1. Chronic urticaria (CU). ** Chronic urticaria (CU) is a disturbing allergic condition of the skin. Although frequently benign, it may sometimes be a red flag sign of a serious internal disease, which should be investigated for rule in or rule out....... ETIOLOGIES : PHYSICAL, INFECTIVE, VASCULITIC, PSYCHOLOGICAL and IDIOPATHIC. An AUTOIMMUNE basis of most of the ‘idiopathic’ forms is now hypothesized. ** Histamine released from mast cells is the major effector in PATHOGENESIS and it is clinically characterized by wheals that have a tendency to recur. 2; AUTOIMMUNE URTICARIA... ANGIONEUROTIC OÊDEMA... AUTOIMMUNE DISEASES..... PSYCHOLOGICAL DISTRESS. DEPRESSION AND OTHER CAUSES AS DISCUSSED BELOW..... 3.LABORATORY INVESTIGATIONS aimed at a specific etiology are not always conclusive, though may be suggestive of an underlying condition. A clinical SEARCH FOR associated SYSTEMIC DISEASE is strongly advocated under APPROPRIATE circumstances. 4. The MAINSTAY OF TREATMENT remains H1 ANTIHISTAMINICS. These may be COMBINED WITH complementary pharmacopeia in the form of H2 BLOCKERS, DOXEPIN, NIFEDIPINE and LEUKOTRIENE INHIBITORS. MORE RADICAL THERAPY :- In the form of IMMUNOGLOBULINS, PLASMAPHERESIS and CYCLOPHOSPHAMIDE may be required for recalcitrant cases....... .** A stepwise management results in favorable outcomes....... ** A single PATIENT MAY HAVE more than one type. Below is a list of some types of physical urticaria and their causes. Dermatographism/dermographism - Firm stroking Delayed pressure urticaria - Pressure Cold urticaria - Cold Aquagenic urticaria - Water exposure Cholinergic urticaria - Heat, exercise, or stress Solar urticaria - Sun exposure Vibratory urticaria - Vibration Autoimmune urticaria...... It is now well-established that about 30-50% patients with CU have circulating functional auto antibodies against the high-affinity IgE receptor (FCeRIa) or against IgE. Also, URTICARIA has been ASSOCIATED WITH A NUMBER OF AUTOIMMUNE DISEASES. A few of them are : SYSTEMIC LUPUS ERYTHEMATOSUS, CRYOGLOBULINEMIA, NEOPLASMS, JUVENILE RHEUMATOID ARTHRITIS (JRA) AUTOIMMUNE THYROID DISEASE, including GRAVES DISEASE. Urticaria is a feature of Muckle-Wells syndrome (AMYLOIYDOSIS, NERVE DEAFNESS and URTICARIA and SCHNITZLER SYNDROME (fever, joint/bone pain, monoclonal gammopathy and urticaria). INFECTIVE CAUSES : Infectious agents reported to cause urticaria include HEPATITIS B VIRUS, STREPTOCOCCUS and MYCOPLASMA SPECIES, HELICOBACTER PYLORI, MYCOBACTERIUM TUBERCULOSIS, and HERPES SIMPLEX VIRUS. Fungal infections such as ONYCHOMYCOSIS, TINEA PEDIS and CANDIDA have been considered as possible associations. CU has been associated with PARASITIC infestations such as STRONGYLOIDIASIS, GIARDIASIS and AMOEBIASIS....... MEDICATIONS: Urticaria may be caused or exacerbated by a number of drugs. More common culprits include ASPIRIN, OTHER nonsteroidal anti-inflammatory drugs (NSAID), OPIOIDS, ACE INHIBITORS, and ALCOHOL. Aspirin may exacerbate CU in 6.7-67% of patients. Other drugs implicated are ALCOHOL, NARCOTICS (CODEINE, MORPHINE) and oral CONTRACEPTIVES. CONTACTANTS: Contact urticaria syndrome refers to the onset of urticaria within 30-60 minutes of contact with an inciting agent. The lesions may be localized or generalized. Precipitating factors include LATEX (especially in health care workers), PLANTS, ANIMALS (eg, CATERPILLARS, DANDER), MEDICATIONS, and FOOD (eg, FISH, GARLIC, ONIONS, TOMATO). NEUROLOGICAL FACTORS: An Italian study, reported an association between CU and FIBROMYALGIA. The authors proposed that CU is a consequence of fibromyalgia-neurogenic skin inflammation. STRESS: PSYCHOLOGICAL FACTORS are reported to play a role in a number of patients. Zenon Brzoza et al in their study showed that the decline in dehydroepiandrosterone sulfate observed in CU is associated with PSYCHOLOGICAL DISTRESS. DEPRESSION may also cause or aggravate CU........
