Case Of Acute Urticaria Research Articles

Frequency of Scabies in Pediatric Allergy Clinic and Evaluation of Demographic Characteristics of Affected Patients

Objective: There has been an increase in the number of cases as pediatricians mistakenly refer scabies to an allergy clinic, misdiagnosing it as allergic illnesses, particularly atopic dermatitis (AD), because of the presence of symptoms such as itching and eczematous lesions. The objective of our study was to examine the prevalence of scabies in children who were referred to the pediatric allergy clinic after being misdiagnosed with AD. We also aimed to determine the clinical and demographic distinctions between individuals with AD and scabies. Methods: The files of 610 patients those referred to Sakarya Training and Research Hospital Pediatric Allergy Clinics between February-December 2022 with complaints of 'itching and rash' were documented retrospectively. Cases of acute urticaria, chronic urticaria, mastocytosis, insect bite, maculopapular rash with viral infection, drug-induced reactions were excluded. Patients whose final diagnosis was AD and who were diagnosed with 'definite scabies' were included in the study. Results: A total of 404 patients were included in the study. The rate of definite diagnosis of scabies was 18.5% (n:75/404). The median age at presentation was 19 months (IQR 8-51) in patients diagnosed with AD and 53 months (IQR 17-117) in patients diagnosed with scabies (p<0.005). The median time from symptom onset to diagnosis was seven months (IQR 2.5-24) in the AD group and two months (IQR 1-4) in the scabies group (p<0.005). Only 20% (n:15/75) of patients with scabies had family history, 16% of patients (n:12/75) had received one or more treatments before. Pruritis was present in only 72% (54/75) of children. Hospitalization rate was 0.05% (n:4/75). Conclusion: We recommend that scabies should be considered as a potential diagnosis for patients who visit to any clinic with symptoms of itching and a skin rash. Timely identification and medical intervention for scabies in children is crucial in order to minimize the spread of the disease throughout the community and prevent potential complications.

Approach to Children with Hives.

Urticaria (or hives) is a pruritic and erythematous skin rash. Angioedema commonly occurs with urticaria. The term "chronic urticaria" is used when hives are present for more than 6 weeks. Acute urticaria is common in children, whereas chronic urticaria is rare. Causes of urticaria can be identified in many cases of acute urticaria with a thorough medical history. Laboratory evaluation may be needed to confirm the etiology of acute urticaria. Chronic urticaria is often idiopathic. Clinicians should avoid universal allergy testing for food allergens or aeroallergens in chronic urticaria as it usually does not help in identifying the cause, can lead to false-positive results, and unnecessary avoidance of allergens or foods. Urticarial vasculitis should be considered for lesions that are painful, present for more than 48 hours, leave scars/hyperpigmentation, or present with systemic symptoms such as fever, weight loss, and arthritis. Skin biopsy should be considered for suspected urticarial vasculitis. [Pediatr Ann. 2021(5):e191-e197.].

AN UNUSUAL INFECTIOUS CAUSE OF ACUTE URTICARIA

Introduction Although many cases of acute urticaria are caused by infectious illnesses, certain pathogens are not frequently reported in association with urticaria. Urticaria Case Description A 28-year-old man presented with 1 week of fevers, neck stiffness and a migratory pruritic rash. His past medical history included asthma and metastatic melanoma that is now in remission. He had received 3 years of pembrolizumab, with the last dose being 1 year prior to presentation. He was non-toxic appearing and had mild nuchal rigidity, a 5 × 7cm well-defined erythematous patch on his back consistent with erythema migrans, and transient, migratory raised plaques on his arms and legs consistent with urticaria. He had a WBC of 12 k with 80.7% neutrophils, and an otherwise normal complete blood count, basic metabolic panel, and liver panel. Lyme IgM was positive, confirmed by Western Blot. CSF revealed 13 nucleated cells with a lymphocytic predominance. He was treated for Lyme meningitis with ceftriaxone 2 g daily. His urticarial rash was controlled with fexofenadine. Upon completion of Lyme treatment, he had no recurrence of urticaria despite discontinuation of fexofenadine. Discussion Infections are a commonly identified cause of acute urticaria with viruses and parasites being the most cited pathogens, and less frequently bacteria. Notably, Lyme disease is not commonly listed as a cause of acute urticaria, although Borrelia burgdorferi has been shown to induce mast cell activation in vitro. This case provides a potential in vivo correlate to these in vitro findings in a patient with concurrent acute urticaria and Lyme borrelliosis. Although many cases of acute urticaria are caused by infectious illnesses, certain pathogens are not frequently reported in association with urticaria. Urticaria A 28-year-old man presented with 1 week of fevers, neck stiffness and a migratory pruritic rash. His past medical history included asthma and metastatic melanoma that is now in remission. He had received 3 years of pembrolizumab, with the last dose being 1 year prior to presentation. He was non-toxic appearing and had mild nuchal rigidity, a 5 × 7cm well-defined erythematous patch on his back consistent with erythema migrans, and transient, migratory raised plaques on his arms and legs consistent with urticaria. He had a WBC of 12 k with 80.7% neutrophils, and an otherwise normal complete blood count, basic metabolic panel, and liver panel. Lyme IgM was positive, confirmed by Western Blot. CSF revealed 13 nucleated cells with a lymphocytic predominance. He was treated for Lyme meningitis with ceftriaxone 2 g daily. His urticarial rash was controlled with fexofenadine. Upon completion of Lyme treatment, he had no recurrence of urticaria despite discontinuation of fexofenadine. Infections are a commonly identified cause of acute urticaria with viruses and parasites being the most cited pathogens, and less frequently bacteria. Notably, Lyme disease is not commonly listed as a cause of acute urticaria, although Borrelia burgdorferi has been shown to induce mast cell activation in vitro. This case provides a potential in vivo correlate to these in vitro findings in a patient with concurrent acute urticaria and Lyme borrelliosis.

