of this disease is always acute. CU may occur as spontaneous (SCU) or induced (ICU). The diagnosis is simple, although a careful evaluation is necessary for differential diagnosis. ICU's diagnosis is mainly clinical, even if provocation tests can be useful. Supplementary studies should be limited and based on the clinical suspicion. Treatment may be divided into three approaches: avoidance, elimination or treatment of the cause, and pharmacological treatment. Recently treatment has been modified with the use of second-generation antihistamines as first-line and increased doses of nonsedating H1 antihistamines, up to 4 times, as second line. Antihistamines are essential to treat CU; however, 40% of patients do not achieve good control despite increased doses and require additional treatment. The most recent evidence indicates a group of drugs to be used as third line in these cases, to improve quality of life and to limit toxicity from frequent or chronic use of systemic steroids. Only 3 drugs are recommended as third line: omalizumab, cyclosporin A or anti-leukotrienes.
Asunto(s)
Antialérgicos/uso terapéutico , Antagonistas de los Receptores Histamínicos/uso terapéutico , Urticaria/diagnóstico , Urticaria/tratamiento farmacológico , Urticaria/etiología , Algoritmos , Angioedema/tratamiento farmacológico , Angioedema/patología , Anticuerpos Antiidiotipos/uso terapéutico , Anticuerpos Monoclonales Humanizados/uso terapéutico , Argentina , Enfermedades Autoinmunes/complicaciones , Enfermedad Crónica , Ensayos Clínicos como Asunto , Ciclosporina/uso terapéutico , Diagnóstico Diferencial , Medicina Basada en la Evidencia/economía , Humanos , Inmunoglobulina E/metabolismo , Antagonistas de Leucotrieno/uso terapéutico , Omalizumab , Calidad de Vida , Urticaria/clasificación , Urticaria/complicaciones , Urticaria/fisiopatologíaRESUMEN
Se actualiza el diagnóstico de la urticaria crónica (UC) y los conceptos, definiciones y sugerencias basados en la evidencia para su tratamiento. La urticaria ocurre en al menos 20% de la población en algún momento de la vida. Su etiología difiere en la forma aguda (menos de 6 semanas), y en la crónica. No es posible pronosticar si las formas agudas evolucionarán a UC, ya que todas son agudas al comienzo. La UC ocurre como espontánea (UCE) o inducible (UCI). El diagnóstico es sencillo, pero incluye un minucioso estudio para descartar diagnósticos diferenciales; para UCI son útiles las pruebas de provocación en la caracterización y manejo. Los estudios complementarios se deben limitar y orientar según sospecha clínica. El tratamiento se divide en tres enfoques: evitación, eliminación o tratamiento del estímulo desencadenante o de la causa, y tratamiento farmacológico. Recientemente éste se modificó, con empleo de antihistamínicos de segunda generación como primera línea y aumento de dosis de antihistamínicos H1 no sedantes, hasta 4 veces, como segunda línea. Los antihistamínicos son fundamentales para tratar la UC; sin embargo, un 40% de los pacientes no logra un buen control pese al aumento de dosis y requiere otro medicamento adicional. La evidencia más reciente considera que un grupo de fármacos puede utilizarse como tercera línea en estos casos, para mejorar la calidad de vida y limitar la toxicidad por el uso frecuente o crónico de esteroides sistémicos. Se recomiendan para esta tercera línea solo 3 fármacos: omalizumab, ciclosporina A o antileucotrienos.
This interdisciplinary paper summarizes the news in the diagnosis and treatment of chronic urticaria (CU), and provides concepts, definitions and evidence-based suggestions for its management. Urticaria occurs in at least 20% of the population at some point in their lives. Acute urticaria (less than 6 weeks' duration), differs from CU in its etiology, but the onset of this disease is always acute. CU may occur as spontaneous (SCU) or induced (ICU). The diagnosis is simple, although a careful evaluation is necessary for differential diagnosis. ICU´s diagnosis is mainly clinical, even if provocation tests can be useful. Supplementary studies should be limited and based on the clinical suspicion. Treatment may be divided into three approaches: avoidance, elimination or treatment of the cause, and pharmacological treatment. Recently treatment has been modified with the use of second-generation antihistamines as first-line and increased doses of nonsedating H1 antihistamines, up to 4 times, as second line. Antihistamines are essential to treat CU; however, 40% of patients do not achieve good control despite increased doses and require additional treatment. The most recent evidence indicates a group of drugs to be used as third line in these cases, to improve quality of life and to limit toxicity from frequent or chronic use of systemic steroids. Only 3 drugs are recommended as third line: omalizumab, cyclosporin A or anti-leukotrienes.