Angioedema ? Hereditary? Acquired Dd- food allergy, insect bite, atopy, drug induced Inv- CBC, rle, complement c4,c1q n c1 esterase inh levels Treatment- avoid triggers Antihistamines, leucotriene antagonist, steroids, epinephrine inj For c1 esterase inh def- c1 esterase conc, eccalantine, icatibant
आयुर्वेद में इसे जीर्ण शीत पित्त कहते हैं। चिकित्सा संबंधी योग,,,, गाय के घी में काली मिर्च मिलाकर पिलाएं शीत पित्त भंजन रस सुबह शाम सेवन कराएं कामदुधा रस मोती युक्त 4 रत्ती शहद में मिलाकर सुबह-शाम सेवन कराएं चंन्दनासव खदिरारिष्ट दोनों को मिलाकर 25 ग्राम सुबह-शाम खाने के बाद दें
Agree with @Dr. Puranjoy Saha sir. D/D Angioneurotic edema.
Ans. 1. diagnosis chr Urticaria
Angioneurotic edema or Giant Urticaria. Because steroid gets relief.
Diagnosis Angionerotic Edema. Allergic reaction. Investigation CBC. E.S.R.Allergen Test. Tt Methylprednisolone 4mg tds.5days Taper dose.
Cases that would interest you
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10 yrs / F itching ++ Pls Dx suggest line of T/tDr. Ram Golde5 Likes42 Answers
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Friends today I am discussing about hives or urticaria. ALLERGIES URTICARIA & ANGIOEDEMA Symptoms of Urticaria (Hives) While the symptoms of urticaria (hives) may seem relatively self-apparent, they are frequently mistaken for those of other skin conditions such as eczema, rosacea, and pityriasis rosea. But, in the same way that the biological mechanism of urticaria is specific, so, too, are the signs and characteristics of the common skin rash—if you consider them carefully. While hives (also referred to as wheals or weals) can differ in their distribution and appearance, they are characterized by itchy, raised welts on the skin's surface that are either red or skin-colored. urticaria symptoms Urticaria is caused by an inflammatory reaction that prompts capillaries in the dermis (the layer of tissue just beneath the outer skin) to leak fluid. When this happens, the accumulation of fluid results in a defined area of raised skin that persists until the fluid is eventually reabsorbed into the surrounding cells. Hives have specific characteristics that set them apart from other skin conditions: The elevated area of skin has a clearly defined border. When you press the rash, it will "blanches" (turns white). They will be itchy, sometimes intensely so. There may also be paired with pain or a burning sensation. They can appear on anywhere on the body and change shape, move around, disappear, and reappear over short periods of time. When they resolve, the skin will return to normal without scarring. Most will not be accompanied by systemic reactions such as fever, nausea, muscle aches, joint pain, or headaches. Urticaria is classified as being either acute or chronic depending on the duration of the eruption. Acute hives last for less than six weeks, while chronic hives extend well beyond six weeks. Acute urticaria is more common in children and young adults. The majority are classified as idiopathic, meaning that we don't know the cause. Most cases are self-limited; individual lesions tend to resolve on their own within a few hours. An eruption rarely lasts more than several days, although it may recur over weeks. If a cause is found, it is usually related to an infection, insect bite, or a food or drug allergy. Urticaria is known to affect up to 20 percent of the population and strikes people irrespective of age, race, or gender. Hives most often appear in the evening or early morning just after waking. Itching is typically worse at night, often interfering with sleep. The distribution and appearance of hives can vary significantly. Some may be widespread, while others may be diffuse or limited to a single, small weal. The appearance of a hive can sometimes give a clue as to the underlying cause. Cold urticaria, caused by exposure to cold temperatures, usually manifests with welts that are between a quarter of an inch and an inch in size that are either slightly reddish or skin-colored. Fainting can occur if large areas of skin are involved. Cholinergic urticaria, also known as heat rash, is caused by excessive sweating and will appear as very small weals surrounded by bright red flares. Strenuous exercise is a common cause. Dermographism urticaria is caused by the