Akut Ürtiker

Cengiz KIRMAZa
aManisa Celal Bayar Üniversitesi Tıp Fakültesi, İmmünoloji ve Alerji Hastalıkları BD, Manisa, TÜRKİYE

Kırmaz C. Akut ürtiker. Çildağ S, editör. İmmünolojik ve Alerjik Deri Hastalıkları. 1. Baskı. Ankara: Türkiye Klinikleri; 2020. p.7-13.

ÖZET
Ürtiker, eritematöz ve çoğunlukla şiddetli kaşıntılı, hafif kabarık papül veya plakların varlığı ile seyreden vasküler bir cilt reaksiyonudur. Lezyonlar genel olarak birkaç saat içinde iz bırakmadan iyileşir. 6 haftadan kısa süren ürtiker ataklarına ‘akut ürtiker’ denilmektedir. Genel olarak sistemik reaksiyon olmadan izole bir olaydır. Nadiren de anafilaktik bir reaksiyonun başlangıcının habercisi olabilir. Genellikle ayrıntılı hasta öyküsü ve fizik muayene ile tanı alır. Bazen tanıyı ve nedenselliği kanıtlamak için laboratuvar testleri kullanılır. Klinik olarak farklı olmasına rağmen, ürtiker, atopik dermatit (egzama), makülopapüler ilaç döküntüleri, kontak dermatit, böcek ısırıkları, eritema multiforme, pityriasis rosea ile karıştırılabilir. Antihistaminikler, ürtiker tedavisinde kullanılan birincil ajanlardır. İkinci jenereasyon anti-histaminikler temel olarak yeterli olur; nadiren günlük dozun dört katını kadar çıkmak gerekebilir. Bazı hastalarda H2-antagonitlerinin H1-antagonislerine eklenmesi tedavi etkinliğini arttırmaktadır. Anti-histaminiklere dirençli vakalarda 5-7 gün gibi kısa süreli peroral ya da tek doz uzun etkili parenteral kortikosteroidler kullanılabilir. Bunun dışında nadir bir grupta trisiklik anti-depresanlar işe yaramaktadır.

