Treatment of Rashes and Hives

Treatment of Rashes and Hives

Karen L. Gregory, DNP, APRN, CNS, RRT, AE-C, FAARC Oklahoma Allergy and Asthma Clinic Georgetown University School of Nursing and Health Studies

Disclosures

Speaker bureau for: ALK Monaghan Novartis

No influence with this presentation.

Association of Asthma Educators 2019 Pre-Conference Buffalo, New York

Pharmacologic Management of All Things Wheezy and Itchy

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Treatment of Rashes and Hives

June 6, 2019 2:30 ? 3:15 p.m.

Objectives

Discuss diagnosis and management acute and chronic hives. Compare and contrast the treatment strategies for rash and hives commonly implemented in clinical practice. Evaluate the utility of adjunctive or novel therapies for treating of rashes and hives.

Chronic Idiopathic Urticaria (CIU)

?Urticaria is a common, mast cell-driven disease presenting with wheals or angioedema or both ?Histamine and other mediators (platelet-activating factor (PAF) and cytokines) released from activated skin mast cells, result in:

? sensory nerve activation ? vasodilatation ? plasma extravasation ? cell recruitment to urticarial lesions

? Mast cell-activating signals in urticaria are ill-defined and likely to be heterogeneous and diverse ? Histologically, wheals are characterized by:

? edema of the upper and mid dermis ? leakage of serum into the tissue ? dilatation and augmented permeability of the

postcapillary venules and lymphatic vessels of the upper dermis

Zuberbier T, Aberer W, Asero R. The EAACI/GA?LEN/EDF/WAO guideline for the definition, classification, diagnosis and management of urticaria. Allergy. 2018;73(7);1393-1414.

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Chronic Idiopathic Urticaria (CIU)

?An estimated 80% to 90% of patients with chronic urticaria have no identifiable cause of the disease1 ?CIU has significant detrimental effects on quality of life ?In 10?20% of the cases, angioedema may be the first and often only manifestation of urticaria2 ?Approximately 60% of the patients with CIU report on angioedema episodes2 ? Pathogenesis is incompletely understood

1. Doong JC, Chichester K, Oliver ET, et al. Chronic idiopathic urticaria: systemic complaints and their relationship with disease and immune measures. 2. Weller K, Maurer M, Grattan C, et al. ASSURE-CSU: a real-world study of burden of disease in patients with symptomatic chronic spontaneous urticaria.

Clin Transl Allergy 2016; 65:29. doi:10.1186/s13601-015- 0072-9 6.

Associated Systemic Complaints During Active Wheal Flares

Gastrointestinal symptoms

Flushing

Joint pain or swelling

Cardiovascular manifestations

Respiratory symptoms

Other constitutional complaints

Note: similar symptoms are also reported by patients with mast cell activation disorders, and CIU is noted as one of the conditions that can be a mimicker

Urticaria

Urticaria can be a sign of several other medical or autoimmune conditions:

thyroid disease liver diseases chronic infections lupus Most people with one of these conditions will have other symptoms apart from the hives

Fraser K, Robertson L. Chronic urticaria and autoimmunity. Skin Therapy Lett. 2013;18(7):5-9.

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Type 1-IV Hypersensitivity

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Clinical Classification of Urticaria

Acute Urticaria

Chronic Idiopathic Urticaria (CIU)

Urticaria 6 weeks Generally unknown etiology ? never found in most cases

Causes may include: drug reactions food allergy systemic disorders infection

Underlying cause may be undetermined Most acute reactions resolve within days to weeks Therapy is symptomatic and attempts to suppress symptoms until urticaria abates

Consistent, reproducible trigger is often not identified

Clinical pearl..... Because chronic urticaria may stem from an upnedrfeorrlmyinagcsoymstpelemteichililsnteosrys,aitnidspimhypsoirctaalnt to examination and pursue only basic laboratory testing and relevant diagnostic considerations

Magerl M, Altrichter S, Borzova E, et al. The definition, diagnostic testing, and management of chronic inducible urticarias-- the EAACI/GA(2) LEN/EDF/UNEV consensus recommendations 2016 update and revision. Allergy 71:780? 802. Zuberbier T, Aberer W, Asero R. The EAACI/GA?LEN/EDF/WAO guideline for the definition, classification, diagnosis and management of urticaria. Allergy. 2018;73(7);1393-1414.

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Subtype-Classification of Chronic Urticaria

Zuberbier T, Aberer W, R. Asero R, et al. The EAACI/GA?LEN/EDF/WAO guideline for the definition, classification, diagnosis and management of urticaria. Allergy. 2018;73:1393?1414

Urticaria Activity Score

Hawro T, Ohanyan T, Schoepke N. The urticaria activity score: validity, reliability, and responsiveness. J Allergy Clin Immunol Pract 2018;6:1185-90.

Urticaria Activity Score (UAS)

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