firm stroking of the skin and manifests with hives along the line of contact. The weals tend to appear five to 10 minutes after contact and generally disappear 10 to 15 minutes after they occur. Pressure urticaria is caused by any pressure placed on the skin, including tight clothing or standing on your feet too long. It manifests with a denser, localized eruption that is red, itchy, and maybe even a little painful. Solar urticaria, caused by exposure to ultraviolet (UV) light, appears in areas of exposed skin, often within minutes of exposure. The rash is very itchy and appears "angry" with an often intense redness and warmth. As with cold urticaria, fainting can occur if the hives are widespread. Vibratory urticaria can be caused by any form of vibration, including clapping or a bumpy car ride. It tends to be short-lasting, appearing and disappearing within an hour. While difficult to distinguish by looks alone, vibratory hives are sometimes accompanied by unusual symptoms such as flushing, headaches, blurry vision, or a metallic taste in the mouth. Water urticaria (aquagenic urticaria) is a rare form of hives caused by contact with water. The hives tend to be small and most often develop on your neck, upper trunk, and arms. As with vibratory urticaria, it tends to come and go within an hour. Rare Symptoms Less commonly, urticaria may precede a severe, all-body allergic reaction known as anaphylaxis. Anaphylaxis is often caused by a hyperallergic response that triggers the development of hives, angioedema (a related skin condition affecting deeper layers of tissue), and severe respiratory symptoms. Common allergy triggers are food, medications, vaccines, and insect stings, although some cases have no known causes. Symptoms of anaphylaxis include: Widespread hives and angioedema with hot skin Coughing, sneezing, and wheezing Throat tightness and shortness of breath Swelling of the lips and/or tongue Rapid or irregular heartbeat Dizziness or lightheadedness Stomach cramps Nausea, vomiting, and diarrhea Chest pains Breathing restriction advancing to airway obstruction Confusion A feeling of impending doom Fainting and collapse Seizures If left untreated, anaphylaxis can lead to shock, asphyxiation, coma, cardiac or respiratory failure, and death. Homeopathy treats diseases as a whole, and similarly, when treating urticaria tries to identify associated symptoms and thereby treat the cause also. After a detailed discussion about predisposition and associated symptoms, a customized remedy will be prescribed, which may include one of the following common homeopathic remedies. Apis Mell: The hives consist of isolated patches that are painful, tender, itch at night, feel like bee stings, become purple. There is burning pain, slight fever, and warmth of the surrounding skin. It is worsened by changing weather and exercise, causing severe itching and burning. The patient may already have asthma. Arsenic Album: The urticaria is caused by eating shellfish and causes burning and restlessness. The condition gets worse being at the seaside and by getting into sea water. Arsenic is also useful to treat urticarial symptoms during the recession of the lesions. The person also could be down emotionally with depression, despair, indifference and irritability. If the lesions are more severe, the restlessness is also severe. It is worse after midnight, from 1 to 2 a.m. Rhus toxicodendron: Prepared from the leaves and bark of the plant poison ivy, Rhus works on multiple body systems including skin, joints, eyes, extremities, and overall vitality. In addition to urticaria, it is also used in cellulitis, arthritis, fevers, etc. It is effective if the urticaria has a burning sensation, inflamed reddened rash that is worsened by cold and improved by warmth. Urtica urens: Made from a plant called stinging nettle, which itself has a tendency to produce urticaria, it is used when there is urticaria from bee stings or after eating shellfish. The lesions are red with severe burning and itching, recurring every year, could be associated with weather changes. Natrum Muriaticum: The common salt sodium chloride is potentized, and its inner healing power activated. It is used for chronic urticaria, where the lesions develop after severe irritation. Dulcamara: The lesions develop followed a general prickly sensation setting in and at night when it is cold and damp. The hives are irregular white patches surrounded by a red area that itch badly. The hives are associated with violent cough, swelling of the lymph nodes, fever, restlessness, sleeplessness, decreased appetite, nausea, vomiting, bitter taste, and intense aching in pit of stomach.Dr. Rajesh Gupta4 Likes5 Answers
