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Query: UMLS:C0042109 (urticaria)
 6,569 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Cutaneous reactions were monitored by spontaneous adverse reaction monitoring system among inpatients in Nehru Hospital, over a period of 3 1/2 years. A total of 379 adverse drug reactions were reported during this period, of which 144 (40%) were cutaneous reactions. Maculopapular rashes (50% of cutaneous reactions), and urticaria (21.5%) were the most common eruption. Stevens-Johnson syndrome (13.9%) and toxic epidermal necrolysis (TEN 4.9%) were the serious cutaneous reactions. There were 4 fatal cutaneous reactions (all due to TEN). Antimicrobials (caused 56.9% reactions), radiocontrast dyes (14.6% reactions) and antiepileptics (15.3% reactions) were the most prominent drugs responsible for these eruptions.
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PMID:Cutaneous adverse reactions in in-patients in a tertiary care hospital. 2088 28

Antimicrobials and anti-inflammatories are the most common drugs causing skin reactions, but reactions are also brought about by ACE inhibitors, antiepileptics, many anticancer and certain other drugs. Exanthema and urticaria are the most common types of drug reactions. Urticaria may or may not be accompanied by angioedema or anaphylaxia. Possible life-threatening drug reactions include also toxic epidermal necrolysis, Stevens-Johnson syndrome and eosinophilia with systemic symptoms. A drug reaction resembles a typical allergic reaction. Diagnosis is based on the clinical picture and anamnesis.
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PMID:[Drug-induced skin reactions]. 2149 51

Acute dermatological problems are seen regularly by physicians. This review aims to provide a framework for the diagnosis and management of urgent dermatological conditions. Cutaneous drug reactions are commonly seen and the different clinical presentations are discussed including the less common but important drug reactions Stevens-Johnson syndrome and toxic epidermal necrolysis. Erythrodermic patients also require prompt evaluation and management. Current guidelines for the management of urticaria and the common acquired autoimmune bullous disorders will be discussed. Patients with complications of eczema and psoriasis frequently require urgent in-patient management and patients with cellulitis and leg ulcers are also seen regularly on acute medical receiving units often requiring both medical and dermatological input.
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PMID:Dermatological emergencies. 2160 59

Epidemiologic investigations of cutaneous adverse drug reactions (cADR) are important to evaluate their impact in dermatology and health care in general as well as their burden for affected patients. Few epidemiologic studies have been performed on frequent non-life-threatening cADR including reactions of both delayed and immediate hypersensitivity, such as maculopapular exanthema, fixed drug eruption and urticaria. Concerning rare but life-threatening severe cutaneous adverse reactions, e.g. toxic epidermal necrolysis (TEN), Stevens-Johnson syndrome (SJS), acute generalized exanthematous pustulosis and drug reaction with eosinophilia and systemic symptoms, several epidemiologic studies have been performed to date, some of which are still ongoing. Such studies enabled the calculation of reliable incidence rates and demographic data, but also allowed to perform risk estimation for drugs. The spectrum of drugs causing cADR differs substantially when separating the various clinical conditions. Whereas antibiotics are by far the most frequent inducers of milder cADR like maculopapular exanthema, they have a much lower risk to induce SJS/TEN, for which high-risk drugs are anti-infective sulfonamides, allopurinol, certain anti-epileptic drugs, nevirapine and nonsteroidal anti-inflammatory drugs (NSAIDS) of the oxicam type. In contrast, acute generalized exanthematous pustulosis is predominantly caused by the antibiotics pristinamycin and aminopenicillins, followed by quinolones, (hydroxy-)chloroquine and sulfonamides. Drug reaction with eosinophilia and systemic symptoms can be induced by a number of drugs known to cause SJS/TEN, such as certain antiepileptics and allopurinol, but also other medications (e.g. minocyclin).
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PMID:Epidemiology of cutaneous adverse drug reactions. 2261 50

