Daniel Gonçalves1, Margarida Figueiredo1, Sónia Carvalho1, Fernanda Carvalho1
1 S. Pediatria – Neonatologia, CH Médio Ave – Unidade Famalicão
RESUMO
Introdução: A urticária colinérgica caracteriza-se pelo aparecimento de pápulas eritematosas e pruriginosas, com diâmetro de 1-3 mm, após um estímulo que eleve a temperatura corporal.
Caso Clínico: Adolescente de 14 anos, sem antecedentes de relevo, que apresentava desde os 12 anos episódios de dispneia e aparecimento de pápulas eritematosas e pruriginosas dispersas pelo corpo cerca de 10 minutos após iniciar actividade física. Referia sintomas semelhantes no banho com água quente e em episódios de ansiedade. Em consulta de Pediatria, foi excluída patologia cardio-pulmonar e realizou prova de provocação, sendo estabelecido o diagnóstico de urticária colinérgica. Foram excluídas outras causas de urticária. A terapêutica com um anti-histamínico H1 com propriedades de estabilização mastocitária (cetotifeno) permitiu um controlo moderado dos sintomas.
Discussão: A urticária colinérgica pode condicionar uma limitação importante na qualidade de vida dos doentes, sendo a dificuldade do seu tratamento um desafio para o pediatra.
]]> Palavras-chave: antagonista H1 da histamina, colinérgica, urticária.
Cholinergic urticaria - case report
ABSTRACT
Introduction: Cholinergic urticaria is characterized by highly pruritic small (1-3 mm) wheals, that occur after raising the body temperature.
Case Report: The authors report the case of a 14-year-old girl, without history of relevant diseases, that experienced dyspnea and pruritus with wheals starting about ten minutes after beginning any kind of physical exercise. The same symptoms were elicited by emotional stress and hot showers, and were present for the last two years. After ruling out cardiopulmonary diseases and other causes of urticaria, we performed a provocation test (exercise challenge) and the diagnosis of cholinergic urticaria was established. Therapy with ketotifen, an H1 antagonist with mast cell stabilization properties, allowed only a moderate symptom control.
Discussion: Cholinergic urticaria may affect greatly the quality of life. Treatment is often difficult, becoming a challenge for the pediatrician.
Keywords: cholinergic, histamine H1 antagonist, urticaria.
Texto completo disponível apenas em PDF.
]]> Full text only available in PDF format.
BIBLIOGRAFIA
1. Duke WW. Urticaria caused specifically by the action of physical agents. JAMA 1924; 83:3-9. [ Links ]
2. Horan RF, Sheffer AL, Briner WW. Physical allergies. Med Sci Sports Exerc 1992; 24:845-8.
3. Zuberbier T, Bindslev-Jensen C, Canonica W, Grattan CE, Greaves MW, Henz BM et al. EAACI/GA2LEN/EDF guideline: defi nition, classification and diagnosis of urticaria. Allergy 2006;61:316-20.
4. Khakoo G, Sofianou-Katsoulis A, Perkin MR, Lack G. Clinical features and natural history of physical urticaria in children. Pediatr Allergy Immunol 2008; 19:363-6.
5. Zuberbier T, Althaus C, Chantraine-Hess S, Czarnetzki BM. Prevalence of cholinergic urticaria in young adults. J Am Acad Dermatol 1994; 31(6):978-81.
6. Takahagi S, Tanaka T, Ishii K, Suzuki H, Kameyoshi Y, Shindo H, et al. Sweat antigen induces histamine release from basophils of patients with cholinergic urticaria associated with atopic diathesis. Br J Dermatol 2009; Feb;160(2):426-8.
7. Magerl M, Borzova E, Giménez-Arnau A, Grattan CEH, Lawlor F, Mathelier-Fusade P, et al. The definition and diagnostic testing of physical and cholinergic urticarias – EAACI/ GA2LEN/EDF/UNEV consensus panel recommendations. Allergy 2009; 64:1715-21.
]]> 8. La Shell MS; England RW. Severe refractory cholinergic urticaria treated with danazol. J Drugs Dermatol 2006: Jul-Aug;5(7):664-7.9. Metz M, Bergmann P, Zuberbier T, Maurer M. Successful treatment of cholinergic urticaria with anti-immunoglobulin E therapy. Allergy 2008; 63:247-9.
10. Morita E, Kunie K, Matsuo H. Fooddependent exercise-induced anaphylaxis. J Dermatol Sci 2007; 47:109-17.
11. Soter NA, Wasserman SI, Austen KF, McFadden ER. Release of mastcell mediators and alterations in lung function in patients with cholinergic urticaria. N Engl J Med 1980; 302:604-8.
12. Zuberbier T, Munzberger C, Haustein U, Trippas E, Burtin B, Mariz SD, et al. Double-blind crossover study of high-dose cetirizine in cholinergic urticaria. Dermatology 1996; 193:324-7.
13. McClean SP, Arreaza EE, Lett-Brown MA, Grant JA. Refractory cholinergic urticaria successfully treated with ketotifen. J Allergy Clin Immunol 1989; 83:738.
14. Moore-Robinson, M, Warin, RP. Some clinical aspects of cholinergic urticaria. Br J Dermatol 1968; 80:794.
15. Hirschmann, JV, Lawlor, F, English, JS, Louback JB, Winkelmann RK, Greaves MW. Cholinergic urticaria. A clinical and histologic study. Arch Dermatol 1987; 123:462.
]]> Serviço de Pediatria – Neonatologia, CH Médio Ave – Unidade Famalicão
Rua Cupertino Miranda, Apartado 31
4764-958 Vila Nova de Famalicão
]]>