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Autoimmune Diseases: Types, Symptoms, Causes and More........Check it Out...! ---------------------------------------------------------------------- ---------------------------------------------------------------------- What is an autoimmune disease? An autoimmune disease is a condition in which your immune system mistakenly attacks your body. The immune system normally guards against germs like bacteria and viruses. When it senses these foreign invaders, it sends out an army of fighter cells to attack them. Normally, the immune system can tell the difference between foreign cells and your own cells. In an autoimmune disease, the immune system mistakes part of your body — like your joints or skin — as foreign. It releases proteins called autoantibodies that attack healthy cells. Some autoimmune diseases target only one organ. Type 1 diabetes damages the pancreas. Other diseases, like lupus, affect the whole body. CAUSES Why does the immune system attack the body? Doctors don’t know what causes the immune system misfire. Yet some people are more likely to get an autoimmune disease than others. Women get autoimmune diseases at a rate of about 2 to 1 compared to men — 6.4 percent of women vs. 2.7 percent of men . Often the disease starts during a woman’s childbearing years (ages 14 to 44). Some autoimmune diseases are more common in certain ethnic groups. For example, lupus affects more African-American and Hispanic people than Caucasians. Certain autoimmune diseases, like multiple sclerosis and lupus, run in families. Not every family member will necessarily have the same disease, but they inherit a susceptibility to an autoimmune condition. Because the incidence of autoimmune diseases is rising, researchers suspect environmental factors like infections and exposures to chemicals or solvents might also be involved . A “Western” diet is another suspected trigger. Eating high-fat, high-sugar, and highly processed foods is linked to inflammation, which might set off an immune response. However, this hasn’t been proven . Another theory is called the hygiene hypothesis. Because of vaccines and antiseptics, children today aren’t exposed to as many germs as they were in the past. The lack of exposure could make their immune system overreact to harmless substances . BOTTOM LINE: Researchers don’t know exactly what causes autoimmune diseases. Diet, infections, and exposure to chemicals might be involved. COMMON AUTOIMMUNE DISEASES 14 common autoimmune diseases There are more than 80 different autoimmune diseases . Here are 14 of the most common ones. 1. Type 1 diabetes The pancreas produces the hormone insulin, which helps regulate blood sugar levels. In type 1 diabetes, the immune system attacks and destroys insulin-producing cells in the pancreas. High blood sugar can damage blood vessels, as well as organs like the heart, kidneys, eyes, and nerves. 2. Rheumatoid arthritis (RA) In rheumatoid arthritis (RA), the immune system attacks the joints. This attack causes redness, warmth, soreness, and stiffness in the joints. Unlike osteoarthritis, which affects people as they get older, RA can start as early as your 30s . 3. Psoriasis/psoriatic arthritis Skin cells normally grow and then shed when they’re no longer needed. Psoriasis causes skin cells to multiply too quickly. The extra cells build up and form red, scaly patches called scales or plaques on the skin. About 30 percent of people with psoriasis also develop swelling, stiffness, and pain in their joints . This form of the disease is called psoriatic arthritis. 4. Multiple sclerosis Multiple sclerosis (MS) damages the myelin sheath — the protective coating that surrounds nerve cells. Damage to the myelin sheath affects the transmission of messages between your brain and body. This damage can lead to symptoms like numbness, weakness, balance issues, and trouble walking. The disease comes in several forms, which progress at different rates. About 50 percent of people with MS need help walking within 15 years after getting the disease. 