Erythema multiforme (EM) is an uncommon, immune-mediated disorder that presents with cutaneous or mucosal lesions or both. In herpes simplex virus (HSV)-associated EM, the findings are thought to result from cell-mediated immune reaction against viral antigen-positive cells that contain the HSV DNA polymerase gene (pol). The target lesion, with concentric zones of color change, represents the characteristic cutaneous finding seen in this disorder. Although EM can be induced by various factors, HSV infection continues to be the most common inciting factor. Histopathologic testing and other laboratory investigations may be used to confirm the diagnosis of EM and to differentiate it from other clinical imitators. Imitators of EM include urticaria, Stevens-Johnson syndrome, fixed drug eruption, bullous pemphigoid, paraneoplastic pemphigus, Sweet's syndrome, Rowell's syndrome, polymorphus light eruption, and cutaneous small-vessel vasculitis. Because disease severity and mucosal involvement differ among patients, treatment should be tailored to each patient, with careful consideration of treatment risk vs benefit. Mild cutaneous involvement of EM can be managed primarily with a goal of achieving symptomatic improvement; however, patients with HSV-associated recurrent EM and idiopathic recurrent EM require treatment with antiviral prophylaxis. Inpatient hospitalization may be required for patients with severe mucosal involvement that causes poor oral intake and subsequent fluid and electrolyte imbalance. With this review, we strive to provide guidance to the practicing dermatologist in the evaluation and treatment of a patient with EM.
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PMID:Clinical features, diagnosis, and treatment of erythema multiforme: a review for the practicing dermatologist. 2278 3

The original Gell and Coomb's classification categorizes hypersensitivity reactions into four subtypes according to the type of immune response and the effector mechanism responsible for cell and tissue injury: type I, immediate or IgE mediated; type II, cytotoxic or IgG/IgM mediated; type III, IgG/IgM immune complex mediated; and type IV, delayed-type hypersensitivity or T-cell mediated. The classification has been improved so that type IIa is the former type II and type IIb is antibody-mediated cell stimulating (Graves Disease and the "autoimmune" type of chronic idiopathic urticaria). Type IV has four major categories: type IVa is CD4(+)Th1 lymphocyte mediated with activation of macrophages (granuloma formation and type I diabetes mellitus); type IVb is CD4(+)Th2 lymphocyte mediated with eosinophilic involvement (persistent asthma and allergic rhinitis); type IVc is cytotoxic CD8(+) T lymphocyte with involvement of perforin-granzme B in apoptosis (Stevens-Johnson syndrome and toxic epidermal necrolysis); type IVd is T-lymphocyte-driven neutrophilic inflammation (pustular psoriasis and acute generalized exanthematous pustulosis). Some diseases have multiple types of immunologic hypersensitivity.
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PMID:Chapter 28: Classification of hypersensitivity reactions. 2279 1

Cutaneous adverse reactions are reported for many therapeutic agents and, in general, are observed in between 0% and 8% of treated patients depending on the drug. Antiosteoporotic agents are considered to be safe in terms of cutaneous effects, however there have been a number of case reports of cutaneous adverse reactions which warrant consideration. This was the subject of a working group meeting of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis in April 2009, which focused on the impact of cutaneous adverse reactions and drug-induced hypersensitivity in the management of postmenopausal osteoporosis. This position paper was drafted following these discussions and includes a flowchart for their recognition. Cutaneous adverse reactions observed with antiosteoporotic agents were reviewed and included information from case reports, regulatory documents and pharmacovigilance. These reactions ranged from benign effects including exanthematous or maculopapular eruption (drug rash), photosensitivity and urticaria, to the severe and potentially life-threatening reactions of angioedema, drug rash with eosinophilia and systemic symptoms (DRESS), Stevens Johnson syndrome and toxic epidermal necrolysis. A review of the available evidence demonstrates that cutaneous adverse reactions occur with all commonly used antiosteoporotic treatments. Notably, there are reports of Stevens Johnson syndrome and toxic epidermal necrolysis for bisphosphonates, and of DRESS and toxic epidermal necrolysis for strontium ranelate. These severe reactions remain very rare (<1 in 10,000 cases). In general, with proper management and early recognition, including immediate and permanent withdrawal of the culprit agent, accompanied by hospitalization, rehydration and systemic corticosteroids if necessary, the prognosis is positive.
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PMID:Cutaneous side effects of antiosteoporosis treatments. 2287 Apr 64

