RESUMO
Episodic angioedema with eosinophilia (EAE) is a rare condition characterized by recurrent attacks of angioedema and urticaria accompanied by a marked elevation of peripheral eosinophil count. We report the case of a young female patient diagnosed with EAE associated with urticarial vasculitis. A 40-year-old female patient was admitted to our institution due to recurrent episodes of cheek and eyelid angioedema in the previous year. Episodes of facial angioedema lasted for two months with spontaneous remission afterwards. In addition, she presented pruritic and painful skin eruptions of erythematous circles, which persisted for longer than 24 h, that were palpable, somewhat purplish, and more pronounced on the face, arms, and trunk. Laboratory investigation showed a sustained elevation of white cell counts with marked eosinophilia. Serum IgM, IgE, and IgA were normal; IgG was slightly elevated. C1-esterase inhibitor and tryptase test were normal. Reverse transcriptase-polymerase chain reaction was performed for detection of FIP1L1-PDGFRA and BCR-ABL rearrangements. None of these alterations were found. Skin biopsies were suggestive of urticarial vasculitis. The patient was submitted to esophagogastroduodenoscopy, which showed mild chronic gastritis, with no eosinophilic infiltration. Cardiac dimensions and function were normal. Abdominal ultrasound and total body CT-scan failed to show lymphadenopathy, organomegaly, and tumors. We report the first case of association between episodic angioedema with eosinophilia and urticarial vasculitis. It is possible that both conditions share a physiopathological mechanism, suggesting that it is not just a chance association.
Assuntos
Angioedema , Eosinofilia , Urticária , Vasculite , Adulto , Angioedema/complicações , Angioedema/diagnóstico , Eosinofilia/complicações , Feminino , Humanos , Pele , Urticária/complicaçõesRESUMO
Episodic angioedema with eosinophilia (EAE) is a rare condition characterized by recurrent attacks of angioedema and urticaria accompanied by a marked elevation of peripheral eosinophil count. We report the case of a young female patient diagnosed with EAE associated with urticarial vasculitis. A 40-year-old female patient was admitted to our institution due to recurrent episodes of cheek and eyelid angioedema in the previous year. Episodes of facial angioedema lasted for two months with spontaneous remission afterwards. In addition, she presented pruritic and painful skin eruptions of erythematous circles, which persisted for longer than 24 h, that were palpable, somewhat purplish, and more pronounced on the face, arms, and trunk. Laboratory investigation showed a sustained elevation of white cell counts with marked eosinophilia. Serum IgM, IgE, and IgA were normal; IgG was slightly elevated. C1-esterase inhibitor and tryptase test were normal. Reverse transcriptase-polymerase chain reaction was performed for detection of FIP1L1-PDGFRA and BCR-ABL rearrangements. None of these alterations were found. Skin biopsies were suggestive of urticarial vasculitis. The patient was submitted to esophagogastroduodenoscopy, which showed mild chronic gastritis, with no eosinophilic infiltration. Cardiac dimensions and function were normal. Abdominal ultrasound and total body CT-scan failed to show lymphadenopathy, organomegaly, and tumors. We report the first case of association between episodic angioedema with eosinophilia and urticarial vasculitis. It is possible that both conditions share a physiopathological mechanism, suggesting that it is not just a chance association.
Assuntos
Humanos , Feminino , Adulto , Urticária/complicações , Vasculite , Eosinofilia/complicações , Angioedema/complicações , Angioedema/diagnóstico , PeleRESUMO
El dermografismo, conocido como "escritura sobre la piel", fenómeno que ocurre en forma espontánea o a la provocación física de la misma, es un síntoma, signo o síndrome semiológico, característico de procesos clínicos alérgicos y no alérgicos. Se expresa comúnmente como dermografismo rojo (urticaria dermatográfica, con o sin angioedema acompañante), con eritema y/o roncha muy frecuente en procesos alérgicos, pero también en las urticarias físicas, autoinmunes o tóxicas por aditivos alimentarios, infecciones, medicamentos y otros agentes. El dermografismo blanco, que se evidencia como un área que palidece alrededor de la línea de estimulación física, muy característico de la atopia; y, el que en esta comunicación hemos denominado dermografismo "mixto o bifásico", por su carácter bimodal, en el que se alternan las expresiones de los dermografismos rojo y blanco, en forma casi simultánea o en sucesión de blanco temprano en el primer minuto a rojo tardío a los cinco minutos o más, o al contrario, rojo inmediato y blanco posterior, típico de atopia. El paciente con hiperreactividad atópica en piel es el que exhibe el dermografismo mixto o bifásico, pues muestra el dermografismo