5. Systemic lupus erythematosus (lupus) Although doctors in the 1800s first described lupus as a skin disease because of the rash it produces, it actually affects many organs, including the joints, kidneys, brain, and heart . Joint pain, fatigue, and rashes are among the most common symptoms. 6. Inflammatory bowel disease Inflammatory bowel disease (IBD) is a term used to describe conditions that cause inflammation in the lining of the intestines. Each type of IBD affects a different part of the GI tract. Crohn’s disease can inflame any part of the GI tract, from the mouth to the anus. Ulcerative colitis affects only the lining of the large intestine (colon) and rectum. 7. Addison’s disease Addison’s disease affects the adrenal glands, which produce the hormones cortisol and aldosterone. Having too little of these hormones can affect the way the body uses and stores carbohydrates and sugar. Symptoms include weakness, fatigue, weight loss, and low blood sugar. 8. Graves’ disease Graves’ disease attacks the thyroid gland in the neck, causing it to produce too much of its hormones. Thyroid hormones control the body’s energy usage, or metabolism. Having too much of these hormones revs up your body’s activities, causing symptoms like nervousness, a fast heartbeat, heat intolerance, and weight loss. One common symptom of this disease is bulging eyes, called exophthalmos. It affects up to 50 percent of people with Graves’ disease . 9. Sjögren’s syndrome This condition attacks the joints, as well as glands that provide lubrication to the eyes and mouth. The hallmark symptoms of Sjögren’s syndrome are joint pain, dry eyes, and dry mouth. 10. Hashimoto’s thyroiditis In Hashimoto’s thyroiditis, thyroid hormone production slows. Symptoms include weight gain, sensitivity to cold, fatigue, hair loss, and swelling of the thyroid (goiter). 11. Myasthenia gravis Myasthenia gravis affects nerves that help the brain control the muscles. When these nerves are impaired, signals can’t direct the muscles to move. The most common symptom is muscle weakness that gets worse with activity and improves with rest. Often muscles that control swallowing and facial movements are involved. 12. Vasculitis Vasculitis happens when the immune system attacks blood vessels. The inflammation that results narrows the arteries and veins, allowing less blood to flow through them. 13. Pernicious anemia This condition affects a protein called intrinsic factor that helps the intestines absorb vitamin B-12 from food. Without this vitamin, the body can’t make enough red blood cells. Pernicious anemia is more common in older adults. It affects 0.1 percent of people in general, but nearly 2 percent of people over age 60 . 14. Celiac disease People with celiac disease can’t eat foods containing gluten — a protein found in wheat, rye, and other grain products. When gluten is in the intestine, the immune system attacks it and causes inflammation. Celiac disease affects about 1 percent of people in the United States . A larger number of people have gluten sensitivity, which isn’t an autoimmune disease, but can have similar symptoms like diarrhea and abdominal pain. SYMPTOMS Autoimmune disease symptoms The early symptoms of many autoimmune diseases are very similar, such as: fatigue achy muscles swelling and redness low-grade fever trouble concentrating numbness and tingling in the hands and feet hair loss skin rashes Individual diseases can also have their own unique symptoms. For example, type 1 diabetes causes extreme thirst, weight loss, and fatigue. IBD causes belly pain, bloating, and diarrhea. With autoimmune diseases like psoriasis or RA, symptoms come and go. Periods of symptoms are called flare-ups. Periods when the symptoms go away are called remissions. BOTTOM LINE: Symptoms like fatigue, muscle aches, swelling, and redness could be signs of an autoimmune disease. Often symptoms come and go over time. SEE A DOCTOR When to see a doctor See a doctor if you have symptoms of an autoimmune disease. You might need to visit a specialist, depending on the type of disease you