Immunologically mediated skin disorders
Anupam Das, Sumit Sethi in Concise Dermatology, 2021
Urticaria is characterized by transient, superficial well-defined pruritic wheals of the skin, whereas angioedema involves oedema of the dermis and subcutaneous or submucosal tissue that is deep and ill-defined. Acutely urticaria occurs in 20% of the population, whereas chronic urticaria and angioedema occur in 0.5%. Dermographism is evoked by skin stroking; pressure urticaria by application of weight to the skin; vibratory angioedema by a vibratory stimulus; cholinergic urticaria can be diagnosed by exercise to sweating; solar urticaria by testing with UVB, UVA, and visible light; cold urticaria by application of ice cube to skin. Second-line therapies could involve a short course of oral systemic corticosteroids for severe urticaria and urticarial vasculitis. A rare disorder with an incidence between 2.3 and 10 per million population, four times more common in females. A rare disease with an incidence of 1.9 per million, occurring twice as frequently in females as in males.
Acute erythematous rash on the face
Richard Ashton, Barbara Leppard in Differential Diagnosis in Dermatology, 2021
Angioedema is oedema in the dermis due to increased vascular permeability. A phototoxic rash looks like sunburn but occurs in a patient who has not been exposed to excessive sunlight. Acute sunburn presents as painful erythema with or without blisters, between a few hours and 2 days after sun exposure. Subacute eczema occurs without obvious vesicles and exudate. There will be erythematous patches and plaques where the border of the rash is ill defined merging imperceptibly into normal skin. Acute eczema on the face presents as tiny vesicles, weeping and crusting, and is usually due to an allergic contact dermatitis or atopic eczema. Herpes simplex is differentiated from impetigo by the history of recurrent episodes, prodromal pain and initial vesicles containing clear fluid, and in adults is the more likely diagnosis. The rash is usually symmetrical and uncomfortable and itchy rather than painful as in herpes zoster.
Immunologically mediated skin disorders
Ronald Marks, Richard Motley in Common Skin Diseases, 2019
Urticaria is extremely common and there are few individuals who do not experience it in one form or another during their lifetime. An important characteristic of urticaria is its transience, but very occasionally urticarial lesions stay for days rather than hours and leave a brownish stain. In angioedema, the lesions are deeper and the swelling much more extensive than in urticarial. Angioedema may accompany urticaria or may occur independently. The ultimate cause of urticaria and angioedema is release of histamine from mast cell granules, but a large number of stimuli can do this. Urticarial lesions develop some time after pressure on the skin, for example from belts or other tight clothing, or from the rungs of a ladder. Penicillin hypersensitivity may cause acute urticaria. Sodium benzoate/benzoic acid used in carbonated drinks and preserved bread may precipitate urticaria in some cases.
Risperidone induced angioedema with concurrent EPS symptoms: a case report and review of literature
Published in Journal of Community Hospital Internal Medicine Perspectives, 2018
Gursharan Singh Samra, Saumitra Kant, Robert Chow
Angioedema has recently been reported as a side effect associated with the antipsychotic risperidone. We report a case of dystonia with concurrent angioedema due to risperidone. A 40-year-old male with a history of schizophrenia was started on 3 mg of risperidone BID and developed perioral and periorbital edema along with increased muscle rigidity and hand tremor within 24 h of initial administration. His symptoms abated after cessation of risperidone and intravenous administration of corticosteroids and antihistamine. This case study adds to the current literature, which has already established angioedema as a dose-dependent side effect of risperidone. Moreover, this case study aims to increase awareness about the potential for the simultaneous occurrence of angioedema and extrapyramidal symptoms, and promotes vigilance among prescribers so that the life-threatening consequences of such effects can be avoided.
A rare presentation of angioedema with isolated retropharyngeal and supraglottic involvement
Published in Journal of Community Hospital Internal Medicine Perspectives, 2019
Angiotensin converting-enzyme (ACE) inhibitors are commonly prescribed drugs with multiple indications including congestive heart failure, hypertension, and diabetic nephropathy. ACE inhibitor induced angioedema is commonly seen across emergency departments and clinics, with transient swelling of lips, tongue, and other facial structures being the common presentation. Isolated airway obstruction as a result of pharyngeal and laryngeal swelling without facial swelling is a rare presentation. We present a case of a patient on lisinopril therapy for one year who experienced severe airway compromise without the classic symptoms of ACE inhibitor induced angioedema. He required emergent cricothyroidotomy to secure his airway, as fiberoptic laryngoscopy showed 90% obstruction and inability to visualize true vocal cords. His ACE inhibitor therapy was discontinued, and he was discharged home within a few days with no residual symptoms.
Treatment of type I and II hereditary angioedema with Rhucin
Published in Expert Review of Clinical Immunology, 2008
Lilian Varga, Henriette Farkas
Hereditary and acquired angioedema are of outstanding clinical importance, as edematous attacks associated with these conditions can thrust afflicted patients into mortal danger. Currently, C1 inhibitor concentrate – a human blood product – is available as a replacement therapy. In view of the limited number of donors, as well as the risk of transmission of blood-borne infections, it is a reasonable expectation to develop a therapeutic alternative based on recombinant technology, which would eliminate all these shortcomings. Pharming (Leiden, The Netherlands) has developed Rhucin®, a recombinant human C1 inhibitor, as a proprietary product, which is currently being evaluated in Phase III clinical trials. Ongoing studies conducted within the framework of the development program are almost complete and their interim findings are reassuring. This should facilitate successful regulatory approval in the near future, which is indispensable in order to make Rhucin available for patients with hereditary angioedema or other disorders amenable to C1 inhibitor replacement.