blanco como estigma de atopia y el dermografismo rojo de la urticaria sintomática aguda o crónica. Esta última forma de dermografismo no se encuentra en las descripciones clásicas y es el objetivo de esta comunicación, que se acompaña de una amplia discusión sobre la ocurrencia de dermografismo en la práctica clínica. Material y Métodos: Se realizó una extensa revisión bibliográfica, consultando bases de datos como Medline, PubMed, DocChek, Wiley, Amedeo, Cochrane, Scielo, Hinari y Lilacs; se presentan viñetas clínicas de casos de pacientes atópicos. Conclusión: En esta revisión se ha presentado la ocurrencia clínica del dermografismo como un fenómeno frecuente de diferentes orígenes, pero que, muchas veces, es acompañante casi invariable de expresiones atópicas, en donde el dermografismo es un signo de ayuda para la tipificación del paciente alérgico...(AU)
Assuntos
Humanos , Alergia e Imunologia , Hipersensibilidade Alimentar/complicações , Hipersensibilidade Imediata , Mastocitose/complicações , Urticária/complicaçõesRESUMO
BACKGROUND: Chronic spontaneous urticaria (CSU) may be associated with autoimmune thyroid diseases, and the Autologous Serum Skin Test (ASST) is an autoreactivity marker. The thyrotropin (TSH) and TSH receptor (TSHR) could play a role in the pathogenesis of CSU. The aim of this study was to evaluate ASST positivity and TSHR gene expression in healthy skin and ASST wheals in euthyroid women with CSU, with (14 patients) and without (15 patients) Hashimoto's thyroiditis (HT). METHODS: ASST was performed and TSHR gene expression studied in wheals induced by ASST and in healthy skin. RESULTS: ASST presented greater positivity (86% × 40%) and larger diameter (10.8 × 9.6 mm) in the HT group (P < 0.05). TSHR gene expression was higher in the ASST area and healthy skin of HT group (P < 0.01). Positive correlation of antibodies levels with ASST wheal measurements and TSHR gene expression was seen. CONCLUSIONS: Women with CSU and HT presented greater positivity and larger measurements for ASST and higher TSHR expression in the skin, suggesting association between CSU, thyroid autoimmunity, and TSHR.
Assuntos
Doença de Hashimoto/genética , RNA Mensageiro/metabolismo , Receptores da Tireotropina/genética , Urticária/genética , Adulto , Autoanticorpos/sangue , Estudos de Casos e Controles , Doença Crônica , Feminino , Doença de Hashimoto/complicações , Doença de Hashimoto/metabolismo , Humanos , Iodeto Peroxidase/imunologia , Pessoa de Meia-Idade , Soro/imunologia , Testes Cutâneos , Tireotropina/sangue , Urticária/complicações , Urticária/metabolismoRESUMO
Abstract We present a case of allergic reaction to patent blue in a patient who underwent excision of sentinel lymph node associated with segmental breast resection. About 20 min after the dye injection, the patient developed hypotension (BP = 70 × 30 mmHg) associated with increased heart frequency. The patient was treated successfully with decreased inspired fraction of inhaled anesthetic and fluid replacement. At the end of the procedure, she presented with bluish urticarial-like plaques on the head, neck, upper limbs, and trunk; hydrocortisone was then used. The patient recovered uneventfully and was discharged from the PACU 2 h after the end of surgery without skin changes, and was discharged from hospital on the morning after surgery. The incidence of allergic reactions with the use of patent blue is far superior to the hypersensitivity reactions seen with anesthetic and adjuvant drugs. Therefore, the anesthesiologist must be aware of cardiovascular instability associated with skin changes during the use of patent blue, for early diagnosis and appropriate treatment of this hypersensitivity reaction to this dye.
Resumo Os autores apresentam um caso de reação alérgica ao azul patente em uma paciente submetida à exérese de linfonodo em sentinela associada a uma ressecção segmentar de mama. Paciente apresentou aproximadamente pós 20 minutos da injeção do corante hipotensão (PA = 70 × 30 mmHg) associada a aumento da frequência cardíaca. Foi tratada satisfatoriamente com diminuição da fração inspirada do anestésico inalatório e reposição volêmica. No fim do procedimento apresentava placas urticariformes azuladas em cabeça, pescoço, membros superiores e tronco e foi usada hidrocortisona. Evoluiu, sem intercorrências, na sala de recuperação pós-anestésica e teve alta duas horas após o término do procedimento cirúrgico sem a presença das alterações cutâneas. Alta hospitalar na manhã seguinte à cirurgia. A incidência de reações alérgicas com o emprego do azul patente é muito superior às reações de hipersensibilidade observadas com drogas anestésicas e adjuvantes. Portanto, o anestesiologista deve ficar atento à instabilidade cardiovascular associada a alterações cutâneas quando do uso do azul patente para o diagnóstico precoce e tratamento adequado dessa reação de hipersensibilidade com o emprego do corante.