have. Rheumatologists treat joint diseases like rheumatoid arthritis and Sjögren’s syndrome. Gastroenterologists treat diseases of the GI tract, such as celiac and Crohn’s disease. Endocrinologists treat conditions of the glands, including Graves’ and Addison’s disease. Dermatologists treat skin conditions such as psoriasis. DIAGNOSIS Tests that diagnose autoimmune diseases No single test can diagnose most autoimmune diseases. Your doctor will use a combination of tests and an assessment of your symptoms to diagnose you. The antinuclear antibody test (ANA) is often the first test that doctors use when symptoms suggest an autoimmune disease. A positive test means you likely have one of these diseases, but it won’t confirm exactly which one you have. Other tests look for specific autoantibodies produced in certain autoimmune diseases. Your doctor might also do tests to check for the inflammation these diseases produce in the body. BOTTOM LINE: A positive ANA blood test can show that you have an autoimmune disease. Your doctor can use your symptoms and other tests to confirm the diagnosis. TREATMENT How are autoimmune diseases treated? Treatments can’t cure autoimmune diseases, but they can control the overactive immune response and bring down inflammation. Drugs used to treat these conditions include: nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Motrin, Advil) and naproxen (Naprosyn) immune-suppressing drugs Treatments are also available to relieve symptoms like pain, swelling, fatigue, and skin rashes. Eating a well-balanced diet and getting regular exercise can also help you feel better. BOTTOM LINE: The main treatment for autoimmune diseases is with medications that bring down inflammation and calm the overactive immune response. Treatments can also help relieve symptoms. BOTTOM LINE The bottom line More than 80 different autoimmune diseases exist. Often their symptoms overlap, making them hard to diagnose. Autoimmune diseases are more common in women, and they often run in families. Blood tests that look for autoantibodies can help doctors diagnose these conditions. Treatments include medicines to calm the overactive immune response and bring down inflammation in the body.Dr. Ved Srivastava5 Likes5 Answers
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Patient is suffering from excessive pains, pains are now in control, R. A factor is also normal, C Reactive protein is also normal,ESRIs not decreased, than what will be the exact diagnosis, plz suggest, L. F. T is also normalDr. Aastha Jain0 Like18 Answers
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Dear Friends, Fever of unknown origin is a very important clinical condition in our day to day practice.. I thought to have an UPDATE on this The subject needs longer discussions.. So will be presented in two parts Let's have the initial one… Fever of unknown origin (FUO) in adults is defined as a (1)Temperature higher than 38.3 C (100.9 F) (2)Lasts for more than three weeks (3)With no obvious source despite appropriate investigations. COMMON ETIOLOGIES OF FEVER OF UNKNOWN ORIGIN.. INFECTIONS Tuberculosis (especially extrapulmonary) Abdominal abscesses Pelvic abscesses Dental abscesses Endocarditis Osteomyelitis Sinusitis Cytomegalovirus Epstein-Barr virus Human immunodeficiency virus Lyme disease Prostatitis Sinusitis MALIGNANCIES Chronic leukemia Lymphoma Metastatic cancers Renal cell carcinoma Colon carcinoma Hepatoma Myelodysplastic syndromes Pancreatic carcinoma Sarcomas AUTOIMMUNE CONDITIONS Adult Still's disease Polymyalgia rheumatica Temporal arteritis Rheumatoid arthritis Rheumatoid fever Inflammatory bowel disease Reiter's syndrome Systemic lupus erythematosus Vasculitides MISCELLANEOUS Complications from cirrhosis Factitious fever Hepatitis (alcoholic, granulomatous, or lupoid) Deep venous thrombosis Sarcoidosis Drug-induced fever DRUGS COMMONLY ASSOCIATED WITH DRUG -INDUCED FEVER.. Allopurinol Captopril Cimetidine Clofibrate Erythromycin Heparin Hydralazine Hydrochlorothiazide Isoniazid Meperidine Methyldopa Nifedipine Nitrofurantoin Penicillin Phenytoin Procainamide Quinidine The approach to diagnose the patient and investigations needed ...will be covered in the second and concluding part if HELPFUL to you Thanks Dr K N PoddarDr. K N Poddar24 Likes20 Answers