Beta-lactam intolerance, most of which is not IgE or even immunologically mediated even though it is commonly called an "allergy," can be safely managed using the following seven steps: 1. Avoid testing, re-challenging, or desensitizing individuals with histories of beta-lactam associated toxic epidermal necrolysis, Stevens-Johnson syndrome, drug reaction with eosinophilia and systemic symptoms syndrome, severe hepatitis, interstitial nephritis, or hemolytic anemia. 2. Avoid unnecessary antibiotic use, especially in the setting of viral infections. 3. Expect new intolerances to be reported after 0.5 to 4% of all antibiotic utilizations, dependent on gender and the specific antibiotic used. 4. Expect a higher incidence of new intolerances in individuals with three or more medication intolerances already noted in their medical records. 5. For individuals with an appropriate penicillin class antibiotic intolerance based on a history of anaphylaxis, urticaria, macular papular rashes, unknown symptoms, or symptoms not excluded in step one, proceed with penicillin skin testing. Skin test with penicilloyl-poly-lysine and native penicillin. If skin test is negative, proceed with an oral amoxicillin challenge. If skin test and oral challenge are negative, penicillin class antibiotics may be used. If skin test or oral challenge is positive, avoid penicillin class antibiotics. If skin test or oral challenge is positive, non-penicillin-beta-lactams may be used, unless there is a history of intolerance to a specific non-penicillin-beta-lactam, then avoid that specific non-penicillin-beta-lactam. If there is life-threatening infection that can only be treated with a penicillin class antibiotic, proceed with oral penicillin desensitization prior to any oral or parenteral penicillin use. 6. For individuals with an appropriate non-penicillin-beta-lactam intolerance, avoid re-exposure to the beta-lactam implicated. An alternative beta-lactam may be used, ideally with different side chains. Penicillin allergy testing is not useful in the management of non-penicillin-beta-lactam intolerance. Non-penicillin-beta-lactam skin testing is not clinically useful and should not be done outside of a research setting. If the non-penicillin-beta-lactam implicated is needed to treat a life-threatening infection, proceed with desensitization. 7. Be ready to treat anaphylaxis with all parenteral beta-lactam use.
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PMID:Recommendations for the management of beta-lactam intolerance. 2354 54

Adverse reactions to medications are extremely common and display a characteristic clinical morphology such as fixed drug eruption (FDE), Stevens-Johnson syndrome, urticaria, morbilliform exanthem, hypersensitivity syndrome, pigmentary changes, lichenoid, dermatitis, acute generalized exanthematous pustulosis, photosensitivity, vasculitis etc. Here we report a case of a 60 year old male who presented to us with multiple bullous eruptions over both the hands and feet after oral ingestion of ciprofloxacin.
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PMID:Bullous fixed drug eruption to ciprofloxacin: a case report. 2373 Jun 66

Catamenial dermatoses are unusual, cyclic, perimenstrual reactions to hormones produced during the menstrual cycle. They occur in a variety of clinical presentations, including urticaria, eczema, fixed drug eruptions, erythema multiforme and anaphylaxis. Autoimmune progesterone dermatitis is the most common, and is caused by an autoimmune response to endogenous progesterone in women of reproductive age. We report a case of catamenial dermatosis in a 42-year-old Jamaican woman with a 10-year history of cyclic blistering and ulcerative eruptions of her mouth and limbs. Her symptoms were fully in keeping with a Stevens-Johnson-type reaction, and were associated with production of prostaglandins occurring during her menstrual cycle.
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PMID:Catamenial dermatoses: has anyone ever considered prostaglandins? 2477 68


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