Urticária Colinérgica - Caso Clínico

 

Daniel Gonçalves¹, Margarida Figueiredo¹, Sónia Carvalho¹, Fernanda Carvalho¹

¹ S. Pediatria – Neonatologia, CH Médio Ave – Unidade Famalicão

Correspondência

 

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.

 

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CORRESPONDÊNCIA

Serviço de Pediatria – Neonatologia, CH Médio Ave – Unidade Famalicão

Rua Cupertino Miranda, Apartado 31

4764-958 Vila Nova de Famalicão

danieldiasgoncalves@gmail.com