Anahtar Kelimeler: Akut ürtiker; tanı; ayırıcı tanı; tedavi

Referanslar

  1. Bernstein jA, lang DM, Khan DA, et al. The diagnosis and management of acute and chronic urticaria: 2014 update. j Allergy Clin Immunol. 2014;133:1270-77. [Crossref]  [PubMed]
  2. Hide M, Francis DM, Grattan CE, Hakimi j, Kochan jp, Greaves MW. Autoantibodies against the high-affinity IgE receptor as a cause of histamine release in chronic urticaria. n Engl j Med. 1993;328:1599-604. [Crossref]  [PubMed]
  3. Zuberbier T, Maurer M. urticaria: current opinions about etiology, diagnosis and therapy. Acta Derm venereol. 2007;87:196-205. [Crossref]  [PubMed]
  4. Kaplan Ap, joseph K, Maykut Rj, Geba Gp, Zeldin RK. Treatment of chronic autoimmune urticaria with omalizumab. j Allergy Clin Immunol. 2008;122:569-73. [Crossref]  [PubMed]
  5. Viola M, Quaratino D, Gaeta F, Rumi G, Caruso C, Romano A. Cross-reactive reactions to nonsteroidal anti-inflammatory drugs. Curr pharm Des. 2008;14:2826-32. [Crossref]  [PubMed]
  6. Kozel MM, Bossuyt pM, Mekkes jR, Bos jD. laboratory tests and identified diagnoses in patients with physical and chronic urticaria and angioedema: a systematic review. j Am Acad Dermatol. 2003;48:409-16. [Crossref]  [PubMed]
  7. Magerl M, Borzova E, Giménez-Arnau A, Grattan CE, lawlor F, Mathelier-Fusade p, et al. The definition and diagnostic testing of physical and cholinergic urticarias-EAACI/ GA2 lEn/EDF/unEv consensus panel recommendations. Allergy. 2009;64:1715- 21. [Crossref]  [PubMed]
  8. Tong lj, Balakrishnan G, Kochan jp, Kinét jp, Kaplan Ap. Assessment of autoimmunity in patients with chronic urticaria. j Allergy Clin Immunol. 1997;99:461-5. [Crossref]  [PubMed]
  9. Cardinale F, Mangini F, Berardi M, Sterpeta loffredo M, Chinellato I, Dellino A, et al. [Intolerance to food additives: an update]. Minerva pediatr. 2008;60:1401-9.
  10. Silverman S, localio R, Apter Aj. Association between chronic urticaria and self-reported penicillin allergy. Ann Allergy Asthma Immunol. 2016;116(4):317-20. [Crossref]  [PubMed]
  11. Schuller DE. Acute urticaria in children: causes and an aggressive diagnostic approach. postgrad Med. 1982;72:179-85. [Crossref]  [PubMed]
  12. Wedi B, Raap u, Kapp A. Chronic urticaria and infections. Curr opin Allergy Clin Immunol. 2004;4:387-96. [Crossref]  [PubMed]
  13. Kaplan Ap. What the first 10,000 patients with chronic urticaria have taught me: a personal journey. j Allergy Clin Immunol. 2009;123 (3):713-7. [Crossref]  [PubMed]
  14. valsecchi R, pigatto p. Chronic urticaria and Helicobacter pylori. Acta Derm venereol. 1998;78(6):440-2. [Crossref]  [PubMed]
  15. leznoff A, josse RG, Denburg j, Dolovich j. Association of chronic urticaria and angioedema with thyroid autoimmunity. Arch Dermatol. 1983;119(8):636-40. [Crossref]  [PubMed]
  16. Leznoff A, Sussman Gl Syndrome of idiopathic chronic urticaria and angioedema with thyroid autoimmunity: a study of 90 patients. j Allergy Clin Immunol. 1989;84:66- 71. [Crossref]  [PubMed]
  17. Kaplan Ap. urticaria angioedema. Adkinson nFY jr, Busse WW, Bochner BS, Holgate ST, Simons FER, eds. Allergy: principles and practice. philadelphia, pa: Mosby; 2003, p. 1537-58.
  18. Sackesen C, Sekerel BE, orhan F, Kocabas Cn, Tuncer A, Adalioglu G. The etiology of different forms of urticaria in childhood. pediatr Dermatol. 2004;21:102-8. [Crossref]  [PubMed]
  19. Zuberbier T, Iffländer j, Semmler C, Henz BM. Acute urticaria: clinical aspects and therapeutic responsiveness. Acta Derm venereol. 1996;76(4):295-7. [Crossref]  [PubMed]
  20. Monroe EW. urticarial vasculitis: an updated review. j Am Acad Dermatol. 1981;5:88-95. [Crossref]  [PubMed]
  21. Kaplan Ap. urticaria and angioedema. Middleton E, Reed CE, Ellis EF, et al, eds. Allergy: principles and practices. St. louis, Mo: Mosby-Year Book; 1998, p. 1104-18.
  22. Charlesworth En. urticaria and angioedema: a clinical spectrum. Ann Allergy Asthma Immunol. 1996;76:484-95. [Crossref]  [PubMed]
  23. Hirschmann jv, lawlor F, English jS, louback jB, Winkelmann RK, Greaves MW. Cholinergic urticaria. A clinical and histologic study. Arch Dermatol. 1987;123:462-7. [Crossref]
  24. Wong RC, Fairley jA, Ellis Cn. Dermographism: a review. j Am Acad Dermatol. 1984;11:643-52. [Crossref]  [PubMed]
  25. Dibbern DA jr. urticaria: selected highlights and recent advances. Med Clin north Am. 2006;90:187-209. [Crossref]  [PubMed]
  26. American Academy of Allergy, Asthma & Immunology. Consultation and referral guidelines citing the evidence: how the allergist-immunologist can help. j Allergy Clin Immunol. 2006;117(2):S495-523. [Crossref]  [PubMed]
