URTIKARIA &

ANGIOEDEMA
Melinda Rambing Kong
406148015
Pembimbing :
dr. Eko Krisnarto sp.KK

Urtikaria (hives)
Penyakit yang sering dijumpai 15-25% individu pernah

mengalami urtikaria dalam hidupnya

Karakteristiknya:
Rekuren
Pruritus
edema kemerahan, berbatas tegas, biasanya pada bagian tengah

lebih pucat (wheals)

Hampir 40% dengan urtikaria juga mengalami

angioedema (pembengkakan yang terjadi di bawah kulit)

Imunologi Urtikaria
1. Allergens
such as pollens,
cross the skin

Allergen

IgE
Mast cell
2.Allergens
bind to IgE on
mast cell in the
tissues just
bellow the skin

3.Mast cell mediators are

released causing redness,
itching and swelling (urticaria)

Urtikaria

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F
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K
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DIAGNOSIS
Anamnesa dan Pemeriksaan Fisikfrekuensi; waktu;

durasi; pola berulang dari lesi; bentuk, ukuran, lokasi, dan

distribusi lesi; faktor pencetus (mis: makanan, obat,
infeksi, gigitan serangga, stimulasi fisik); respon terhadap
terapi sebelumnya, dan riwayat atopi dalam keluarga.
Diagnostik test:
Skin prick tests (SPTs)
Serum-specific IgE tests

Table 1 Conditions to consider in the differential diagnosis of urticaria

Urticarial vasculitis
Systemic mastocytosis
Atopic dermatitis
Bullous pemphigoid
Erythema multiforme

Familial cold autoinflammatory

syndrome

Fixed drug eruptions

Subacute cutaneous lupus

erythematosus
Pruritic urticarial papules and
plaques of pregnancy
Muckle-Wells syndrome
Schnitzlers syndrome with
monoclonal IgG kappa

Lesions are usually painful (rather than pruritic), last >48 hours, and leave
discoloration on the skin
Rare condition that involves the internal organs (liver, spleen, lymph nodes,
bone marrow), in addition to the skin
Chronic, highly pruritic inflammatory skin disease
Clinical manifestations vary with age
Chronic, autoimmune, blistering skin disease
Acute, self-limited, skin condition
Considered to be a type IV hypersensitivity reaction to certain infections,
medications, and other various triggers
Rare, inherited inflammatory disorder characterized by recurrent episodes of
rash, fever/chills, joint pain, and other signs/symptoms of systemic
inflammation triggered by exposure to cooling temperatures
Onset usually occurs during infancy and early childhood and persists
throughout the patients life
Lesions occur from exposure to a particular medication and occur at the
same site upon reexposure to the offending medication
Lesions usually blister and leave residual pigmentation
A non-scarring, photosensitive skin condition
May occur in patients with systemic lupus erythematosus (SLE) and Sjgren
syndrome
Benign skin condition that usually arises late in the third trimester of a first
pregnancy
Rare genetic disease that causes hearing loss and recurrent hives
May lead to amyloidosis
Rare disease characterized by chronic, non-pruritic hives, periodic fever,
bone and joint pain, swollen lymph glands and an enlarged spleen and liver

Tatalaksana
Hindari pencetus pada beberapa pasien dengan

urtikaria akut (mis: makanan, obat, lateks, bisa serangga)

Antihistamin
Kortikosteroid pada beberapa pasien dengan urtikaria
berat yang tidak respon terhadap antihistamin
Prednison 40mg/hari selama 7 hari

Terapi imunosupresif & imunomodulator

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K
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Table 2 Antihistamines commonly used and indicated for the treatment of urticaria
Usual aduld dose
Usual pediadric dose
Second-generation H1-receptor antihistamines (first-line therapy)
Cetirizine (Reactine)
10-40 mg daily
5-10 mL (1-2 teaspoons) daily
(childrens formulation)
Desloratadine (Aerius)
5-20 mg daily
2.5-5 mL (0.5-1.0 teaspoon) daily
(childrens formulation)
Fexofenadine (Allegra)
120-480 mg daily
Not currently indicated for children
under 12 years of age
Loratadine (Claritin)
10-40 mg daily
5-10 mL (1-2 teaspoons) daily
(childrens formulation)
First-generation H1-receptor antihistamines (best used as adjunctive therapy for patients with
nocturnal symptoms)
Hydroxyzine (Atarax)
25-50 mg, three to four times Children < 6 years: 30 to 100 mg daily
daily
in divided doses
Diphenhydramine (Benadryl) 25-50 mg, every -6 hours
2.5-20 mL (0.5-4 teaspoons) every 4
to 6 hours (depending on age/ weight)
Cyproheptadine (Periactin)
4-20 mg daily
2-4 mg, two to three times daily
(depending on age/weight)
Chlorpheniramine
4 mg every 46 hours
1 mg every 46 hours
(ChorTripolon)
Clemastine (Tavist-1)
1.34 - 2.68 mg, two to three 1.34 mg, once or twice daily
times daily

Angioedema (tanpa Urtikatia)

angioedema tanpa disertai urtikaria jarang ditemukan,

dan harus diwaspadai ke arah diagnosa alternatif, seperti:

Angioedema herediter
Angioedema didapat
Angioedema idiopatik
Angioedema yang berhubungan dengan ACE inhibitor

Angioedema Herediter (HAE)

Penyakit keturunan yang terjadi akibat

kekurangan inhibitor C1 (suatu protein di dalam darah,

bagian dari sistem komplemen yang terlibat dalam sistem
kekebalan dan reaksi alergi)
HAE tipe 1: kadar dan fungsi C1 inhibitor menurun
HAE tipe 2: kadar C1 inhibitor normal, tapi fungsinya
menurun
Biasanya pada remaja dan dewasa

Angioedema Didapat (AAE)

Tipe 1: sindrom defisiensi C1 inhibitor yang paling sering

berhubungan dengan penyakit limfoproliferatif sel-B.

Tipe 2: berhubungan dengan hadirnya autoantibodi yang
langsung melawan molekul C1 inhibitor.
Biasanya pada orang tua (dekade ke 4)

 Secara klinis, HAE dan AAE sama, yaitu ditandai dengan

angioedema berulang, tanpa urtikaria atau pruritus, yang

paling sering menyerang kulit atau jaringan mukosa dari
GI dan traktus respiratori bagian atas.

Angioedema Idiopatik
Penyebabnya tidak diketahui
Mekanismenya tidak jelas
Berdasarkan respon pasien terhadap pengobatan,

beberapa kasus diduga disebabkan oleh aktivasi sel mast

yang dimediasi oleh mekanisme IgE.

Angioedema yg berhubungan dengan ACE inhibitor

Lebih sering pada pengguna ACE inhibitor:
Wanita
Perokok
Keturunan Afrika-Amerika
Dimediasi bradikinin
Paling sering muncul pada minggu pertama penggunaan

ACE inhibitor

Diagnosis
Secara klinis
Pemeriksaan kadar protein komplemen spesifik: kadar C1

abnormal

Tatalaksana

Thank
you