Asunto(s)
Humanos , Antialérgicos/uso terapéutico , Antagonistas de los Receptores Histamínicos/uso terapéutico , Urticaria/diagnóstico , Urticaria/tratamiento farmacológico , Urticaria/etiología , Algoritmos , Argentina , Angioedema/tratamiento farmacológico , Angioedema/patología , Anticuerpos Antiidiotipos/uso terapéutico , Anticuerpos Monoclonales Humanizados/uso terapéutico , Enfermedades Autoinmunes/complicaciones , Enfermedad Crónica , Ensayos Clínicos como Asunto , Ciclosporina/uso terapéutico , Diagnóstico Diferencial , Medicina Basada en la Evidencia/economía , Inmunoglobulina E/metabolismo , Antagonistas de Leucotrieno/uso terapéutico , Omalizumab , Calidad de Vida , Urticaria/clasificación , Urticaria/complicaciones , Urticaria/fisiopatologíaRESUMEN
INTRODUCTION: The toxicity of Dieffenbachia picta, an ornamental plant, arises from its ability to cause painful edema of oral mucous membranes, buccal ulcerations, and tongue hypertrophy after chewing on the stem or contact with the sap. OBJECTIVES: We compared the anti-inflammatory effect of eugenol (2-methoxy-4-(2-propenyl)phenol) to different drugs, and investigated the role of oxalate crystals in the development of the inflammation reaction. METHODS: Tongue edema in live mice were measured with a digital tachymeter, 2 h after topical application (0.1 mL) or tissue injection (0.05 mL) of D. picta sap. The mice were treated by intraperitoneal or topical application of drugs, 15 min after edema induction. Vascular permeability was quantified based on abdominal skin plasma extravasation of Evans blue dye in response to intradermal administration of D. picta sap. The proteolytic assay was carried out as previously described (Kunitz M. Crystalline soybean trypsin inhibitor. General properties. J Gen Physiol 1947; 30:291-310.). RESULTS: Arachidonate cascade antagonists and eugenol showed anti-edematogenic effects. High doses of eugenol (50 µg/kg) and sodium cromoglycate (100 mg/kg), but not a combination of the two, inhibited plasma extravasations. The sap without crystals, its methanol extract, or the ethanol-washed crystals in saline-reconstituted solution did not reproduce the tongue edema seen with the original sap. Topical application of 10% sodium bicarbonate completely abolished the tongue edema. CONCLUSIONS: The inflammatory response induced by D. picta may be due to mechanical tissue damage resulting from the physical presence of calcium oxalate crystals. We were, however, unable to exclude the possibility of an insoluble toxicity present within the sap as an etiological agent. We realized that emergency treatment should also aim to inhibit antidromic vasodilation and axon reflex flare, reducing mastocyte degranulation and release of tachykinins from nerve endings. We speculate that eugenol showed better antiedematogenic results because it seems to function not only as a classic non-steroidal anti-inflammatory drug, but also as a local anesthetic, blocking neurotransmission in the damaged tissue.
Asunto(s)
Angioedema/inducido químicamente , Antiinflamatorios/farmacología , Eugenol/farmacología , Aceites de Plantas/toxicidad , Enfermedades de la Lengua/inducido químicamente , Lengua/efectos de los fármacos , Administración Tópica , Angioedema/patología , Animales , Araceae/química , Modelos Animales de Enfermedad , Interacciones Farmacológicas , Humanos , Inyecciones Intraperitoneales , Masculino , Ratones , Oxalatos/metabolismo , Lengua/patología , Enfermedades de la Lengua/patologíaRESUMEN
The use of fillers for cosmetic purposes is becoming increasingly frequent. Although initially considered inert, these products produce adverse reactions around the injection site. We present 5 cases of women with a history of filler injections who presented a hard and persistent angioedema followed by local subcutaneous nodules. They were referred to the allergist for suspected allergy related angioedema without response to usual antihistamine treatment. The angioedema episodes initiated 27.6 months (range 1 to 48) after the fillers treatment. The patients underwent exacerbations and remissions of angioedema, partially relieved with oral steroids and, in 2 cases, local triamcinolone injections. Mean time from onset of symptoms to remission of angioedema was 8.75 months (range 1 to 24). Until October 2009 four patients continued into remission after 24.5 months (range 7 to 36) free of symptoms. One patient continued with exacerbations 11 months after the initial symptoms. Fillers may cause angioedema as an adverse event and should be considered in the differential diagnosis of persistent angioedema. They are only sensitive to steroid treatment and in some steroid dependent cases they respond to ciclosporin. The frequency of angioedema after filler injections among patients with angioedema in the Unit of Asthma Allergy and Clinical Immunology was 0.5%.