  27. Haas n, Toppe E, Henz BM. Microscopic morphology of different types of urticaria. Arch Dermatol. 1998;134:41-6. [Crossref]  [PubMed]
  28. Slater jW, Zechnich AD, Haxby DG. Secondgeneration antihistamines: a comparative review. Drugs. 1999;57:31-47. [Crossref]  [PubMed]
  29. Zuberbier T, Asero R, Bindslev-jensen C, Walter Canonica G, Church MK, Giménez-Arnau AM, et al. EAACI/GA(2)lEn/EDF/WAo guideline: management of urticaria. Allergy. 2009; 64:1427-43. [Crossref]
  30. Zuberbier T, et al. European Academy of Allergy and Clinical Immunology, Global Allergy and Asthma European network, European Dermatology Forum, World Allergy organization. The EAACI/GA(2) lEn/EDF/WAo Guideline for the definition, classification, diagnosis, and management of urticaria: the 2013 revision and update. Allergy. 2014;69:868-87. [Crossref]  [PubMed]
  31. Zuberbier T. A Summary of the new International EAACI/GA2lEn/EDF/WAo Guidelines in urticaria. World Allergy organ j. 2012;5 (1):S1-5. [Crossref]
  32. Breneman Dl. Cetirizine versus hydroxyzine and placebo in chronic idiopathic urticaria. Ann pharmacother. 1996;30:1075-9. [Crossref]  [PubMed]
  33. lin RY, Curry A, pesola GR, Knight Rj, lee HS, Bakalchuk l, et al. Improved outcomes in patients with acute allergic syndromes who are treated with combined H1 and H2 antagonists. Ann Emerg Med. 2000;36:462-8. [Crossref]  [PubMed]
  34. Kaplan Ap. Chronic urticaria and angioedema. n Engl j Med. 2002;346:175-9. [Crossref]  [PubMed]
  35. Pollack Cv jr, Romano Tj. outpatient management of acute urticaria: the role of prednisone. Ann Emerg Med. 1995;26:547-51. [Crossref]  [PubMed]
  36. Frigas E, park MA. Acute urticaria and angioedema: diagnostic and treatment considerations. Am j Clin Dermatol. 2009;10:239- 50. [Crossref]  [PubMed]
  37. Grattan CE, o'Donnell BF, Francis DM, niimi n, Barlow Rj, Seed pT, et al. Randomized double-blind study of cyclosporin in chronic 'idiopathic' urticaria. Br j Dermatol. 2000;143: 365-72. [Crossref]  [PubMed]
  38. vena GA, Cassano n, Colombo D, peruzzi E, pigatto p. Cyclosporine in chronic idiopathic urticaria: a double-blind, randomized, placebocontrolled trial. j Am Acad Dermatol. 2006; 55:705-9. [Crossref]  [PubMed]
  39. o'Donnell BF, Barr RM, Black AK, Francis DM, Kermani F, niimi n, et al. Intravenous immunoglobulin in autoimmune chronic urticaria. Br j Dermatol. 1998;138:101-6. [Crossref]  [PubMed]
  40. Grattan CE, Francis DM, Slater nG, Barlow Rj, Greaves MW. plasmapheresis for severe, unremitting, chronic urticaria. lancet. 1992;339: 1078-80. [Crossref]  [PubMed]
  41. Werni R, Schwarz T, Gschnait F. Colchicine treatment of urticarial vasculitis. Dermatologica. 1986;172:36-40. [Crossref]  [PubMed]
  42. Ruzicka T, Goerz G. Systemic lupus erythematosus and vasculitic urticaria. Effect of dapsone and complement levels. Dermatologica. 1981;162:203-5. [Crossref]  [PubMed]
  43. nettis E, Dambra p, D'oronzio l, loria Mp, Ferrannini A, Tursi A. Comparison of montelukast and fexofenadine for chronic idiopathic urticaria. Arch Dermatol. 2001;137:99-100.
  44. Asero R, Tedeschi A, lorini M. leukotriene receptor antagonists in chronic urticaria. Allergy. 2001;56:456-7. [Crossref]  [PubMed]
  45. Maurer M1, Rosén K, Hsieh Hj, Saini S, Grattan C, Gimenéz-Arnau A, Agarwal S, Doyle R, Canvin j, Kaplan A, Casale T. omalizumab for the treatment of chronic idiopathic or spontaneous urticaria. n Engl j Med. 2013;368:924- 35. [Crossref]  [PubMed]
  46. Wong jT, nagy CS, Krinzman Sj, Maclean jA, Bloch Kj. Rapid oral challenge-desensitization for patients with aspirin-related urticaria-angioedema. j Allergy Clin Immunol. 2000;105:997-1001. [Crossref]  [PubMed]
  47. Grattan CE. Aspirin sensitivity and urticaria. Clin Exp Dermatol. 2003;28:123-7. [Crossref]  [PubMed]
  48. Díaz jara M, pérez Montero A, Gracia Bara MT, Cabrerizo S, Zapatero l, Martínez Molero MI. Allergic reactions due to ibuprofen in children. pediatr Dermatol. 2001;18:66-7. [Crossref]  [PubMed]
  49. Beltrani vS. urticaria and angioedema. Dermatol Clin. 1996;14:171-98. [Crossref]  [PubMed]
  50. Soter nA. Acute and chronic urticaria and angioedema. j Am Acad Dermatol. 1991;25:146- 54. [Crossref]  [PubMed]
  51. Varadarajulu S. urticaria and angioedema. Controlling acute episodes, coping with chronic cases. postgrad Med. 2005;117:25-31. [Crossref]  [PubMed]
  52. O'Donnell BF, lawlor F, Simpson j, Morgan M, Greaves MW. The impact of chronic urticaria on the quality of life. Br j Dermatol. 1997;136:197-201. [Crossref]  [PubMed]