EVALUATION OF DYSFUNCTION IN BLOOD COAGULATION IN CHILDREN WITH URTICARIA

Recently, an association between coagulation dysfunction and the pathology of urticaria has been reported, but research in children is scarce. We measured levels of prothrombin fragments 1+2 (PTF1+2), fibrin degradation product (FDP), D-dimer, and mean platelet volume (MPV) in 32 children with urticaria. The study cohort comprised 18 cases of chronic and active urticaria, 7 cases of chronic and inactive urticaria, and 7 cases of acute urticaria. PTF1+2 levels in the chronic and active urticaria group were higher than those in the chronic and inactive urticaria group (p<0.01). PTF1+2 levels in the acute urticaria group were higher than those in the chronic and inactive group (p<0.05). No significant difference was observed in the levels of FDP, D-dimer, and MPV among the three groups of the patients. Levels of PTF1+2, FDP, and D-dimer decreased as symptoms improved. Plasma levels of PTF1+2 may be useful for assessment of the activity of urticaria.

Acute urticaria as a side effect of the Mirena® (levonorgestrel-releasing intrauterine system): a case report

BackgroundThe levonorgestrel intrauterine system, Mirena®, is widely used for contraception and the treatment of idiopathic menorrhagia. Here, we reported one case of acute urticaria following Mirena® implantation to increase the awareness of possible adverse side effects associated with Mirena®.Case presentationThe case presented is a 27-year-old Chinese woman who received Mirena® implantation for her adenomyosis and menorrhagia. The operation was successful and the patient did not experience any discomfort during the operation. However, she developed acute urticaria on her entire body accompanied with pruritic, slight left lower quadrant pain, and slight dizziness two hours after the operation. The patient was recommended to have the Mirena® removed immediately, and she took 10 mg oral methylprednisolone and 5 mg desloratadine tablet daily for five days. Her urticaria resolved and did not recur.ConclusionThe patient’s acute urticaria seems to have been associated with the Mirena® levonorgestrel intrauterine system implantation, since she had no history of allergic reactions to materials used during the operation such as plastic, metal, alcohol, medications, and povidone-iodine.

Quand la peau suscite l’urgence

Some skin diseases require an emergency medical intervention. This is obviously the case with several rare but life-threatening diseases including angioedema, anaphylaxis, acute drug reactions with blisters, pustules, or internal involvement, such as ‘hypersensitivity syndrome’/DRESS, or Kaposi-Juliusberg syndrome. More frequently patients are seeking emergency advice for an acute skin condition often accompanied by fever that looks dramatic to them, their relatives and general practitioner. This is the case of acute urticaria and acute contact dermatitis, especially on the face. For each of the above diseases, excluding urticaria, we will discuss the clinical presentation, the main differential diagnoses, the laboratory examinations that may be useful in emergencies and the principles of management.

Acute Urticaria Associated with Streptococcal Infection

Eighty-one cases of acute urticaria were treated in our institution over a two-year period. In 13 of 32 cases screened for streptococcal pharyngitis, either positive throat culture, significant streptococcal exoenzyme antibodies (Streptozyme test), or both were found. Other causative factors for the acute urticaria had been excluded. It is our feeling that beta-hemolytic streptococcal infection may be a causative agent in many cases of acute urticaria, and that the infection may not always be clinically apparent. We therefore recommend a throat culture and determination of streptococcal enzyme level as routine procedures in evaluating acute urticaria. We also suggest, based on the findings in one case, that discontinuing therapy for a streptococcal infection when urticaria develops, even though necessary, might be inappropriate.