Asunto(s)
Angioedema/patología , Técnicas Cosméticas/efectos adversos , Dermatosis Facial/patología , Tejido Subcutáneo/patología , Adulto , Anciano , Angioedema/tratamiento farmacológico , Angioedema/etiología , Técnicas Cosméticas/clasificación , Diagnóstico Diferencial , Dermatosis Facial/tratamiento farmacológico , Dermatosis Facial/etiología , Femenino , Humanos , Inyecciones Subcutáneas , Persona de Mediana Edad , Inducción de Remisión , Ritidoplastia , Esteroides/uso terapéutico , Factores de TiempoRESUMEN
En los últimos años se ha incrementado la utilización de sustancias de relleno facial con fines estéticos. Estos productos, originalmente considerados inertes, se asocian con diversos efectos adversos localizados alrededor del sitio de la aplicación. Describimos a 5 mujeres con antecedentes de inyecciones de sustancia de relleno facial que presentaron como síntoma inicial angioedema facial duro y persistente seguido por la aparición de nódulos subcutáneos. Todas las pacientes fueron derivadas al servicio de alergia por sospecha de angioedema de causa alérgica sin respuesta al tratamiento con antihistamínicos. El angioedema inició 27.6 meses (1 a 48) luego de la inyección del producto, y las pacientes evolucionaron con brotes y remisiones que fueron tratados con corticoides orales y en 2 oportunidades con inyecciones locales. El tiempo medio desde el inicio de los síntomas hasta la remisión del angioedema fue 8.75 meses (1 a 24). A octubre de 2009 cuatro pacientes se mantuvieron en remisión persistente, luego de un seguimiento clínico de 24.5 meses (7 a 36). Una paciente continúa con exacerbaciones luego de 11 meses de iniciados los síntomas. Las sustancias de relleno facial pueden producir angioedema como evento adverso y deben ser consideradas en el diagnóstico diferencial del angioedema persistente. Sólo responden al tratamiento con esteroides y en algunos casos esteroides dependientes, con ciclosporina. La frecuencia de angioedema por rellenos faciales entre pacientes con angioedema asistidos en la Unidad de Asma, Alergia e Inmunología Clínica fue del 0.5%.
The use of fillers for cosmetic purposes is becoming increasingly frequent. Although initially considered inert, these products produce adverse reactions around the injection site. We present 5 cases of women with a history of filler injections who presented a hard and persistent angioedema followed by local subcutaneous nodules . They were referred to the allergist for suspected allergy related angioedema without response to usual antihistamine treat¬ment. The angioedema episodes initiated 27.6 months (range 1 to 48) after the fillers treatment. The patients underwent exacerbations and remissions of angioedema, partially releived with oral steroids and, in 2 cases, local triamcinolone injections. Mean time from onset of symptoms to remission of angioedema was 8.75 months (range 1to 24). Until October 2009 four patients continued into remission after 24.5 months (range 7 to 36) free of symptoms. One patient continued with exacerbations 11months after the initial symptoms. Fillers may cause angioedema as an adverse event and should be considered in the differential diagnosis of persistent angioedema. They are only sensitive to steroid treatment and in some steroid dependent cases they respond to ciclosporin. The frequency of angioedema after filler injections among patients with angioedema in the Unit of Asthma Allergy and Clinical Immunology was 0.5%.
Asunto(s)
Adulto , Anciano , Femenino , Humanos , Persona de Mediana Edad , Angioedema/patología , Técnicas Cosméticas/efectos adversos , Dermatosis Facial/patología , Tejido Subcutáneo/patología , Angioedema/tratamiento farmacológico , Angioedema/etiología , Técnicas Cosméticas/clasificación , Diagnóstico Diferencial , Dermatosis Facial/tratamiento farmacológico , Dermatosis Facial/etiología , Inyecciones Subcutáneas , Inducción de Remisión , Ritidoplastia , Esteroides/uso terapéutico , Factores de TiempoRESUMEN
Characteristic features of acute annular urticaria in 34 infants and small children were large, erythematous annular and polycyclic lesions with violaceous centers, eyelid, hand, and foot edema, absence of angioedema of the airway, absence of pruritus, spontaneous resolution in 8 to 10 days, and frequent history of furazolidone medication for diarrhea. Nondermatologists often misdiagnose acute annular urticaria as erythema multiforme and unnecessarily overtreat patients. The differential diagnosis with other conditions presenting with annular lesions in children is discussed.