Assuntos
Humanos , Feminino , Corantes de Rosanilina/efeitos adversos , Mama/cirurgia , Hidrocortisona/uso terapêutico , Hipersensibilidade a Drogas/diagnóstico , Hipersensibilidade a Drogas/tratamento farmacológico , Corantes/efeitos adversos , Urticária/complicações , Urticária/tratamento farmacológico , Hipersensibilidade a Drogas/complicações , Pessoa de Meia-Idade , Anti-Inflamatórios/uso terapêuticoRESUMO
We present a case of allergic reaction to patent blue in a patient who underwent excision of sentinel lymph node associated with segmental breast resection. About 20min after the dye injection, the patient developed hypotension (BP=70×30mmHg) associated with increased heart frequency. The patient was treated successfully with decreased inspired fraction of inhaled anesthetic and fluid replacement. At the end of the procedure, she presented with bluish urticarial-like plaques on the head, neck, upper limbs, and trunk; hydrocortisone was then used. The patient recovered uneventfully and was discharged from the PACU 2h after the end of surgery without skin changes, and was discharged from hospital on the morning after surgery. The incidence of allergic reactions with the use of patent blue is far superior to the hypersensitivity reactions seen with anesthetic and adjuvant drugs. Therefore, the anesthesiologist must be aware of cardiovascular instability associated with skin changes during the use of patent blue, for early diagnosis and appropriate treatment of this hypersensitivity reaction to this dye.
Assuntos
Mama/cirurgia , Corantes/efeitos adversos , Hipersensibilidade a Drogas/diagnóstico , Hipersensibilidade a Drogas/tratamento farmacológico , Hidrocortisona/uso terapêutico , Corantes de Rosanilina/efeitos adversos , Anti-Inflamatórios/uso terapêutico , Hipersensibilidade a Drogas/complicações , Feminino , Humanos , Pessoa de Meia-Idade , Urticária/complicações , Urticária/tratamento farmacológicoRESUMO
BACKGROUND: Chronic urticaria (CU) can be provoked by a wide variety of causes. Some studies suggest contact sensitization may play a role in the disease. OBJECTIVE: To investigate the incidence and distribution characteristics of allergic contact sensitization in central Chinese subjects with CU, and assess contact allergen avoidance measures in managing CU. METHODS: Patch tests were performed, following the recommended standard procedure, with 20 selected allergens, in line with the European baseline series. All subjects with positive results were prescribed appropriate avoidance measures for the sensitizing substances, while subjects with negative results served as the control group. CU severity was assessed daily from week1 to week4 and for each subject, applying the Urticaria Activity Score. RESULTS: 42.9% (233/543) of subjects with CU showed positive reactions to one or more contact allergen(s). Potassium dichromate, benzene mix and carba mix were more common in male patients, while nickel sulfate was more frequent in females. The positive rates for different allergens varied with age and occupation. The median (interquartile range) severity scores at week 1 were 20 (14-21) and 15 (14-27) for the allergen avoidance group and control group, respectively (P>0.05); and 12 (7-15) and 14 (12-17) at week 4 (P<0.001). CONCLUSION: The incidence of allergic contact sensitization in CU patients was high, and appropriate contact allergen avoidance measures benefitted CU management. Contact allergens may play a role in the pathogenic mechanism of CU and patch tests are an option for CU patients.
Assuntos
Alérgenos/imunologia , Dermatite Alérgica de Contato/epidemiologia , Dermatite Alérgica de Contato/etiologia , Urticária/complicações , Urticária/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , China/epidemiologia , Doença Crônica , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Ocupações/estatística & dados numéricos , Testes do Emplastro , Índice de Gravidade de Doença , Distribuição por Sexo , Estatísticas não Paramétricas , Adulto JovemRESUMO
Abstract BACKGROUND: Chronic urticaria (CU) can be provoked by a wide variety of causes. Some studies suggest contact sensitization may play a role in the disease. OBJECTIVE: To investigate the incidence and distribution characteristics of allergic contact sensitization in central Chinese subjects with CU, and assess contact allergen avoidance measures in managing CU. METHODS: Patch tests were performed, following the recommended standard procedure, with 20 selected allergens, in line with the European baseline series. All subjects with positive results were prescribed appropriate avoidance measures for the sensitizing substances, while subjects with negative results served as the control group. CU severity was assessed daily from week1 to week4 and for each subject, applying the Urticaria Activity Score. RESULTS: 42.9% (233/543) of subjects with CU showed positive reactions to one or more contact allergen(s). Potassium dichromate, benzene mix and carba mix were more common in male patients, while nickel sulfate was more frequent in females. The positive rates for different allergens varied with age and occupation. The median (interquartile range) severity scores at week 1 were 20 (14-21) and 15 (14-27) for the allergen avoidance group and control group, respectively (P>0.05); and 12 (7-15) and 14 (12-17) at week 4 (P<0.001). CONCLUSION: The incidence of allergic contact sensitization in CU patients was high, and appropriate contact allergen avoidance measures benefitted CU management. Contact allergens may play a role in the pathogenic mechanism of CU and patch tests are an option for CU patients.