DIFFERENTIAL DIAGNOSIS

A. ANAPHYLACTOID REACTION
Reaksi seperti anaphylaxis yang terjadi tanpa allergent-IgE antibody event, terjadi
karena

nonimmune

release

(e.g.,

reaksi

terhadap

radiocontrast,

opiates,

vancomycin, chymopapain, aspirin) dari vasoactived inflammatory mediators,

termasuk histamine.
ETIOLOGY
Reaksi ini bisa terjadi karena olahraga; akibat dari releasenya histamin saat suhu
tubuh meningkat; karena peningkatan level endorphin; karena ionic compounds
seperti contrast media yang mengandung radiographiciodine atau polimyxin B
antibiotic; karena larutan yang mengandung polysaccharide seperti dextran; karena
morphine, codeine, ormeperidine; dan karena NSAIDs. Term ini tidak bisa digunakan
sebagai sinonim terhadap mild anaphylaxis karena IgE-allergenreactions
SYMPTOMS
Anaphylactoid reactions menyebabkan gatal dan kemerahan yang identik dengan
anaphylaxis. Anaphylactoid reactions di terapi dengan obat yang sama dengan
anaphylaxis.
SOURCE: http://medical-dictionary.thefreedictionary.com/anaphylactoid+reaction
B. URTICARIA ANGIODEMA
DEFINITIONS
Urticaria is a transient erythematous swelling of the skin, associated with itching,
which usually resolves within 24 hours.
Angioedema (previously known as angioneurotic edema) is characterized by
swellings caused by edema in the deeper dermal, cutaneous and sub-mucosal
tissue. The overlying skin may appear normal.
CAUSES

SYMPTOMS
Urticarial lesions itch, have a central white wheal that is elevated, and are surrounded
by an erythematous halo. The lesions are typically rounded and circumscribed.
Characteristically, hives should blanch with pressure; they generally resolve within 24
hours, leaving no residual change to the skin. The redness, which is augmented by
local neural reflexes, is due to dilated blood vessels in superficial layers of the skin;
the wheal is due to leakage of these vessels as fluid extravasates and compresses
the vessels beneath it so that the central area appears clear.

Swelling of deeper layers of the skin, angioedema, commonly accompanies urticaria.

This swelling often results from the same inflammatory processes that cause hives.
The redness that is seen surrounding superficial lesions is not observed, though the
swelling is readily appreciated. Angioedema generally occurs on the extremities and
digits as well as areas of the head, neck, face, and in men, genitalia. It is often
described as being painful or burning.
DIAGNOSIS

TREATMENT
A. URTICARIA
Strategies for the management of acute urticaria include avoidance measures,
antihistamines and corticosteroids. For urticaria, antihistamines are the mainstay of
therapy. Corticosteroids

and

various

immunomodulatory/

immunosuppressive

therapies may also be used for more severe cases, or for those patients who
experience a poor response to antihistamines.

B. ANGIOEDEMA

Airway management

For mast cell-mediated angioedema, an antihistamine and sometimes a

systemic corticosteroid and epinephrine

For ACE inhibitorrelated angioedema, occasionally fresh frozen plasma and

C1 inhibitor concentrate

For recurrent idiopathic angioedema, an oral antihistamine given bid

Source :
1. http://www.aafp.org/afp/2004/0301/p1123.html

2. http://aacijournal.biomedcentral.com/articles/10.1186/1710-1492-7-S1-S9
3. http://www.msdmanuals.com/professional/immunology-allergic-disorders/allergic,autoimmune,-and-other-hypersensitivity-disorders/angioedema